Intrusive thoughts are unwanted thoughts, images, or urges that can feel upsetting, confusing, or wildly out of character. They're more common in people with obsessive-compulsive disorder (OCD) but can happen to anyone, and they can involve everything from violence and sex to religion, relationships, and the fear of having done something wrong.
Intrusive thoughts can feel especially disturbing because they often involve someone or something the person cherishes. “We tend to have intrusive thoughts about the things we care most about,” Jerud says.
A calm, compassionate response can make it easier to keep talking. “It can help them feel like there’s hope,” Jerud says. “Maybe I don’t have to beat myself up for having these thoughts in the first place.”
Start by thanking your friend for trusting you. Skip responses like “How could you think that?” or “Don’t say that,” which can reinforce the shame they’re already feeling.
Pay attention to how you sound and look, too. A warm invitation to explain more can feel like judgment if you’re staring intensely or using a sharp tone. If you look startled, acknowledge it instead of hoping they didn’t notice. Kimberly Leonte, a psychologist in Boston who specializes in OCD, suggests wording it like this: “I guess I wasn’t expecting that, but I want to hear more.”
Offer support without repeatedly reassuring them
Say your partner keeps asking whether an unwanted thought means they’re dangerous. You reassure them, they feel better, and you both get back to your evening. Until another question arrives: But what if you’re wrong? What if they didn’t explain the thought accurately enough? Next thing you know, they’re asking for reassurance again.
Instead of debating what the thought means, acknowledge how they’re feeling and express confidence in their ability to get through the discomfort. Thompson Smith suggests: “I know this feels really uncomfortable right now. I’m not going to help you go down the rabbit hole, but I’m happy to sit with you while it’s hard.”
Meanwhile, aim to avoid suggestions like “Just stop thinking about it” or “Replace it with a happy thought.” Besides being considerably easier said than done, trying to force an intrusive thought away can keep someone preoccupied with whether it’s gone yet.
“Do you want me to just listen, or do you want help figuring out what to do next?” Thompson Smith suggests asking. If this is the first time they’ve said their intrusive thoughts out loud, they might not be ready to discuss next steps.
Sometimes, they simply want someone to listen. Your loved one might be telling you because “they just don’t want to be alone in this, and you can help them hold it,” Thompson Smith says. Or they may need to know “you’re not gonna judge me or people aren’t gonna run away if I start trying to be open and get help.”
Know when intrusive thoughts call for professional help
For OCD, look for a therapist trained in exposure and response prevention, or ERP, Jerud suggests. It helps people learn to tolerate intrusive thoughts without turning to rituals like repeated reassurance. The International OCD Foundation maintains a directory to help people find one.
Keep being the friend you’ve always been
After someone opens up about their intrusive thoughts, keep treating them like you always have. Send the ridiculous meme, ask whether they’re still coming to dinner, and keep including them in the things you usually do together.
You might get frustrated or struggle to find the right words, Leonte says. If you react in a way you regret, apologize and let them know you’re still there for them. “No one’s perfect,” she says. “The goal isn’t to be perfect, it’s just to be supportive.”
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