OCD and Thought-Action Fusion

As I’ve mentioned before, and most of us already know, our minds have minds of their own. All kinds of thoughts run through them on a daily basis: some happy, some distressing, some weird, some comical. So many thoughts over which we have no control. Some hang around longer than we’d like, while others are fleeting. Most of us filter out the thoughts that are necessary and important at any given time, and pay little to no attention to the rest. But for those with obsessive-compulsive disorder, it is rarely this simple.

OCD is complicated, and many different elements may contribute to the development of the disorder. One of these factors is a process known as thought-action fusion. This is when a person believes that thinking bad or distressing thoughts is just as terrible as performing the action associated with the thought. So say a thought pops into your head that involves physically hurting somebody you care about. Those who deal with thought-action fusion believe that thinking this thought is just as horrible as following through with it. Imagine how terrifying this can be (not to mention what it does to the sufferer’s self-esteem).

Additionally, thought-action fusion can also include the belief that thinking these terrible thoughts can somehow make them come true. So if you believe that thinking about harming a loved one can actually cause this harm to happen, what would you do? Most of us would try as hard as we could not to think this awful thought. And, given that our minds have minds of their own, the more we try not to think of something, the more we can’t stop thinking about it. It’s not hard to see how this process is conducive to the development of obsessions.

Even though I don’t have OCD, I can sometimes personally relate to different aspects of the disorder, to a point. In terms of thought-action fusion, I realize that I have, on occasion, been superstitious about thinking certain negative thoughts. Stop thinking that; it might come true. I don’t really believe my thoughts can control what happens, yet I find myself trying to stop these thoughts anyway. It’s no different from feeling you might “jinx” something by thinking or talking about it.

Once again we see that the thoughts and behaviors of those with OCD are often no different from those who do not have the disorder. It is the severity that sets them apart. For those who suffer from thought-action fusion that feeds their obsessive-compulsive disorder, cognitive behavioral therapy with a competent therapist can help. And once this cognitive distortion is conquered, there will be a little less fuel to feed the fire of OCD.

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17 Responses to OCD and Thought-Action Fusion

  1. This is a very clear and helpful explanation of thought-action fusion, Janet. I suffered terribly from this when I was young, especially when fundamentalist religion was added to it–I was taught that thinking of doing a bad thing was just as sinful as doing it. So I was just this big knot of guilt.

    You make good points, too, about how everyone goes through thought-action fusion, but the difference between those with OCD and those who don’t have OCD is the intensity of it.

    Great post!

  2. ocdtalk says:

    Thank you, Tina. Wow. That must have been torture for you as a child, believing that thinking something bad was a sin….I’m sorry you suffered so much. Thank you for sharing.

  3. Hi, I enjoyed reading your blog, my sister is a sufferer of OCD and ses just started a blog called OCD, motherhood and me, I’ll add the link in, I hope you don’t mind me sharing it x


  4. Don Grothoff says:

    What a wonderful blog, I enjoy how and what you right. I would like to add that I believe we do create with our thoughts. The idea of what you put out is what you get back.

    Here is the part that makes the difference, it is not the random, passing thought with nothing really behind it that creates. We have many of those but they are passing.

    The creative thought is the persistent thought that has backing to it. We concentrate on it, meditate on it and have intention behind it. That does not always mean it is a conscious thought either but it usually is one we have had for so long that it has become our rule.

    Thoughts like “I am not good enough” or “money is the root of all evil” we wouldn’t think in looking at those that we would want to believe that but it becomes so engrained that we do. This we have a life lacking in money or finances and wonder why.

    I got a little off subject but we have taught that belief to our kids for a long time and when my daughters OCD started it really played on it where she not only believed it could happen she felt she would create it. We have worked to try to bring that around but it takes time, effort and now therapy.

  5. ocdtalk says:

    Thank you for your comment, Don. Yes, we all have some of those types of beliefs that you mentioned ingrained in us as children, and these beliefs can certainly distort our world and affect how we think and live……for many people it’s not an issue, and for others, it is. I hope your daughter is doing better now and you are pleased with her therapy/therapist.

  6. Andrea says:

    ahhh, sooo true!! “Once again we see that the thoughts and behaviors of those with OCD are often no different from those who do not have the disorder. It is the severity that sets them apart.” This-I think about a lot! I think well hey, my husband does this & worse than me on that etc. Or I feel like everyone has superstitions or does certain things…It definitely IS the severity that sets people with OCD apart. Thank you for sharing this!

    • ocdtalk says:

      Thanks for your comment, Andrea. I think the fact that the severity is what really sets us apart makes me realize how we are “all in this together.” When those without OCD take the time to take a close look at their own thoughts and behaviors, they can often see how similar they actually are to those who have the disorder.

  7. Pam says:

    Janet, I have never posted on a website before but I have really been enjoying your entries…my son is in the severe throws of OCD and social phobia to the point he will not leave the home. Bathing has become a problem also. We live in a southern rural area and find most residential/outpatient treatment programs are located in northern states. We have had 5 trying years and struggle daily. We would be appreciative of any recommendations, facilities….he is a very bright young man and OCD has taken everything. His world has become so small. Thank you for this outlet.

  8. ocdtalk says:

    Hi Pam, Thank you for writing. I am so sorry to hear what your son, and you, have been going through. It is heartbreaking, as OCD is treatable. Would he be willing to go to a residential program? There are many good ones, but I’m not really in a position to recommend one. I would suggest contacting the International OCD Foundation and/or Beyond OCD (formerly OCD Chicago). Their links are on my sidebar under OCD Resources. I think they are two of the best resources around and could certainly point you in the right direction, either to a residential program or a therapist who specializes in treating OCD. I am thinking of you and know there is so much hope for your son; he just needs the right therapy and therapist. Please keep in touch and let me know how things are going.

  9. My dilemma concerns whether or not this is something GENERATED by people with OCD in their own psyche or if this is something that BIOLOGICALLY their overactive minds tend to drive them to do. In my experience, it is the latter and not the former. The anxieties explode through the mind stronger and stronger and take over and then the unwitting victims of these anxieties then become overtaken by thought-fusion. Nonetheless, cognitive behavioral therapy will be effective if either case is true. https://www.facebook.com/AttackOcd?ref=hl

    • Nick says:


      You bring up a good point. As an ocder myself I can only share my own experience and that would point it to being both biological and generated. I would say biological because everyone regardless on if they have ocd or not all have had experiences where they thought a thought was the same as an action. so everyone has this. i would say generated because, unlike most people who do not have ocd or some other anxiety spectrum, a person who does have ocd or another anxiety spectrum will not simply shrug off the thought. instead they will analyze it over and over again. this trains the brain to treat these thoughts as dangerous when in fact they are nothing more than harmless, wispy shades that is the norm to an active mind. due to this training of the mind the next time an ocder has an intrusive thought they will immediately label it as dangerous causing the brain to immediately latch on to the thought and analyze it to see what level the threat is. while the brain is doing this it will also release a flood of adrenaline into the blood stream to aid the body in a flight or fight response to what it has now classified as a threat. adrenaline is highly addictive in large amounts or continuous amounts…which proves the saying given by a daredevil that they are literally addicted to the rush. they really are addicted to the adrenaline. sadly, a person with ocd or anxiety can also become addicted or used to the level of adrenaline produced by the body. one of the hardest tricks to learn when dealing with ocd is how to face your fears, how to simply allow a thought to be without reacting to it. many people with ocd, myself included, have had relapses at one time or another because even when everything is going great in ones life and there are no stressors the mind will create them simply because of the adrenaline level it is used to is no longer there. so to get back on point, i think the thought-action fusion is biological in nature to an extent but can become a learned behavior given enough time. but the good news is that the brain is constantly learning and any learned behavior can be retrained. we ocders teach ourselves to react to intrusive thoughts, we can also retrain ourselves to see a thought for what it really is…harmless shades that are so far removed from an action as to be indescribable. a thought is simply a thought that is automatic. an action on the other hand is the choice to make a thought a reality. they are very different things a thought and action.


      • Thanks so much or sharing your insight, Nick. I think you sum it all up by saying: “a thought is simply a thought that is automatic. an action on the other hand is the choice to make a thought a reality.” A simple fact, but not always clear to us!

  10. Renate says:

    What if you had one of those thought-fusion-action thoughts a long time ago and didn’t pay much attention to it and then years later the thought about thing actually happens? Long ago, before I was ever diagnosed with OCD, I had a thought pop into my head that I wanted my sister to get bladder cancer. At that time (1972!!) I had no clue there was such a thing. I forgot about the thought but now my sister has bladder pain that will not go away. She saw all kinds of doctors and none was able to help her. What if she does have bladder cancer now. The thought that I caused this is making me feel so guilty that I can no longer function. I would never forgive myself if she did get cancer. I have no clue where that thought came from and I keep going back to try to analyze it but that was 41 years ago. Has anyone ever had similar thoughts and did they actually come true and how do you live with that afterwards?

    • Thanks for sharing, Renate. I am not a therapist but will share my thoughts with you. When dealing with cognitive distortions, it is certainly possible the very things you fear you cause might actually come true. That’s life. Good things happen and bad things happen and none of us can ever be sure what’s around the corner. I think that’s what those with OCD (and the rest of us) need to come to terms with. To me, the question is, “Do you really believe your thoughts can cause your sister to get bladder cancer?” That’s what has to be dealt with, the cognitive distortions, because it truly is distorted thinking. Your sister might get bladder cancer (though I truly hope she doesn’t) but NOT because that thought popped into your head. I wish you and your sister all the best. Maybe some other readers will chime in.

      • Renate says:

        Thank you for your speedy reply, Janet. I really appreciate it. Yes, I do believe that my sister will most likely get bladder cancer. Why on earth did I think such a thought that came out of the blue? I hope I’m wrong but it is hell to have to live with fearing that any day I will hear the bad news from her. She told me not to worry about it and that the pain, which she has had since this April, may be caused by something not even related to the bladder. I’m trying to tell myself that everything will be ok but right now I’m just totally stressing out because I’m also having a cancer scare myself. I’m having an endoscopy done on Monday to check out the growth in my stomach that showed up on x-rays. Wish me luck that it is benign. Thanks!

      • I will keep you in my thoughts……hoping all turns out well.

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