Intrusive thoughts, such as unexpected urges or ideas, are common and often dismissed as random. However, when these thoughts persist and cause significant distress and anxiety, they can indicate Obsessive-Compulsive Disorder (OCD). Brisbane-based writer and filmmaker Martin Ingle, diagnosed with OCD in his early 20s, experienced intrusive thoughts related to his sexuality and harming others, differing from common portrayals of the disorder. These thoughts led him to avoid social interactions and work.
Understanding Intrusive Thoughts
Vlasios Brakoulias, a psychiatrist and professor, explains that the exact cause of intrusive thoughts is unknown but may resemble dream mechanisms, reflecting subconscious and instinctual feelings. These thoughts can be embarrassing or contrary to an individual's desires. Poor mental health, such as stress or anxiety, can make it more challenging to distinguish intrusive thoughts from conscious ones.
For individuals with OCD, intrusive thoughts become recurring and inescapable, prompting questions like, "Why did I think that? What if it's true?" This rumination often leads to compulsions, which are repetitive physical or mental actions performed to counteract the persistent thoughts. OCD diagnosis requires obsessions and compulsions to consume at least an hour daily, significantly impairing a person's ability to function.
Subtypes and Impact of OCD
OCD encompasses various subtypes, some involving taboo or distressing thoughts that may deter individuals from seeking help. An example is paedophilia-themed OCD, where individuals experience thoughts related to harming children, despite having no intention of acting on them. These are described as ego-dystonic thoughts, meaning they conflict with one's self-image and values.
Research indicates that people struggling with such taboo intrusive thoughts are more prone to substance use, likely due to the intense distress caused by these symptoms. The internal and often hidden nature of these thoughts means that the impact of OCD may not be visible to close family and friends.
Treatment Options
Approximately 4% of the Australian population is diagnosed with clinical OCD, while another 8–10% experience subclinical OCD, where symptoms cause distress but do not meet full diagnostic criteria.
For subclinical OCD, identifying intrusive thoughts and understanding the disorder can improve symptoms even without formal treatment. However, clinical OCD typically requires support from mental healthcare professionals. Psychological and pharmacological treatments can lead to significant improvements.
A common psychological treatment is Exposure and Response Prevention (ERP) therapy, a modified form of Cognitive Behavioural Therapy (CBT). ERP involves confronting intrusive thoughts without engaging in compulsive behaviors. Martin Ingle described his treatment experience as difficult but ultimately valuable, likening the process to 'walking through the fire' to achieve recovery.