Intrusive thoughts are common across cultures
An international study examined unwanted intrusive thoughts among university students across cultures. The findings suggest that strange, unpleasant or unwanted thoughts are far from uncommon.
The study found that the vast majority of participants had experienced at least one unwanted intrusive thought within the previous three months.
What did the study examine?
Radomsky and colleagues examined unwanted intrusive thoughts among university students across cultures. The participants did not have a known clinical diagnosis of OCD. The study included 777 participants from 15 research sites in 13 countries across six continents.
The researchers used a semi-structured interview designed to distinguish unwanted intrusive thoughts from ordinary worry and rumination. Participants were asked whether they had experienced unwanted intrusive thoughts, images, impulses or feelings within the previous three months.
How common are intrusive thoughts?
The findings were consistent: intrusive thoughts were very common.
In the article abstract, 93.6% of participants reported at least one unwanted intrusive thought, image or impulse within the previous three months. After data cleaning, the results section gives the figure as 94.3%. Whichever figure is used, the overall picture is the same: almost all participants had experienced at least one intrusive thought.
Most participants also reported more than one type of intrusive thought. Intrusive thoughts were not only common. They often occurred in several forms in the same person.
The most common category was intrusive thoughts characterised by doubt. This may include thoughts such as: “Did I do that correctly?”, “Have I forgotten something?”, “Can I be sure?” or “What if…?”. The researchers highlight that doubt was the most frequently reported category at almost all research sites.
The least frequently reported categories were the more repugnant or taboo thoughts, such as sexual, blasphemous or morally unacceptable thoughts.
How did participants try to deal with the thoughts?
The study also examined how participants appraised and responded to their most distressing intrusive thought.
The appraisals that stood out most clearly concerned uncertainty, threat, control and responsibility.
Participants used different strategies to deal with the thoughts. The most common were self-reassurance, attempts to stop the thought, reasoning, replacing the thought with another thought and distraction. Ritualising, neutralising, avoidance and reassurance seeking were reported less frequently.
What did the authors conclude?
The authors conclude that unwanted intrusive thoughts are common across the countries and cultures examined in the study.
The study did not examine people with OCD and therefore cannot, in itself, explain why some intrusive thoughts become clinical symptoms. What it does show is that unwanted thoughts, images and impulses are not rare. In this way, the study contributes to a broader understanding: intrusive thoughts are common, and their presence alone does not tell us anything certain about clinical OCD.
In the lexicon, we also describe the difference between obsessions and compulsions.
Limitations
The study also has limitations. The participants were university students and therefore not a representative sample of the general population. The study did not examine people with clinical OCD.
The authors also note that cultural factors, translation and the way interviews were administered may have influenced reporting. The figures should therefore not be used as precise population estimates.
Even so, the study is strong because it examined intrusive thoughts across many countries and cultures using an interview-based method.
OCD specialist’s assessment of the study
Many studies have now shown that intrusive thoughts are a common human experience. People without OCD can also have unwanted, strange or unpleasant thoughts.
What is particularly strong about Radomsky and colleagues’ study is the cross-cultural finding. The same pattern appears across countries, languages and cultures. That matters, even though the study has a clear limitation: it tells us most about young university students, not about the population as a whole.
When people experience OCD, they often feel very alone. Many feel as if they must be the only person who could have thoughts like these. This is especially true when the thoughts feel shameful, aggressive, sexual, religious or morally wrong.
Here, research can be an important counterweight to shame: unpleasant thoughts are common, across cultures too. Thoughts are not desired, important or revealing simply because they appear.
The crucial issue in OCD is therefore not simply that the thought arises. The important question is how the thought is interpreted, and what the person does next. If the thought is treated as dangerous, revealing or as something that requires complete certainty, the person can become caught in checking, reassurance seeking, avoidance or mental analysis.
Clinically, this is an important point: OCD is not about having an unpleasant thought. It is about OCD making the thought feel like a problem that has to be solved.
Treatment is therefore not about removing all thoughts. It is about practising not giving OCD the response it demands. This is also the core idea in exposure and response prevention.