Troubled by a Weird Imagery Problem

Reader’s Question

I’m wondering if you can help me understand a weird imagery problem I’m having with thoughts. The best way I can explain it is that when I’m doing something (like typing this email) in my mind I see another location than where I am. I will see flashes of streets where I’ve been driving, or someone’s house, etc. I never see people, just locations. It’s starting to happen more and more often and getting annoying and very confusing at times. For example, I’ll actually see the location with my eyes and then have the thought pop into my head. Like right now I see a subway stop and now when I actually pass by that subway stop I’ll think of this email or whatever else I was thinking at that time.

I couldn’t find this strange symptom anywhere, and I’m wondering as it happens more frequently if this is an underlying symptom of a bigger problem like OCD, etc.

Our Clinical Psychologist’s Reply

You seem to be describing “Intrusive Images”, the presence of an image that intrudes into our consciousness. These are found in a variety of psychiatric situations. As you suspected, it’s very common in Obsessive-Compulsive Disorder, with 81% of folks in one study reporting intrusive images, as well as thoughts, songs, sounds, etc. Intrusive images are also common in Post-Traumatic Stress Disorder (PTSD) and is often viewed as a “flashback”. These images are also found in Major Depression and several other psychiatric diagnoses. They are also found in individuals who have used LSD and other drugs in the past. Increasing “thought images” may be an early sign of a significant psychiatric disorder as well.

While Intrusive Images (II) are common — your situation is not. In almost all of the above-mentioned clinical conditions, the II are what we call mood-congruent — that is, they are related to the individual and consist of content that is emotionally disturbing, tormenting, or upsetting. Individuals with OCD have II about germs, death, etc. PTSD may have II about their trauma (combat, physical attack, etc.). Those with Major Depression are tormented by II with a content of funerals, death, suicide, etc.

Your intrusive images are unusual in that they 1) are inconsistent with a disturbed mood, 2) contain very little content that is personally relevant, and 3) have no people content. In this situation, we often need to look in another direction. For example, these may be a form of epilepsy, a type of small seizure appearing in a specific area of the brain (hence specific content each time). These II may be related to other neurological concerns. They may also be produced as a side effect of any medications you are prescribed/taking, as some can produce nondistressing hallucinations by their accidental influence on the Dopamine neurotransmitter.

The fact that they are appearing more frequently and prompting confusion tells us that a medical examination is necessary. There are two routes in the beginning — psychiatric and neurological. If these are psychiatric, you’ll have additional symptoms related to Depression, OCD, or PTSD. If you have sleep/appetite problems, poor concentration, crying spells, obsessive thoughts, rituals, phobias, suicide thoughts, etc. — then start with a psychiatric examination.

On the other hand, if you have few or no psychiatric issues (behavior problems, mood issues, physical symptoms of distress, etc.), then I’d consider a neurological consultation. Any time symptoms are increasing and becoming so intrusive that they disrupt our daily routine, we need to do something. With both, be sure to take along your medications or other substances you use (vitamins, herbs, etc.).

Your Intrusive Images may be a minor issue in terms of content (what is seen), but a major issue in terms of producing confusion and being disruptive to your life/activities. A professional consultation is needed in my opinion.