Let’s talk about intrusive thoughts.

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Hi Sam, I’ve been having some disturbing, awful thoughts that I just feel so hopeless about. I haven’t told my therapist, though, because I’m so ashamed of them.

Some of them are sexual in nature, which I can’t even imagine telling another person, and some of them are violent (I swear, I’d never act on them, but the content makes me feel like I must be going insane). I feel like I’m at the end of my rope.

What do I do?

First thing’s first: Thank you for asking such a brave question.

I know it wasn’t an easy thing to do, but I’m so glad you did it anyway. You’ve already taken the first step (which is cliché, but in this case, really important to remember).

I’m going to challenge you to consider that, no matter how horrifying your thoughts are, you still deserve support. You could have the ugliest, most unhinged thoughts in the entire world and that wouldn’t change the fact that a mental health provider still owes you compassionate, nonjudgmental, and competent care.

You probably get that logically, but it’s the emotional piece that’s much harder to deal with. And I get it. You know why I get it? Because I’ve been in your exact situation before.

Before I was properly diagnosed with obsessive-compulsive disorder, I used to have a whole flurry of thoughts that scared the sh*t out of me. I thought about killing my cat or my partner. I thought about pushing people in front of trains. I even went through a period of time where I became petrified of abusing children.

If you can picture it, it started to feel like a really sh*tty version of mental dodgeball. Except, instead of balls, it was images of me literally choking my cat.

“My God, Sam,” you might be thinking, “Why are you admitting this in an advice column?!”

But it’s totally okay.

You heard me right: It’s okay to have thoughts like these.

To be clear, it’s not okay if these thoughts are distressing, and it’s definitely not okay that you find yourself at the end of your rope.

But disturbing thoughts in general? Believe it or not, everyone has them.

The difference is, for some people (like me, and I strongly suspect you as well), we don’t disregard them as weird and move on with our day. We obsess about them and worry that they might be saying something bigger about us.

In that case, what we’re talking about here are “intrusive thoughts” which are recurring, unwanted, and often disturbing thoughts or images that cause distress.

These often occur in people who have obsessive-compulsive disorder. Some common examples:

  • fear of purposefully hurting loved ones (assaulting or killing them) or yourself
  • fear of accidentally harming loved ones (burning down the house, poisoning someone, exposing them to illness) or yourself
  • worrying that you’ll run over someone with a vehicle or that you did
  • fear of molesting or abusing a child
  • fear of having a sexual orientation other than the one you identify with (so if you’re straight, a fear of being gay; if you’re gay, a fear of being straight)
  • fear of having a gender identity other than the one you identify with (so if you’re cisgender, a fear of actually being transgender; if you’re transgender, a fear that you might actually be cisgender)
  • fear that you don’t actually love your partner or that they aren’t the “right” person
  • fear that you might shout expletives or slurs, or that you said something inappropriate
  • recurring thoughts that you consider sinful or blasphemous (like wanting to worship Satan, or sexualizing saints or religious figures)
  • recurring thoughts that you aren’t living in accordance with your moral or ethical values
  • recurring thoughts about the nature of reality or existence (basically, one long, drawn out existential crisis)

The OCD Center of Los Angeles has a crucial resource outlining all these forms of OCD and more that I’d highly recommend taking a look at.

Every single person has disturbing thoughts, so in that way, obsessive-compulsive disorder isn’t a disorder of “difference” — it’s the degree to which these thoughts impact someone’s life.

From the sound of it, these thoughts that you’re having are definitely impacting you, which means it’s time to reach out for professional help. The good news? (Yes, there’s good news!) I can pretty much guarantee you that your therapist has heard it all before.

Whatever terrible, dreadful thing that keeps popping up in your brain is, in all likelihood, not going to be shocking to your clinicians.

They studied it in graduate school, they’ve talked about it with other clients, and more than likely, they’ve had a few bizarre thoughts themselves (after all, they’re human beings, too!).

It’s also their job to be professional grownups who can handle anything you throw at them.

Still, if you aren’t sure how to bring it up to your clinicians, this is my tried and true advice for what will be, no doubt, the most awkward conversation of your life:

1. Practice on your own first

Writing a script and rehearsing it in the shower or car is how I psyched myself up the first time — while vacuuming is also a good way to do this if you don’t want to be heard.

“I know this sounds ridiculous, but…” “I feel so terrible and ashamed about this, but…” were starters that helped me figure out what words I wanted to say.

2. Maybe don’t say it at all

I’ve known people who have written their intrusive thoughts down, and then handed that piece of paper to their therapist or psychiatrist.

For example: “I’m not comfortable saying this to you, but I felt you needed to know I was struggling with this, so I wrote something down for you to read.” I did this with my psychiatrist once, and when he was done reading, he shrugged and joked, “Good to know. You can burn it now, if you want, I can take it from here.”

3. Test the waters first

It’s perfectly fine to speak in hypotheticals if you’re not ready yet. This is a way of assessing the kind of reaction you can expect from your clinician, and easing yourself into it.

For example: “Can I pose a hypothetical question? If a client of yours reported having some intrusive thoughts that they were very ashamed of, how would you handle that conversation?”

4. Let them ask the questions

Sometimes it can feel safer to dive into these conversations if your clinician is taking the lead. You can always ask, “I’m worried I might have OCD, and I was wondering if you could give me more information about intrusive thoughts in particular.”

5. Lean on other resources

There’s an incredible book that I read, “The Imp of the Mind,” that I honestly feel should be required reading for anyone struggling with thoughts like these.

If you aren’t sure how to open up, I’d recommend reading this book and highlighting any passages that feel relevant to you. You can also do this with online resources, like the articles you’d find at the OCD Center of Los Angeles.

6. Seek out a different clinician

If you’re really not comfortable talking to your therapist, it might also point to a need to switch therapists. Not every clinician knows a whole lot about OCD, either, so it might be time to seek out a better fit.

I talk about this more in another Healthline article, which you can read here.

7. Try online therapy!

If talking to someone face-to-face is truly a barrier that’s impeding your ability to get help, trying another therapy format could be the solution.

I wrote about my own experiences with online therapy here (in short? it was life-changing).

8. Place a bet

If your brain is anything like mine, you might be thinking, “But Sam, how do I KNOW this is an intrusive thought and I’m not just like, a psychopath?” Ha, friend, I know that script by heart. I’m a veteran of this game.

One reframe that helps me is to imagine that someone breaks into my apartment, holds a gun to my head, and says, “If you don’t answer this question correctly, I’ll shoot you. Are you actually going to kill your cat? [or whatever your equivalent fear is].” (Yeah, yeah, it’s a very violent scenario, but the stakes are important here.)

Nine times out of ten? If push came to shove, and we had no choice but to take our best guess, the logical part of our brain knows the difference between an intrusive thought and a legitimate danger.

And even if you’re still not sure, that’s okay, too. Life itself is full of uncertainty. It’s not your job to figure this out — leave it to the professionals.

Listen: You deserve to feel better than this. And it sounds to me like you’re going to need some help in order to get there.

Your brain is being so rude and so unfair, and I’m really sorry about that. My brain is a real jerk sometimes, too, so I understand the agonizing frustration that comes with this territory.

While I know it’s such an uncomfortable thing to talk about, I do want to assure you that it’s totally worth it.

Each time you open up and get (very, very) honest about how you’re struggling, that gives your clinicians the information they need to support you. Even better, it starts to take the power away from those thoughts, because the shame is no longer keeping you imprisoned in your own mind.

Besides, the cool thing about mental health professionals? They’re sworn to secrecy (like, legally) and if you never want to see them again? You don’t have to. As far as spilling awful secrets goes, the risk here is relatively low.

You also pay their bills. So by all means, demand your money’s worth!

I won’t pretend that it’s easy, but as they say, the truth will set you free. Maybe not right away, because few things in mental health are immediately gratifying, but yes, with time this will get better.

And who knows, maybe you’ll wind up broadcasting it on the internet to millions of people, too (I never could have imagined that for myself, but that’s the magic of recovery — you might surprise yourself).

You got this. Promise.