How Thought-Action Fusion Relates to OCD

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Not all people with obsessive-compulsive disorder (OCD) experience thought-action fusion, but for those who do, it can feel like they're buried under a mountain of fear.

Understanding Thought-Action Fusion

Thought-action fusion is when you believe that simply thinking about an action carries the same weight as actually carrying out that action. For example, if a thought randomly pops into your mind about something unacceptable, such as physically assaulting someone, you might believe this to be just as morally bad as actually harming them, thus making you feel like an immoral person.

Thought-action fusion can also lead people to believe that thinking about an unwanted event makes it more likely that the event will happen. For instance, you might think that imagining a loved one dying in a plane crash somehow increases the chances that this will actually happen.

In severe cases, another outcome of thought-action fusion is believing that just thinking about something means it's going to happen as if you have no control. For example, you may be worried that you're going to start screaming obscenities in a crowded room, which leads to the next thought, that you will scream obscenities, even if you don't want to, followed by actually screaming obscenities.

Thought-action fusion seems to be most prevalent in people who suffer from a form of OCD that's called "Pure Obsessional OCD."

Also known as "Pure O," "Pure Obsession OCD" occurs when the person does not engage in the compulsion aspect of OCD but deals with the thoughts, images, and feelings associated with the obsession aspect.

Why Thought-Action Fusion Is Dangerous

Thought-action fusion may function to cause and maintain obsessive-compulsive disorder symptoms by promoting thought suppression, the act of pushing aside your thoughts. Namely, thought-action fusion makes thoughts appear more dangerous, which often leads to suppressing them. Although pushing away these dangerous thoughts seems to make sense, research has proven that suppressing thoughts only makes them worse, particularly in people with OCD who then obsess and fixate over the "forbidden" thought even more. Thought suppression may actually be partly how obsessions are formed. 

New Research 

Though research on thought-action fusion has mostly been associated with OCD, more current research has also been done to study the effects of thought-action fusion in other anxiety disorders. The results showed that thought-action fusion tends to be present in these disorders as well, particularly generalized anxiety disorder (GAD). The research proved that thought-action fusion does respond well to treatment and therefore should also be assessed and possibly even treated for disorders other than OCD as well. 


There are several different scales and/or diagnostic tests that mental health professionals may use to tell how significantly thought-action fusion is affecting you. 


Addressing thought-action fusion is a key component of many cognitive-behaviorally oriented psychological treatments for OCD and is usually accomplished through exposure therapy exercises and mindfulness. Psychotherapy has been shown to be very beneficial in helping people who suffer from thought-action fusion to identify steps to confront their irrational thoughts and behaviors, as well as to learn to stop suppressing their thoughts.

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By Owen Kelly, PhD
Owen Kelly, PhD, is a clinical psychologist, professor, and author in Ontario, ON, who specializes in anxiety and mood disorders.