User:Erd0617/Intrusive thought

 *Everything in bold is my addition to this article* 

General
Many people experience the type of bad or unwanted thoughts that people with more troubling intrusive thoughts have, but most people can dismiss these thoughts. For most people, intrusive thoughts are a "fleeting annoyance". Psychologist Stanley Rachman presented a questionnaire to healthy college students and found that virtually all said they had these thoughts from time to time, including thoughts of sexual violence, sexual punishment, "unnatural" sex acts, painful sexual practices, blasphemous or obscene images, thoughts of harming elderly people or someone close to them, violence against animals or towards children, and impulsive or abusive outbursts or utterances. Such thoughts are universal among humans, and have "almost certainly always been a part of the human condition".

When intrusive thoughts occur with obsessive-compulsive disorder (OCD), patients are less able to ignore the unpleasant thoughts and may pay undue attention to them, causing the thoughts to become more frequent and distressing. The suppression of intrusive thoughts often cause these thoughts to become more intense and persistent. The thoughts may become obsessions that are paralyzing, severe, and constantly present, these might involve such topics such as thoughts of violence, sex, or religious blasphemy to name a few examples. Distinguishing them from normal intrusive thoughts experienced by many people, the intrusive thoughts associated with OCD may be anxiety provoking, irrepressible, and persistent.

How people react to intrusive thoughts may determine whether these thoughts will become severe, turn into obsessions, or require treatment. Intrusive thoughts can occur with or without compulsions. Carrying out the compulsion reduces the anxiety, but makes the urge to perform the compulsion stronger each time it recurs, reinforcing the intrusive thoughts. According to Lee Baer, suppressing the thoughts only makes them stronger, and recognizing that bad thoughts do not signify that one is truly evil is one of the steps to overcoming them. There is evidence of the benefit of acceptance as an alternative to the suppression of intrusive thoughts. In one particular study, those instructed to suppress intrusive thoughts experienced more distress after suppression, while patients instructed to accept the bad thoughts experienced decreased discomfort. These results may be related to underlying cognitive processes involved in OCD. However, accepting the thoughts can be more difficult for persons with OCD. In the 19th century, OCD was known as "the doubting sickness"; the "pathological doubt" that accompanies OCD can make it harder for a person with OCD to distinguish "normal" intrusive thoughts as experienced by most people, which lead them to be too embarrassed to talk about it out of fear that other people would think they were insane.

The possibility that most patients suffering from intrusive thoughts will ever act on those thoughts is low. Patients who are experiencing intense guilt, anxiety, shame, and are upset over these thoughts are very different from those who actually act on them. The history of violent crime is dominated by those who feel no guilt or remorse; the very fact that someone is tormented by intrusive thoughts and has never acted on them before is an excellent predictor that they will not act upon the thoughts. Patients who are not troubled or shamed by their thoughts, do not find them distasteful, or who have actually taken action, might need to have more serious conditions such as psychosis or potentially criminal behaviors ruled out. According to Lee Baer, a patient should be concerned that intrusive thoughts are dangerous if the person does not feel upset by the thoughts, or rather finds them pleasurable; has ever acted on violent or sexual thoughts or urges; hears voices or sees things that others do not see; or feels uncontrollable irresistible anger.

Exposure therapy
Exposure therapy is the treatment of choice for intrusive thoughts. According to Deborah Osgood-Hynes, Psy.D. Director of Psychological Services and Training at the MGH/McLean OCD Institute, "In order to reduce a fear, you have to face a fear. This is true of all types of anxiety and fear reactions, not just OCD." Because it is uncomfortable to experience bad thoughts and urges, shame, doubt or fear, the initial reaction is usually to do something to make the feelings diminish. By engaging in a ritual or compulsion to diminish the anxiety or bad feeling, the action is strengthened via a process called negative reinforcement—the mind learns that the way to avoid the bad feeling is by engaging in a ritual or compulsions. When OCD becomes severe, this leads to more interference in life and continues the frequency and severity of the thoughts the person sought to avoid even if those thoughts are not important or meaningful to the person.

Exposure therapy (or exposure and response prevention) is the practice of staying in an anxiety-provoking or feared situation until the distress or anxiety diminishes. The goal is to reduce the fear reaction, learning to not react to the bad thoughts. This is the most effective way to reduce the frequency and severity of the intrusive thoughts. The goal is to be able to "expose yourself to the thing that most triggers your fear or discomfort for one to two hours at a time, without leaving the situation, or doing anything else to distract or comfort you." Exposure therapy will not completely eliminate intrusive thoughts—everyone has bad thoughts—but most patients find that it can decrease their thoughts sufficiently that intrusive thoughts no longer interfere with their lives.

Age factors
Adults under the age of 40 seem to be the most affected by intrusive thoughts. Individuals in this age range tend to be less experienced at coping with these thoughts, and the stress and negative affect induced by them. Younger adults also tend to have stressors specific to that period of life that can be particularly challenging especially in the face of intrusive thoughts. Although, when introduced with an intrusive thought, both age groups immediately look for ways to reduce the recurrence of the thoughts.

Those in middle to late adulthood (40-60) have the highest prevalence of OCD and therefore seem to be the most susceptible to the anxiety and negative emotions associated with intrusive thought. Middle adults are in a unique position because they have to struggle with both the stressors of early and late adulthood. They may be more vulnerable to intrusive thoughts because they have more topics to relate to. Even with this being the case, middle adults are still better at coping with intrusive thoughts than early adults, although it takes them longer at first to process an intrusive thought. Older adults tend to see the intrusive thought more as a cognitive failure rather than a moral failure opposite to young adults. They have a harder time suppressing the intrusive thoughts than young adults causing them to experience higher stress levels when dealing with these thoughts.

Intrusive thoughts appear to occur at the same rate across the lifespan, however, older adults seem to be less negatively affected than younger adults. Older adults have more experience in ignoring or suppressing strong negative reactions to stress.

(This section of the article seems to be the least researched. So, I will add some additional resources to this section as well as check the current references listed here. Also, I will be adding more information about other situations that might affect one's severity of intrusive thoughts like Justyss mentioned in the Peer Review.)*

Associated conditions
Intrusive thoughts are associated with OCD or obsessive-compulsive personality disorder, but may also occur with other conditions such as post-traumatic stress disorder, clinical depression, postpartum depression, and anxiety. One of these conditions is almost always present in people whose intrusive thoughts reach a clinical level of severity. A large study published in 2005 found that aggressive, sexual, and religious obsessions were broadly associated with comorbid anxiety disorders and depression. The intrusive thoughts that occur in a schizophrenic episode differ from the obsessional thoughts that occur with OCD or depression in that the intrusive thoughts of schizophrenics are false or delusional beliefs (i.e. held by the schizophrenic individual to be real and not doubted, as is typically the case with intrusive thoughts).

Post-traumatic stress disorder
The key difference between OCD and post-traumatic stress disorder (PTSD) is that the intrusive thoughts of PTSD sufferers are of content relating to traumatic events that actually happened to them, whereas OCD sufferers have thoughts of imagined catastrophes. PTSD patients with intrusive thoughts have to sort out violent, sexual, or blasphemous thoughts from memories of traumatic experiences. When patients with intrusive thoughts do not respond to treatment, physicians may suspect past physical, emotional, or sexual abuse. If a person who has experienced trauma practices looks for the positive outcomes, it is suggested they will experience less depression and higher self well-being. While a person may experience less depression for benefit finding, they may also experience an increased amount of intrusive and/or avoidant thoughts.

One study looking at women with PTSD found that intrusive thoughts were more persistent when the individual tried to cope by using avoidance-based thought regulation strategies. Their findings further support that not all coping strategies are helpful in diminishing the frequency of intrusive thoughts.

Depression
People who are clinically depressed may experience intrusive thoughts more intensely, and view them as evidence that they are worthless or sinful people. The suicidal thoughts that are common in depression must be distinguished from intrusive thoughts, because suicidal thoughts—unlike harmless sexual, aggressive, or religious thoughts—can be dangerous.

Non-depressed individuals have been shown to have a higher activation in the dorsolateral prefrontal cortex, which is the area of the brain that primarily functions in cognition, working memory, and planning,  while attempting to suppress intrusive thoughts. This activation decreases in people at risk of or currently diagnosed with depression. When the intrusive thoughts re-emerge, non depressed individuals also show higher activation levels in the anterior cingulate cortices, which functions in error detection, motivation, and emotional regulation, than their depressed counterparts.

Roughly 60% of depressed individuals report experiencing bodily, visual, or auditory perceptions along with their intrusive thoughts. There is a correlation with experiencing those sensations with intrusive thoughts and more intense depressive symptoms as well as the need for heavier treatment.

''I did not see any information about how you plan to edit the article? What are the areas for improvement based on your evaluation?''

(JAC- this article talks a lot about thought. Maybe you could talk about how society effects these thoughts. Things like social economic status, race, gender, education, ect.)

(JAC- this article could also benefit from having a section about mindfulness and rationalizing inner thoughts)