Almost everyone has odd or unpleasant thoughts at times. In OCD, these thoughts get 'stuck', cause intense distress and lead to rituals to neutralise them.
The distress itself shows the thoughts are against your values.
Key concepts
- Having a thought is not the same as wanting or doing it
- Trying to push thoughts away makes them return more
- ERP therapy teaches the brain to let thoughts pass
Symptoms and signs
- Unwanted images of harming loved ones
- Blasphemous or sexual thoughts that feel shocking
- Mental checking, praying or seeking reassurance to feel safe
Causes
- Over-importance given to thoughts
- Brain circuits involved in doubt and checking
- Stress and life changes (e.g. after childbirth)
Risk factors
- Family history of OCD or anxiety
- Perfectionism and strong sense of responsibility
- Strict moral or religious upbringing
Evidence-based management
- Label it: 'This is an OCD thought'
- Reduce rituals and reassurance-seeking gradually
- ERP with a trained therapist
- Medicines that reduce obsessions when OCD is moderate to severe
When to seek professional help
- Thoughts and rituals taking more than an hour a day
- Avoiding children, knives or places of worship due to thoughts
- Feeling hopeless or depressed
Frequently asked questions
Am I a bad person for having these thoughts?
No. OCD targets what you care about most. The thoughts are symptoms, not your character.
Will I act on them?
People with OCD intrusive thoughts are distressed by them and do not act on them.
Medical references
Guidelines and official sources used for this article.
- Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). NICE, UK, 2005.
- ICD-11 for Mortality and Morbidity Statistics. World Health Organization.
- Author
- Dr. Kuldeep Budania, MBBS, MD Psychiatry
- Medical reviewer
- Dr. Kuldeep Budania, MD Psychiatry
- Last reviewed
This article is for general information and is not a substitute for personal medical advice.
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