Many people familiar with obsessive-compulsive disorder (OCD) are aware of intrusive thoughts, but the fact is that people living with OCD can also experience intrusive feelings, urges, and images.
Some people who don’t have intrusive thoughts per se question whether they “qualify” for an OCD diagnosis. In reality, intrusive feelings, emotions, or urges—even intrusive images and memories—are common, and no matter how OCD manifests for you, your experience is valid.
What’s more, the same treatment that makes it possible to manage intrusive thoughts works just as well for intrusive emotions, urges, and other ways that OCD manifests in the mind (such as intrusive images and memories).
Keep reading to learn more about intrusive feelings, and urges in OCD, and how to get help.
Intrusive feelings, urges, and images—explained
OCD is a mental health condition characterized by obsessions, which often take the form of intrusive thoughts that appear seemingly out of nowhere and cause significant distress—usually because they’re out of line with someone’s true values or character. The same holds true for intrusive feelings, emotions, and urges (as well as intrusive images and intrusive memories); in other words, any type of intrusion in the mind creates anxiety or distress, which is why people with OCD respond with compulsions, or repetitive physical behaviors or mental rituals done in an attempt to find relief.
So what does it look like to experience an intrusive feeling, an intrusive urge, or an intrusive image? While they look different for everyone, here are some examples:
Intrusive feelings
You learn about a harm that happened to someone, and feel nothing. It’s not because you don’t care, it’s that OCD spurs on a feeling of unwanted numbness. Or your partner walks into the room, and you’re overcome with disgust about their physical appearance. It’s not that you don’t love them or find them attractive; it’s that your relationship OCD (the particular OCD subtype that you have) is centered on doubts about your relationship, which is sometimes experienced through unwanted, intrusive emotions.
Intrusive urges
Whenever you enter a room, you feel the impulse to open and close the door three times. There’s no reason for you to do this, except for the sense that it must be done.
Intrusive images
You’re extremely concerned with people getting sick, and regularly see intrusive images of loved ones in the hospital on life support.
Are intrusive feelings always accompanied by intrusive thoughts?
Not necessarily. Intrusive thoughts may be accompanied by feelings, but some people may also experience intrusive feelings without a concrete thought attached to it. For example, you may feel an overwhelming emotional response to something without being aware of a clear reason or trigger for the feeling.
NOCD therapist Stacy Quick, LPC describes how this plays out for one NOCD therapy member who has always associated the color red with a feeling of danger. “Just the idea of touching red items, wearing red shirts, and buying any item that has red on it has been ‘forbidden’ by her own mind,” Quick explains. The intrusive emotion experienced around the color red leads her to believe that something terrible will happen if she comes into contact with it. This feeling is so intense that Lydia recently felt scared after learning that her new job requires her to wear red shorts. “She knows that these aren’t logical feelings, but they feel so real,” says Quick.
Often, intrusive feelings such as Lydia’s are tied to magical thinking and a heightened sense of responsibility. Quick explains that “you may feel like your actions can control the outcome of the physical world, believing that if there’s even a small chance of preventing danger, you’re responsible for acting in a certain way.” This sense of responsibility may compel you to take specific actions to protect yourself or others, even if the connection between your actions and the perceived negative feelings don’t make logical sense.
It’s also not uncommon to experience intrusive urges, which can feel like strong impulses to take action—even if that action is something you don’t actually want to do. Quick recalls working with a therapy member who was an avid motorcycle rider. Riding through the countryside used to be a way to unwind, until it started to prompt an unwanted urge to drive off the mountain. This urge was particularly unsettling for Quick’s patient, as he wasn’t depressed and had never had thoughts of ending his life. As a result, the intrusive urge filled him with anxiety and confusion, to the point that avoidance became a compulsion, as he became terrified of riding his motorcycle.
How to deal with intrusive thoughts, feelings, urges, and images
First, it’s important to understand that experiencing an intrusive thought, emotion, image, or urge doesn’t make you more likely to act on what you visualize or feel. “It’s not impulsiveness that people with OCD struggle with; it’s their mind’s inability to let go of these uninvited urges, thoughts, and feelings,” Quick says.
Also critical to know: No matter how OCD obsessions show up for you—as an intrusive thought, feeling urge, image, or sensation—treatment is the same.
The most effective treatment for OCD is exposure and response prevention (ERP) therapy. ERP is a specialized therapy for OCD that’s backed by decades of clinical research. By doing ERP, you won’t have to spend all your time obsessing over an unwanted feeling, emotion, or urge, and then doing compulsions to cope with your distress about it.
So how does it work? ERP is done in partnership with an ERP-trained therapist, and it’s an active form of therapy—meaning your therapist will guide you to do certain exercises or practices that are called exposures. Exposures allow you the opportunity to practice tolerating unwanted feelings and emotions, rather than engaging in avoidance or compulsions.
Let’s say you have relationship OCD and you experience intrusive feelings that something is “very wrong.” As a result, you repeatedly check your phone to look for texts from your partner that give you temporary relief from the negative, worried feelings. ERP for this intrusive feeling might involve setting a timer, and not checking your phone for increasingly longer intervals, allowing you to gradually reduce your reliance on constant reassurance, says Dr. McGrath. “You might send a text and then purposely turn off your phone and not open it up again for the next hour… if someone replied, great, and if they didn’t? Okay, we’ll turn the phone off again for another hour and then we’ll turn it back on again.”
Over time, ERP helps you learn that you don’t need instant validation or reassurance to feel at ease, adds McGrath.
Similarly, ERP can offer relief from other forms of obsessions, such as intrusive images. Let’s say you love animals, yet unwanted images of dead puppies pop into your head every time you see someone walking their dog. This causes you to avoid a certain route to work that you know dog walkers frequent.
Dr. McGrath shares that ERP for intrusive images means facing the images head on. In this case, “we’re going to have you look at pictures of dogs, and we’re going to allow for the image of the dead animal to be there, and we’re going to learn that we can handle it.” The reason? “The more you try not to think of something, the more that image is going to be there.”
Bottom line
OCD can be isolating, especially when your experience doesn’t match the typical description of intrusive thoughts commonly associated with the condition. However, it’s important to remember that OCD takes many forms. What’s more, through ERP, you can learn that you can manage the anxiety linked to your intrusive thoughts, feelings, images, and urges better than you thought you could. “Once you know that you can handle them, and not do compulsions to cope with them, they’re going to fade into the background and you’re probably not going to have them anymore,” says Dr. McGrath.
