Intrusive thoughts affect more people with OCD and can lead to substance abuse, explains psychiatrist – Mental Health

Intrusive thoughts are involuntary and make a person believe that they will somehow lose control.

They do not correspond to reality or to the wishes of those who experience them. They often give the impression that the individual is going to commit an act he considers abhorrent, such as hurting another person or himself. Or, if he does or does not do something, something catastrophic could happen.

“It is very important to understand that intrusive thoughts are involuntary. People who experience them usually feel repulsed by them”, emphasizes psychiatrist Flávia Batista Gustafson.

“There are many types of intrusive thoughts, but common topics include sexually inappropriate thoughts, thoughts about interpersonal relationships, with betrayal content, for example, religious thoughts that are opposed and inadmissible by the person’s belief, and thoughts related to violence against other people or yourself”, he explains.

Although they can affect anyone, they are more common in people with disorders such as anxiety, post-traumatic stress, and especially OCD (Obsessive-Compulsive Disorder).

“Those people [com TOC] they are also more likely to spend more time thinking about the implications of those thoughts and are more likely to overestimate the likelihood of the dreaded outcomes if they come to fruition, which ultimately feeds back on the problem. A vicious cycle is formed in which intrusive thoughts are always coming back, which causes a lot of suffering”, says Gustafson.

With the Covid-19 pandemic more under control and the return to face-to-face work and social events, it is common for people who previously had intrusive thoughts to become more vulnerable to them.

“Intrusive thoughts about being infected with the Covid-19 virus or even other illnesses can be amplified, and a person can experience great suffering when forced to move into professional and social circles again,” he notes.

Without proper treatment, those who face this phenomenon may end up resorting to the use of alcohol and other drugs to try to distract their minds. “People ‘medicate’ themselves with alcohol, or less frequently with other illicit drugs, in search of relaxation and momentary relief from symptoms,” says Gustafson.

“The problem is exactly that: a momentary relief. Next comes the unwanted part, which is the worsening of symptoms. The person then starts drinking more alcohol to feel relieved again, leading to dangerous abuse and potential dependence, which consequently adds a new layer of problems to deal with.”

Read the interview with the psychiatrist below.

What are intrusive thoughts and how do they arise?
Intrusive thoughts are unwanted thoughts that appear out of nowhere. They can be triggered by everyday stress, but they can also be symptoms of a mental disorder. They are usually unpleasant and even disturbing, which can make people not seek help at first because they feel embarrassed by these thoughts.

Intrusive thoughts are involuntary and have no relation to a person’s reality or desires. People don’t act on these thoughts, quite the contrary, they generally find them horrible and unacceptable.

These thoughts can be persistent and cause significant distress in some people. Often, the more people try to get rid of these thoughts, the more they persist and the more intense they become.

Could you cite an example of intrusive thinking that is common?
It is very important to understand that intrusive thoughts are involuntary. People who experience them are often repulsed by them.

There are many types of intrusive thoughts, but common topics of intrusive thoughts include: sexually inappropriate thoughts, thoughts about interpersonal relationships with betrayal content, for example, religious thoughts that are opposite and inadmissible by the person’s belief, and related thoughts violence against other people or yourself.

Intrusive thoughts are common in disorders such as anxiety, post-traumatic stress disorder, bipolar disorder, and OCD (obsessive-compulsive disorder). Why do patients diagnosed with these disorders tend to have this kind of thinking?
People diagnosed with mental disorders (in this case, especially those with OCD) are more likely to judge their intrusive thoughts as bad, immoral, or dangerous.

These interpretations often lead to a strong negative emotional reaction, which amplifies the perceived strength of the intrusive thoughts, thus heightening the focus on them.

These people are also more likely to spend more time thinking about the implications of those thoughts and are more likely to overestimate the likelihood of the dreaded outcomes if they come to fruition, which ultimately feeds back into the problem. A vicious cycle is formed in which intrusive thoughts keep coming back, which causes a lot of suffering.

What is the difference between intrusive thinking, hallucination and delusion?
Hallucinations and delusions are symptoms quite different from intrusive thoughts, and are often present in psychotic disorders.

Hallucinations can occur in any sensory modality (auditory, visual, olfactory, gustatory and tactile), but auditory ones are by far the most common. It’s a perception that feels completely real to the person, but it’s not happening. Auditory hallucinations are often experienced as voices, familiar or unfamiliar, that are perceived as distinct from the person’s own thoughts.

The definition of delusion is a little different, although it also involves the experience of something that feels real but isn’t. It is an obviously false belief, yet the individual who experiences it thinks it is absolutely true. This person will firmly believe in the delusion, even when repeatedly shown evidence to the contrary.

Both hallucinations and delusions are actually disorders. These are experiences that seem real to someone who is suffering from them, but have no connection with reality.

Now, with the pandemic more under control, people are returning to face-to-face work and social events. Is it common for some people to have intrusive thoughts for fear of Covid-19 contamination? Or even because they have been in isolation for a long time and are facing a kind of agoraphobia?
Certainly. People who already suffered from intrusive thoughts before the pandemic are now much more vulnerable as the world reopens to the “new normal”.

Intrusive thoughts about infection with the Covid-19 virus or even other illnesses can be amplified, and the person can experience great pain when forced into professional and social circles again.

Many of these people have found some emotional comfort in isolation and the home office during the most critical phase of the pandemic and may find it very difficult to face the world again.

Is it common for a person who has intrusive thoughts and who has not yet had a correct diagnosis to use drugs and alcohol? What are the dangers that this practice can entail?
When we talk about intrusive thoughts that cause a lot of suffering, we always remember the increased risk of substance abuse, especially alcohol.

The person “medicates” themselves with alcohol, or less frequently with other illicit drugs, in search of relaxation and momentary relief from symptoms.

The problem is just that: a momentary relief. Next comes the unwanted part, which is the worsening of symptoms. The person then starts drinking more alcohol to feel relieved again, leading to dangerous abuse and potential dependence, which in turn adds a new layer of problems to deal with.

With a correct diagnosis and treatments with a psychiatrist and psychologist, is it possible to control these thoughts?
Intrusive thoughts are not always the result of a medical condition. In fact, most people have them from time to time. However, for many people, intrusive thoughts can actually be a symptom of a mental health problem such as OCD or post-traumatic stress disorder.

These thoughts can also be a symptom of neurological problems, such as brain damage, dementia or Parkinson’s disease, for example. That’s why a good diagnosis is imperative.

The best way to manage intrusive thoughts is to reduce a person’s sensitivity to those thoughts and their content. The treatment will be individualized to each person, but, in general terms, the psychiatrist will make the diagnosis and prescribe the most suitable medication.

At the same time, the approach with psychotherapy is essential, with CBT (cognitive behavioral therapy) being the most indicated. Last but not least, the person must be guided to follow a healthy lifestyle, with nutritious food, physical activity and sleep hygiene, which will only add to their general well-being.

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