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= Intrusive thought = From Wikipedia, the free encyclopedia

An intrusive thought is an unwelcome involuntary thought, image, or unpleasant idea that may become an obsession, is upsetting or distressing, and can feel difficult to manage or eliminate. When such thoughts are associated with obsessive-compulsive disorder (OCD), depression, body dysmorphic disorder (BDD), and sometimes attention-deficit hyperactivity disorder (ADHD), the thoughts may become paralyzing, anxiety-provoking, or persistent. Intrusive thoughts may also be associated with episodic memory, unwanted worries or memories from OCD,posttraumatic stress disorder, other anxiety disorders, eating disorders, or psychosis. Intrusive thoughts, urges, and images are of inappropriate things at inappropriate times, and generally have aggressive, sexual, or blasphemous themes.

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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.[1] For most people, intrusive thoughts are a "fleeting annoyance".[5] Psychologist Stanley Rachman presented a questionnaire to healthy college students and found that virtually all reported experiencing intrusive 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.[6] Such thoughts are universal among humans, and have "almost certainly always been a part of the human condition".[7]

When unwanted intrusive thoughts occur with obsessive-compulsive disorder (OCD), patients are less able to ignore or dismiss these thoughts and may pay undue attention to them. Compared to the general population, the intrusive thoughts experienced in individuals with OCD tend to be longer lasting, more severe, and more distressing. The experience of unpleasant intrusive thoughts may be followed by attempts to ignore, suppress, or neutralize such thoughts. However, the suppression of intrusive thoughts may lead these thoughts to become more intense and persistent over time.[8] Intrusive thoughts may develop into obsessions that are paralyzing, severe, and constantly present; and may revolve around thoughts of violence, sex, or religious blasphemy to name a few examples.[5] Distinguishing them from normal intrusive thoughts experienced by many people, the intrusive thoughts associated with OCD may be anxiety provoking, irrepressible, and persistent.[9]

How people react to intrusive thoughts may determine whether these thoughts will become severe, turn into obsessions, or require treatment. Cognitive models of OCD propose that misinterpretations of intrusive thoughts are what differentiate between normal and pathological intrusive thoughts. These models suggest that intrusive thoughts may develop into obsessions when they hold personal significance for the individual or when they are interpreted as posing a threat for which the individual is personally responsible. There is evidence suggesting that individuals who tend to hold themselves responsible for their thoughts or the perceived outcomes of their thoughts also tend to feel greater anxiety in response to intrusive thoughts. Inflated perceptions of personal responsibility have also been associated with increased severity of OCD symptoms and increased frequency of engaging in compulsive behaviors.

Intrusive thoughts can occur with or without compulsions. Compulsions can involve behaviors or mental activities that are typically aimed at reducing the anxiety or distress from unwanted thoughts. Carrying out compulsions may temporarily reduce the anxiety associated with unpleasant thoughts, but can also end up reinforcing and increasing the frequency of 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.[10] 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.[11] These results may be related to underlying cognitive processes involved in OCD.[12]However, accepting the thoughts can be more difficult for persons with OCD.

The possibility that patients suffering from intrusive thoughts will ever act on those thoughts is extremely low. However, many patients tend to experience intense guilt, anxiety, and shame in relation to their intrusive thoughts. Early research on intrusive thoughts in OCD has found that some individuals believe their thoughts can influence events in the real world. This thinking bias is formally known as thought-action fusion (TAF) and can take on two forms: (1) TAF-Likelihood, which refers to the belief that having an intrusive thought about an unpleasant event means that event is more likely to occur in real life, and (2) TAF-Morality, which refers to the belief that having an immoral intrusive thought is just as bad as carrying out the immoral action in real life. According to cognitive models of OCD, these beliefs may lead some individuals to interpret their thoughts as revealing their true self; that they are dangerous or capable of harm. Such misinterpretations of intrusive thoughts are suggested to contribute to the intense feelings of guilt, anxiety, and shame that many patients experience. 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.[15] 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.[16]