Intrusive thoughts are not pleasant when they are constant and not the kind of thing you want to think about.
May is mental health awareness month, and while we often hear about burnout, depression, and anxiety, I’d like to spotlight something a little quieter – but no less disruptive: the thoughts that live in the background of your mind, often unspoken, and sometimes frightening. If you’ve ever had a sudden, bizarre thought, like “What if I just drove into that pole?” or “What if I lost control on this plane?”—you’re not alone.
Many people have thoughts that spin around in their head… they’re usually along the lines of “What if I had just done this or that…” but that’s not really the same thing as what a person with truly intrusive thoughts experiences. Curious to know what the top 5 are?
Top 5 Most Common Intrusive Thoughts:
1. Harm-Based Thoughts
“What if I hurt someone I love?”
“What if I push someone in front of a train?”
“What if I lose control and stab someone?”
🔍 These are some of the most common and most distressing. People fear they might act on violent impulses, even though they never would. These are especially frequent in OCD.
2. Sexual Intrusive Thoughts
“What if I have an inappropriate thought about someone I care about?”
“What if I’m attracted to someone I absolutely shouldn’t be?”
🔍 These kinds of thoughts can be deeply disturbing and are often experienced by people with OCD or high-anxiety brains, not because they want them, but because they fear them.
They are not fantasies, and they do not reflect the person’s morals, desires, or character. In fact, they are usually repulsive to the person experiencing them, which is exactly what causes so much shame and silence.
People of strong faith or strict moral values can be especially distressed by these thoughts, fearing that even the presence of the thought is sinful. But in clinical psychology, the distress and disgust these thoughts cause is actually what differentiates them from harmful intentions.
3. Religious or Blasphemous Thoughts (Scrupulosity)
“What if I offend God?”
“What if I secretly want to worship the devil?”
“Did I pray the wrong way?”
🔍 Intrusive thoughts around morality, sin, or offending a higher power are very common in religious or spiritual individuals and in unhealthy situations will lead to compulsive behaviors (ie repeated/nonstop praying).
4. Fear of Losing Control
“What if I suddenly scream in a quiet room?”
“What if I strip off my clothes in public?”
“What if I throw something dangerous?”
🔍 These thoughts often strike in public settings or socially sensitive environments, triggering embarrassment or panic.
5. Health or Contamination Fears
“What if I touched something dirty and contaminated my whole house?”
“What if I caught a disease and spread it without knowing?”
🔍 While contamination fears were always fairly common, they surged during the COVID-19 pandemic—and for some, they never fully went away. Even now, it’s not unusual to see someone driving alone with a mask on, or hiking a wide-open trail while fully covered. To outsiders, it may seem irrational, but to someone struggling with intrusive thoughts or contamination OCD, it feels necessary for safety. These thought patterns can lead to compulsive handwashing, avoidance of public spaces, and significant social limitations.
The Hallmark
The hallmark of an intrusive thought is that it causes distress and is not aligned with the person’s true desires or values. What separates them from dangerous ideation is the level of anxiety, guilt, or disgust they provoke.
Mild and innocuous intrusive thoughts are surprisingly common. For most people, they pass without a second thought. But for others with mental illness, they stick, spiral, and create real distress often leading the person to therapy so they can get help. For those folks, the intrusive thoughts are unwanted, and the person can feel ashamed or afraid of them.
What’s Going On in the Brain?
Many of these conditions share something in common: dysregulated serotonin levels. Serotonin helps regulate mood, sleep, memory, and looping thoughts. SSRIs (like sertraline/Zoloft, fluoxetine/Prozac, escitalopram/Lexapro) target serotonin. Some people benefit, but they take 4–6 weeks to work and may have side effects like fatigue or digestive upset. Other medications include benzodiazepines (ie lorazepam/Ativan®, or clonazepam/Klonopin®), used short-term due to dependence risks.
Interestingly, serotonin also plays a role in sensory processing—which may help explain why some individuals with anxiety or OCD also struggle with misophonia, a condition where certain sounds trigger extreme emotional reactions. I’ve written more about that connection in my other blog, When Noise Triggers Rage: Exploring the Mysteries of Misophonia.
The Nutrient Depletion Nobody Talks About
Medications can mug your nutrients—especially magnesium. SSRIs, birth control, diuretics, and antacids often deplete magnesium, essential for calming nerves, easing cramps, and improving sleep. Simply put, if your magnesium is low, your anxiety might go high. Supplement with magnesium glycinate (for calm) or magnesium threonate (for brain function).
Digital Overload Is Not Helping
Digital overload keeps the brain in ‘fight or flight’ mode. Constant notifications, scrolling, and late-night screen use overstimulate the nervous system. Taking breaks, practicing mindful breathing, and restoring circadian rhythm can reduce panic and obsessive thoughts.
Intrusive Thoughts: 6 Natural Tools to Calm the Mind
- – Magnesium (glycinate or threonate): Calms nerves, reduces cramps
- – L-theanine: Promotes calm focus
- – Inositol: Helps with OCD and panic (under supervision)
- – Ashwagandha: Regulates cortisol
- – GABA: Calms excitability in the brain
- – Progesterone: Calms the brain and balances hormones – see below for more on this. Read my other blog post, Progesterone Protects Against Post-Hysterectomy Stupidity.
Hormonal Imbalance and GABA Disruption
Many people associate hormonal shifts with hot flashes or PMS, but few realize how powerfully hormones influence brain chemistr, especially GABA.
Progesterone, a calming hormone that declines after menopause (and is suppressed by some birth control methods), is a key player in GABA production. GABA is your brain’s natural calming agent, helping you sleep, stay grounded, and reduce anxious thoughts.
When progesterone is low as it often is in postmenopausal women or in individuals on hormonal contraceptives that suppress ovulation, GABA production drops, and the brain may feel ‘stuck in high gear.’ This can show up with symptoms like insomnia, anxiety, heightened sensitivity to stress when you’re normally even-keeled, and even panic attacks,
Speaking of GABA hormone, this is the neurotransmitter that is impacted when you take Neurontin® (gabapentin), and millions of people take this drug for neuropathy, sleep, pain, seizures and more: How to Properly Take Gabapentin and Restore 5 Lost Nutrients.
Birth Control and the ‘Third Category’
You might think of hormonal imbalance as a postmenopausal issue, but there’s a third category worth hearing about: Women who are on hormonal contraception. Birth control pills, shots, patches, and rings often contain synthetic hormones that prevent ovulation. This means the body isn’t producing natural progesterone. Instead, it’s exposed to synthetic progestins, which do not convert into the neurosteroid allopregnanolone and do not support GABA in the same way.
Simply put, while synthetic progestins can prevent pregnancy, they do not provide the same calming effect as real progesterone. This explains why some women on hormonal contraception (or those taking post-hysterectomy) experience mood swings, anxiety, or poor sleep, even when their cycles are routine and ‘regular.’
Summary
Mental health challenges affect more than 1 in 5 adults in the U.S. each year according to the National Institute of Mental Health. And millions more struggle silently with stress, anxiety, sleep disturbances, phobias, or intrusive thoughts that don’t meet formal diagnostic criteria—but still impact daily life. The Harvard Health Publishing site had THIS to say on managing intrusive thoughts.
Mental health is not all or nothing. It’s a spectrum.
Some days you may feel grounded; other days, not so much. Whether you’re navigating hormonal changes, managing a fear that won’t budge, or simply dealing with constant overstimulation, your experience matters—and you deserve support.
Take a moment to check in:
- What is your body telling you?
- What are your thoughts asking for?
- Are you giving your mind and mood the nutrients they need?
Sometimes, healing doesn’t require an overhaul.
Sometimes, it starts with a nice deep diaphragmatic breath… a gentle pause… and maybe even a bit of magnesium. Sometimes you need professional help and assistance to sort out a strategic plan to get well.
Suzy Cohen, has been a licensed pharmacist for over 30 years and believes the best approach to chronic illness is a combination of natural medicine and conventional. She founded her own dietary supplement company specializing in custom-formulas, some of which have patents. With a special focus on functional medicine, thyroid health and drug nutrient depletion, Suzy is the author of several related books including Thyroid Healthy, Drug Muggers, Diabetes Without Drugs, and a nationally syndicated column.
