What Are the Characteristics of Intrusive Thoughts in OCD?

Who hasn’t had a thought they can’t get out of their mind? Or had a random or inappropriate idea pop into their head? Or felt compelled to double-check and triple-check that the front door is locked? Such intrusive thoughts are normal. Typically they go away and we go about our lives.

But for some people, intrusive thoughts can become uncontrollable, persistent and invasive, and so they may try to alleviate them through compulsive rituals: repeatedly washing their hands, for instance, if they fear being contaminated from touching surfaces like doors and countertops.

It’s at this point that we say the person has obsessive-compulsive disorder, or OCD.

But how exactly do the obsessive thoughts of people with OCD differ from the more garden-variety intrusive thoughts we all experience from time to time?

This is the question Jean-Sébastien Audet set out to answer in his Ph.D. under the supervision of Frederick Aardema, a professor in the Department of Psychiatry and Addiction at Université de Montréal.

Audet conducted a systematic review to determine what characteristics are specific to OCD compared to intrusive thoughts in the general population and in people suffering from anxiety and depression.

Helping sufferers understand

Audet believes that delineating the characteristics unique to OCD can help sufferers and their loved ones understand the disorder and realize that the thoughts they have have no basis in reality. Determining those characteristics also facilitates early diagnosis and treatment.

In most cases, OCD responds well to medication and a type of therapy known as "exposure and response prevention." This approach involves exposing people to situations that cause or trigger their obsessive thoughts and then helping them learn new ways of dealing with their anxiety instead of engaging in their usual rituals.

The research group headed by Aardema also recommends a type of therapy known as inference-based therapy.

“We think OCD is the result of a flawed narrative—a story that justifies the individual’s fears even though these fears have no basis in reality,” Audet explained. “Inference-based therapy helps the person see these false inferences and eventually stop their compulsive behaviour because it no longer makes sense to them.”

Reference: Audet, J.-S., Bourguignon, L., & Aardema, F. (2023). What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations. Clinical Psychology & Psychotherapy. https://doi.org/10.1002/cpp.2887

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