Intrusive thoughts are ones that people do not want to have and feel they have no control over. These thoughts may cause a person anxiety, distress, or shame.

Intrusive thoughts may be recurring thoughts that are sexual, violent, socially unacceptable, or paranoid in nature.

Various conditions may cause intrusive thoughts, such as obsessive-compulsive disorder (OCD), anxiety disorders, or postpartum depression.

In this article, we look at the types of intrusive thoughts a person may have, medications and therapies to treat intrusive thoughts, and other steps a person can take to help manage intrusive or unwanted thoughts.

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Intrusive thoughts are thoughts that come into a person’s mind and cause distress or anxiety.

Intrusive thoughts may be:

  • sexual
  • violent
  • socially unacceptable
  • doubts or fears about relationships, decisions, body image, sexual orientation or identity, safety, or other issues
  • about death, religion, or unanswerable questions
  • nonsensical

People who have intrusive thoughts may feel shame around these thoughts or fear that these thoughts make them a bad person.

People may also worry that something bad will happen to them or that they will carry out the acts.

Certain health conditions can cause intrusive thoughts, including:

  • OCD: Recurring intrusive thoughts that people feel they have no control over may be a sign of OCD.
  • Post-traumatic stress disorder (PTSD): PTSD can cause people to have recurrent intrusive thoughts and memories.
  • Eating disorders: An eating disorder may cause people to have intrusive thoughts about body image, food, and eating.
  • Anxiety disorders: An anxiety disorder may make people have persistent worries or intrusive thoughts that will not go away.
  • Postpartum depression: People with postpartum depression may have intrusive thoughts about harming their child.
  • Psychosis: Bizarre or paranoid intrusive thoughts may be a symptom of psychosis. Schizophrenia, bipolar disorder, and some medications may cause psychosis.

Certain medications may help treat intrusive thoughts by altering chemical messengers, called neurotransmitters, in the body:

Selective serotonin reuptake inhibitors (SSRIs)

SSRIs are a type of medication people may use as a treatment for depression. People may also use SSRIs to treat mental health conditions that can cause intrusive thoughts, such as:

SSRIs block the reabsorption of serotonin and increase activity at serotonin levels in the brain.

Benzodiazepines

Benzodiazepines are medications that slow down the rate at which messages travel between the brain and the rest of the body.

Benzodiazepines can help relieve stress and anxiety, but they do come with a risk of dependence. They also have a boxed warning from the Food and Drug Administration (FDA).

People should only use benzodiazepines as a doctor prescribes. Usually, they are for short-term use only.

Tricyclic antidepressants (TCAs)

TCAs increase levels of the two neurotransmitters serotonin and norepinephrine and increase activity at those receptor sites.

TCAs may have more side effects than other medications for intrusive thoughts, so they may be an option if other medications do not work.

Generic (brand) nameTypeDescriptionPossible side effects
diazepam (Ducene, Valium),
oxazepam (Alepam, Murelax, Serepax), nitrazepam (Alodorm or Mogadon),
temazepam (Restoril, Euhypnos, Normison), alprazolam (Xanax, Kalma, or Alprax)
BenzodiazepinesDiazepam and nitrazepam are long acting. Oxazepam and temazepam are intermediate acting, and alprazolam is short acting. Benzodiazepines have a risk of dependence.Side effects may include depression, confusion, changes in mood and memory, headaches, drowsiness, fatigue, dry mouth, slurred speech, vision changes, impaired coordination, dizziness, nausea, loss of appetite, diarrhea, and constipation. Withdrawal symptoms may occur when stopping use.
fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Brisdelle, Paxil, Paxil CR, Pexeva), fluvoxamine (Luvox), citalopram (Celexa), escitalopram (Lexapro), vilazodone (Viibryd)SSRIsSSRIs are usually the first-line treatment option for depression and other mental health conditions.Side effects may include sexual dysfunction, sleep issues, anxiety, changes in weight, dizziness, dry mouth, headaches, and gastrointestinal issues.
clomipramine (Anafranil)TCAsClomipramine may be as effective or more effective than SSRIs for treating OCD, but it may cause more adverse side effects.Side effects may include constipation, dizziness, dry mouth, blurred vision, confusion, urinary retention, and increased heart rate.

Other treatments include the following, which people may use as stand-alone treatments or in combination with medication:

Cognitive behavioral therapy (CBT)

CBT is a type of psychotherapy that may be effective in treating anxiety disorders, other mental health conditions, and eating disorders.

CBT works to change thinking patterns by helping people:

  • learn to recognize distorted thoughts that are causing problems and then see them in reality
  • learn problem-solving strategies to deal with difficulties
  • learn techniques to calm the mind and body
  • develop coping skills

CBT may significantly improve a person’s quality of life. It may be as effective or more effective than other types of therapy or medication.

Exposure and response prevention therapy (ERP)

ERP is a type of CBT that may be particularly beneficial to people with OCD.

With ERP, rather than trying to ignore or suppress an intrusive thought, people will learn to notice the thought and work with a healthcare professional to prevent any compulsive behavior that may result from it.

According to the National Institute of Mental Health, ERP is an effective treatment for people with compulsive behaviors, even if medications were not effective in the past.

Other steps that people may find helpful for managing intrusive thoughts include:

  • learning to notice any intrusive thoughts and then labeling them as “intrusive thoughts”
  • remembering that these thoughts are not of their choosing and occur automatically
  • letting the intrusive thoughts float through the mind without trying to push them away
  • pausing and taking time to accept and allow the thoughts
  • expecting the thoughts to return
  • continuing with whatever was happening before the thought occurred and allowing any feelings of anxiety or worry to be present

It may also be helpful for people to avoid trying to work out any meaning to the thoughts.

People can contact a doctor if they have intrusive thoughts that are interfering with their everyday life or causing them distress. They can also reach out if they think the intrusive thoughts are a sign of a mental health condition.

Working with a therapist or healthcare professional may help people understand that their intrusive thoughts are separate from them and help them work on reducing their impact.

If people have any thoughts of self-harm or suicide, they should seek help from a healthcare professional straight away or call 911. People can also call the Suicide and Crisis Lifeline at 988.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

CBT and ERP may be effective treatments for intrusive thoughts. They may be as effective as medications, or effective in combination with medications, for treating OCD.

Learning to allow intrusive thoughts and any feelings they may bring up without trying to push them away may be an effective way of reducing the frequency and intensity of intrusive thoughts.

Intrusive thoughts are thoughts that may feel disturbing, distressing, or unmanageable to the person having them.

The more people try to suppress intrusive thoughts, the more frequently they may occur.

Learning techniques to notice and allow intrusive thoughts, such as through CBT, may help reduce the impact of intrusive thoughts.

Medications and ERP may also help, particularly for conditions such as OCD.

If people are experiencing intrusive thoughts, they can speak with a healthcare professional for advice and treatment.