OCD: intrusive thoughts

Saif repeats his wudu three, four, ten times, because something did not feel complete. He starts his prayers again when a stray thought interrupts them. In the kitchen he puts the knives away so that a sudden image, of hurting his wife, cannot come true, though he loves her and has never hurt anyone. He is terrified of what the thoughts say about him.

An illustration drawn from common experience. The person is invented; the pattern is not.

Understanding OCD with intrusive thoughts

Everyone has strange, unwanted thoughts sometimes. In OCD they get stuck: intrusive thoughts or images about harming someone, about sex, about blasphemy or sin, or about things not being right, which horrify the person having them. Because they go against everything the person values, they cause enormous distress, and people respond with rituals: repeating prayers or ablutions, avoiding objects, confessing, seeking reassurance. Religious forms are sometimes called scrupulosity. These thoughts are a symptom, not a hidden wish, and having them does not make a person dangerous.

How common is OCD with intrusive thoughts?

About 2.3% of American adults meet the criteria for OCD at some point in life, according to the US National Comorbidity Survey Replication. This is the figure for OCD of every kind, from a US study.

Signs and symptoms of OCD with intrusive thoughts

• Horrifying thoughts that return again and again, and feel completely unlike you
• Repeating prayers, ablutions or actions until they feel “right”
• Avoiding knives, children, places of worship, or being alone with people
• Constantly seeking reassurance that you are a good person

Treatment for OCD with intrusive thoughts

Exposure and response prevention, a form of CBT, and certain antidepressant medicines are the recommended treatments in UK national guidelines. Therapy helps people stop fighting the thoughts and drop the rituals that keep them alive. Care respects each person’s faith, and the aim is to free worship from OCD.

What getting better can look like

Saif’s recovery might look like one wudu, one prayer, unhurried, with the stray thought allowed to pass like traffic outside the mosque.

Common questions about OCD with intrusive thoughts

Do intrusive thoughts mean I secretly want to hurt someone?

No. In OCD, unwanted thoughts about harm, sex or religion go against everything the person values, which is why they cause such distress. They are a symptom, not a hidden wish, and having them does not make a person dangerous. The condition is well understood and treatable.

Is repeating wudu or prayers because it doesn’t feel right a sign of OCD?

It can be. Repeating prayers or ablutions until they feel “right”, driven by fear of sin or of something being incomplete, is a recognised form of OCD sometimes called scrupulosity. Good care respects each person’s faith; the aim is to free worship from OCD, not to change belief.

When to see a psychiatrist

If unwanted thoughts are frightening you and rituals are taking over your days, please know this is a well-understood condition, and it is treatable.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

If you or someone else is in immediate danger, call 999 or go to the nearest hospital emergency department.

Sources

• Ruscio et al., Molecular Psychiatry, 2010 (PMID 18725912; NCS-R)
• NICE guideline CG31, Obsessive-compulsive disorder and body dysmorphic disorder, 2005