Why do OCD Intrusive Thoughts Feel So Real (Should I be worried?)

The uncertainty of whether or not these intrusive thoughts are real is ultimately what allows OCD to thrive.

The truth is, living with this condition can be unbearable for the sufferer.

Every day, your mind is bombarded by intrusive thoughts that terrify you, thoughts that go against everything you value and believe in. 

These thoughts make you question your very identity, leaving you feeling ashamed and afraid. 

You desperately try to resist them, but they persist, gnawing at your sanity. It’s a suffocating fear that something terrible will happen if you don’t listen to these intrusive thoughts. 

To ease the torment, you engage in rituals or repetitive behaviors—rituals that seem irrational to others but provide temporary relief from the overwhelming anxiety.

But here’s the cruel irony: these rituals only give you a fleeting sense of control. 

The anxiety always comes rushing back, forcing you to repeat the same behaviors over and over again. It’s an exhausting cycle that consumes your time, energy, and emotional well-being.

You question your own intentions, wondering if you’re capable of the unthinkable. The thoughts that haunt you seem so real, so vivid, that it becomes increasingly difficult to distinguish them from your true desires. 

But there is hope. 

With specialist support, understanding, and treatment, it is possible to manage OCD and reclaim your life.

There is light at the end of the tunnel, and with time and resilience, you can find your way toward a more peaceful and fulfilling life.

What does it feel like to have OCD?

OCD ranks in the top 10 most debilitating mental conditions in the world. 

For those who suffer from this disorder, it’s incredibly painful when it is brushed off by those with little understanding, as a personality trait or ‘quirk’.

The reality is, OCD can feel like living in perpetual torment. This condition attacks the things you hold in the highest regard and makes you question your morality, identity, and even sanity.

It’s not unusual for those with OCD to feel like they’re going crazy which in many cases stops sufferers from reaching out for support, for fear of judgment.

Here’s a summary of what it looks like and feels like to live with OCD:

• Thoughts terrify you

Imagine being terrified of your own thoughts. For example…

You lock the door and night and wonder, “What if I don’t lock this correctly and my entire family is murdered in the night?”

You take painkillers to numb the pain of a headache, and your thoughts tell you that this is a sign that you want to overdose and kill yourself.

You go to a public restroom and your mind whirs with possible thoughts of life-threatening germs.

You become all-consumed with the thoughts of past events that overwhelm you with feelings of guilt or shame surrounding your behaviors.

The greatest struggle is that all of this occurs inside your head. Many clients will say that it feels like being trapped inside a cage that you can’t escape from, playing a record on a loop that you cannot stop.

• The consequence of the thoughts coming true terrifies you

Those with OCD get caught up in the need for certainty. They want to be 100% sure that nothing bad will happen if they don’t respond to their thoughts.

They want a guarantee that those fears and doubts are completely false.

And this is why OCD is so clever at holding our attention. It plays off our desire for certainty so no matter what theme it presents itself as, it can take hold of even the smallest glimmer of uncertainty.

Because of this, the potential consequence of these intrusive thoughts becoming a reality petrifies us.

It feels risky to leave them unexplored for fear of what might happen if the worst were to happen. The stakes feel too high.

The need to respond and solve these thoughts is urgent.

• Avoidance

A common compulsive behavior then becomes avoidance.

Avoidance of people, places, and things. And often, avoidance spreads to every corner of our lives and we end up avoiding all of the things we value.

For example, someone with sexual OCD who has fears of being attracted to their mother may avoid their mother to make sure nothing ever happens and to eliminate the trigger.

Someone with pedophilia OCD may avoid their own child for fear of behaving inappropriately toward them, even though their deep desire is to care for and love them.

This is how OCD begins to limit and restrict our existence and experience of things that bring us joy. This is why it isn’t uncommon for this disorder to be linked with other mental illnesses such as depression.

• Constant fear (obsessions)

Living with OCD feels like living in a perpetual state of fear. Constantly on edge with only momentary relief found in compulsive behaviors that keep the cycle in motion.

It can feel like you never have a moment’s peace.

You’re constantly on edge with your mind churning over the ‘what if’ thoughts and it is truly exhausting.

Those with OCD feel emotionally and physically drained by the sheer willpower required just to make it through an ordinary day.

• Compulsions

In a desperate bid to find relief from the uncertainty and anxiety of these obsessions, sufferers engage in physical and mental compulsions that offer a moment’s rest from the endless torment.

What non-sufferers don’t realize is that these compulsive behaviors can be incredibly time-consuming.

Some may only require a brief moment to complete the cycle, others can be stuck in their compulsive behaviors for hours.

Imagine having to shut the curtains in a way that is ‘just right’ or else your sister will die.

When you’re dealing with fears such as this, you can see why it’s difficult to embrace uncertainty.

How intrusive thoughts present themselves in OCD

Intrusive thoughts can take many forms and all can be as disturbing as the others.

Here are some common examples of how intrusive thoughts may present themselves…

• What if thoughts: 

What if ABC happens?

What if you want ABC to happen?

• Doubt thoughts

Are you sure you want to do that?

Maybe you’re going to *insert fear*

• Demands

Do it!

You have to…

You need to…

You want to…

• Self-criticism Thoughts

Because you did ABC, you are awful

You’re horrible because…

You like this

• Questions that mimic curiosity

Is this why…?

I wonder if…

Example of OCD intrusive thoughts

OCD can present in various subtypes, and intrusive thoughts can differ based on the specific theme or obsession. 

Here are some examples of intrusive thoughts associated with different OCD subtypes:

(This is not an extensive list of all OCD subtypes. Other subtypes not included in the list are Relationship OCD, Religious/Scrupilocity OCD, Emotional Contamination OCD, Pedophilia OCD, Suicidal OCD, Sexual Orientation OCD, Just Right OCD, Real Event OCD, False Memory OCD, Postpartum/Perinatal OCD, Existential OCD, Hyper-Awareness OCD, Hyper-Responsibility OCD, and Perfectionism OCD)

1. Contamination OCD: Intrusive thoughts may involve fear of germs, dirt, or chemicals. Examples include thoughts of getting sick from touching doorknobs, being contaminated by others’ saliva, or feeling contaminated by certain objects or environments.

2. Symmetry and Ordering OCD: Intrusive thoughts may revolve around achieving perfect symmetry or maintaining a specific order. Examples include feeling distressed by asymmetrical objects, being consumed by the need to arrange items precisely, or experiencing anxiety when things are out of place.

3. Checking OCD: Intrusive thoughts may center around doubts and fears related to safety or potential harm. Examples include thoughts of leaving doors unlocked, and appliances turned on, or concerns about causing harm to others due to negligence.

4. Harm OCD: Intrusive thoughts may involve violent or aggressive impulses directed towards oneself or others. Examples include fear of losing control and harming loved ones, thoughts of causing accidents or engaging in harmful actions that go against personal values.

5. Sexual OCD: Intrusive thoughts may involve explicit or taboo content that goes against an individual’s moral or ethical values. Examples include unwanted sexual thoughts or images involving inappropriate individuals, religious figures, or aggressive sexual acts.

6. Hoarding OCD: Intrusive thoughts may be related to excessive attachment to possessions and fear of losing them. Examples include distressing thoughts about discarding items that may have sentimental value or concerns about needing specific items in the future.

It’s important to note that individuals with OCD may experience multiple subtypes or a combination of intrusive thoughts. 

Ultimately, the content of the thoughts doesn’t really matter, it’s about changing how we respond to them no matter which context they happen to arise.

Why do OCD intrusive thoughts feel so real?

The reason you must treat yourself with self-compassion if you’re managing OCD is that it’s an incredibly convincing disorder.

You are not weak and you are not broken.

The reason this disorder is prevalent in up to 2% of the population is because those fears feel very real, very imminent, and very urgent. This is why we’re compelled to act and neutralize those obsessions.

👉Here’s why intrusive thoughts feel so real…

The nature of intrusive thoughts can make them feel real

It’s when these thoughts are coupled with a feeling of anxiety, that we feel compelled to take notice.

When you experience these obsessions and your brain triggers the fight, flight, and freeze response (the anxious response), you experience a dump of hormones in the body such as adrenaline and cortisol that signals that you need to ACT NOW.

Bodily sensations such as a racing heart, sweaty palms, nausea, stomach ache, and a tight chest make it feel as if the threat is very real, and that we must ‘escape’ this perceived danger.

But there isn’t any real danger.

The ‘danger’ in this scenario is the intrusive thoughts.

This is a very real experience that happens in the mind and body in the exact same way as it would do if we were being held at gunpoint.

So imagine that you go to leave your house and you have the thought, “If you don’t lock the door at least 4 times, your son is going to die” The thoughts triggers your anxious response which releases hormones that result in specific bodily sensations.

You’re uncertain as to whether or not this thought is real, but your brain is unwilling to risk it because the potential consequence is too great.

And so you lock the door 4 times, just to make sure.

It feels real because the emotions and physical sensations we experience in our body, coupled with the intrusive thought, make us feel that this is a threat that needs to be dealt with!

Why do they stick around?

Intrusive thoughts in OCD tend to stick around and persist due to the way the brain processes information and responds to perceived threats. There are a few reasons why intrusive thoughts may continue to resurface:

1. Anxiety amplification: Intrusive thoughts often cause intense anxiety and distress. The more anxious a person becomes in response to these thoughts, the more attention and significance the brain assigns to them. This amplification of anxiety reinforces the thoughts and increases their frequency and intensity.

2. Cognitive biases: People with OCD often experience cognitive biases, such as thought-action fusion and overestimation of threats. Thought-action fusion is the belief that having a thought about something is equivalent to carrying out the action itself. Overestimation of threats involves perceiving potential dangers as more significant and likely to occur than they actually are. These cognitive biases lead individuals to attach excessive importance to their intrusive thoughts, further fueling their persistence.

3. Avoidance and safety behaviors: In an attempt to reduce anxiety, individuals with OCD may engage in avoidance behaviors or perform rituals. These behaviors provide temporary relief from anxiety but inadvertently reinforce the belief that intrusive thoughts are significant threats. The brain learns that engaging in these behaviors is necessary for safety, and as a result, the thoughts persist.

4. Hyperawareness: Individuals with OCD often develop a heightened sense of awareness and vigilance regarding their intrusive thoughts. They become hypersensitive to any occurrence or trigger associated with their obsessions. This hyperawareness keeps the thoughts at the forefront of their mind, making them more likely to recur.

5. Neural pathways and conditioning: Over time, repeated exposure to intrusive thoughts and engaging in compulsive behaviors strengthens the neural pathways associated with those thoughts and behaviors. This conditioning reinforces the connection between the thoughts and the anxiety response, making it more likely for the thoughts to resurface in the future.

It’s important to remember that intrusive thoughts are not indicative of one’s character or desires. They are a symptom of OCD and do not reflect an individual’s true intentions. 

Effective treatment approaches for OCD, such as cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP), aim to help individuals reframe their thoughts, reduce anxiety, and break the cycle of obsessions and compulsions.

How can I be sure they aren’t real?

The greatest problem we have is that we take our minds too seriously.

Thoughts are not facts, they’re just thoughts.

What’s tricky about this question is that this in and of itself can become a compulsive behavior, because you’re seeking to find certainty. Do you see?

Your search for ‘sure’ is a key component of what allows these thoughts to thrive and affect you in such negative ways.

And that’s okay – that doesn’t mean you should beat yourself up! It means that you’re starting to gain knowledge and awareness, and that’s the first step to recovery.

If you’re reading this article – or any article covering this same topic – on repeat because you’re hoping to find reassurance and certainty that these thoughts aren’t real…

Then it’s a sign that you could be caught in the OCD cycle.

Do they mean anything about you?

Intrusive thoughts are egodystonic in nature.

This means that they go against our true values and attack the things we hold in high regard.

For example, you may have recently become a new parent to your first son or daughter. Perhaps this is the family you’ve dreamed about for quite some time, and now, it’s finally here! 

But OCD will play on what can be considered natural fears for a new parent.

Fears for the child’s safety, for example. Perhaps you wonder, “Can I keep the child safe? What if I harm them by accident and then it’s my fault they’re hurt?”

Suddenly, you want to be with your new child, but instead, you’re avoiding them when possible out of fear for their safety.

In this situation, you are not a bad person or a bad parent who wants to harm your child. You are a caring parent who wants nothing more than your child to be safe, and this is why OCD thrives. Because that slight ember of uncertainty is enough to convince you that these fears are real and a source of concern.

Best treatment for OCD intrusive thoughts

The most effective treatment for managing OCD intrusive thoughts is exposure and response prevention therapy, ERP.

This proven behavioral methodology teaches you how to tolerate the uncertainty and anxiety following those intrusive thoughts, without needing to engage in compulsions.

When you begin treatment with a qualified specialist, they will start by providing education and knowledge about the different components of OCD so that you feel equipped to engage in the treatment.

ERP is often complemented by other modalities such as ACT (acceptance and commitment therapy) and Mindfulness. You will be given these tools to help support you as you move through the treatment plan.

You will then work together to create a hierarchy of exposures that you can begin working through. These exposures will be done at your own pace and you will never be asked to do anything that you don’t feel achievable.

Through ERP, you will learn healthy ways to cope with those intrusive thoughts and the anxiety that accompanies them. Over time, the anxiety decreases and those intuitive thoughts become far less problematic.

Private 1:1 Therapy

Starting OCD treatment can seem daunting.

When our clients come to us, there’s often a high degree of hesitation and skepticism. After all, facing your fears probably doesn’t seem like a lot of fun, so how do you know if it’s worth it?

Well, our team of highly qualified mental health professionals is trained to the highest standards and offers a warm and compassionate approach to therapy.

Clients come to us afraid and doubtful.

They know they can’t carry on living this way but they just aren’t sure that recovery is possible for them. We quickly show them that it is!

When you come to us, you’ll be met with an elite team of licensed OCD specialists who are invested in your recovery.

You’ll be met without judgment and you won’t be asked to do anything that you don’t feel you can manage.

We’re going to work on this together.

A life where intrusive thoughts don’t rule every waking hour of our day is not as far away as you might think.

If you’re interested to see how we can support you and you’re based in California or Arizona, please submit an initial intake form here.

We would be honored to assist your OCD recovery.

Online program

If private therapy isn’t currently an option for you, OCD specialist Kimberley Quinlan has created an affordable online program called ERP SCHOOL that is accessible to everyone.

You will learn the exact tools and techniques given to those in a private therapy setting, and you will understand how to apply them to your specific intrusive thoughts and compulsions.

By the end of the program, you will have the knowledge and understanding to stop letting your intrusive thoughts ruin your life and resist the urge to do compulsions that keep you trapped in the OCD Cycle.

Join ERP SCHOOL here.