Harm OCD Cognitive Distortions

To learn more about Harm OCD, please read Part I of this series.

For those suffering with Harm OCD, a subtype of Obsessive Compulsive Disorder (OCD), finding any hope that they can recover and carry on a normal, happy, and productive life can truly be their heart’s desire. Many people with Harm OCD fear that they are secretly a violent or harmful person, or fear they are going to become one. They fear that because of their unwanted violent thoughts, horrific mental images, or even subtle bodily sensations or movements, they are deep down dangerous and therefore must do everything they can to prevent themselves from causing harm to others. Similarly, they can feel hyper-responsible for the safety of others and that their inaction will result in harm to others.

Cognitive Behavioral Treatment for Harm OCD

Cognitive Behavioral Treatment (CBT) is part of the “Gold Standard” treatment for OCD and other anxiety related disorders. CBT is an evidence-based therapeutic approach that has decades of research to support its effectiveness in treating OCD, phobias, panic and anxiety attacks, Generalized Anxiety Disorder, and Hypochondria, just to name a few.

At its core, CBT helps people re-examine their thoughts and develop more rational perspectives of themselves, their relationships, and the world around them. Consequently, if people can change the way they think about their thoughts, they can change the way they act and react in light of those newly reconsidered thoughts.

What Are Cognitive Distortions?

Cognitive Distortions are faulty thought patterns that skew the way we perceive ourselves and the world around us. We all experience them, and we all experience a wide range of them throughout our life. That said, we often experience just a few more commonly than others. Knowing which ones impact us the most, and what they do to our perception of ourselves and our genuine level of danger can be a tremendous motivator to taking the next steps in therapy.

Cognitive Distortions for Harm OCD

While there are many cognitive distortions that people with Harm OCD can experience, I’ll briefly discuss few common distortions, offer some examples of them, and discuss what you can do to challenge them.

Catastrophizing in Harm OCD

This distortion is one of the most common Cognitive Distortions for anyone experiencing anxiety, and it’s especially true for those with OCD. When people experience the Catastrophizing distortion, they tend to jump to conclusions and assume that they worst case scenario not only could happen, but will happen.

For example, someone with Catastrophizing may think the following:

• I was slightly distracted on my drive to work, so I probably ran someone over!
• If I don’t check all the doors and locks before I go to bed, someone will break in the house, steal all of our stuff, steal our identities online, and probably kill the whole family!
• I have to pick up all the trash I see or it might fly into traffic causing a 10 car pile-up and it’ll be all my fault!

Emotional Reasoning in Harm OCD

If there was any distortion that caused more pain than others, and one that compelled more people to do their compulsions, Emotional Reasoning would be it. Additionally, Emotional Reasoning goes hand-in-hand with many other distortions and amplifies their impact on the sufferer’s life. Those experiencing Emotional Reasoning draw conclusions simply based on their feelings. In other words, they believe that feelings are facts.

Some examples of Emotional Reasoning can include:

• I not only had a violent thought, but I also felt angry at the time, so I must actually be violent.
• Seeing people killed in tv shows doesn’t make me sad. I must not have empathy for others and am OK with people dying.

Hyper-Responsibility in Harm OCD

Caring for others and being mindful of their wellbeing is a characteristic that most people value. Typically, if we could do something that would make others safer, or at least feel safer, we would all probably do it. This is true especially when it involves a simple act or gesture. Examples can include using the blinker when we merge into a new lane on a freeway, or checking that the front door.

However, sometimes our altruism can be weaponized against us in the form of the Hyper-Responsibility Cognitive Distortion. This distortion causes people to feel that they must protect others from any form of danger, even if that danger is the OCD sufferer themselves! In other words, the OCD sufferer is personally responsible for the safety of everyone around them.

Some examples of Hyper-Responsibility can include:

• I have to check and confirm that all the doors and windows are locked before going to bed or someone will break in a kill everyone and will all be my fault.
• If I’m alone I’ve got to record myself just to make sure that I’m not going to unknowingly kill someone. Better safe than sorry.
• If I don’t pick up that piece of trash, it could get swept out to sea and kill a sea turtle. It’ll be easy, and I can save a life.

Challenging Cognitive Distortions in Harm OCD

If you identify with some of the distortions listed above, there is still hope for you. Everyone, OCD or not, experiences distorted thinking from time to time, but when the faulty thoughts are allowed to exist without any review or consideration of alternatives then they can wreak havoc on our perceptions of reality. 

Identify when you are having a Cognitive Distortions

One of the most important things you can do to challenge distorted thinking is to become aware of which Cognitive Distortions you commonly experience and identify when your brain is skewing your perception of reality. This takes time to master, but as you build your ability to distance yourself from your thoughts and observe what thoughts you are having, you will start to see a pattern and a style of thinking.

To begin noticing this pattern, start keeping a record of the thoughts that trigger your anxiety, or when you feel the urge to do a compulsion. Write down why you feel you need to do this, and even what you think will happen if you don’t do this. Later, sometimes 24 hours later, go back and see if your logic makes sense, or if the thought seems to be consistent with one of the distortions listed above. Over time, you will get better at identifying which thoughts are likely being distorted in irrational ways. 

Disconnect From Your Cognitive Distortion

Another way to build your distortion identification skill in real time is by practicing mindfulness. In fact, Acceptance and Commitment Therapy (ACT) calls the process of distancing oneself from their thoughts “Defusion,” meaning not being fused to one’s thoughts. In other words, defusion exercises can help you to recognize that you are not your thoughts, but instead are a being independent of your thoughts, feelings, mental images, and physical sensations despite the fact that you can experience them. When we defuse from our thoughts, we can then decide which ones we need to act on, and which ones can be ignored.

A Dose of Reality

Now that you are identifying when a Cognitive Distortion is happening, and you are better able to recognize that you are not your thoughts and therefore don’t have to do anything about it, it can be helpful to counteract the distortion with a dose of reality.

Offering yourself a Dose of Reality can help center your attention and help you focus on what is true about your self, your reality, and your actions. It can be a simple reminder you give yourself in the face of anxiety or when you feel the urge to do a compulsion.

Remember, these reminders are not intended to make you feel better. Meaning, they are not intended to take your anxiety away. If you are saying these “magic words” intending to take the anxiety away, then you should consider them a compulsion and avoid them. But, if they help you resist your compulsion, tolerate the anxiety, and give you the firm grounding from which to do the opposite of what your obsessive thought is telling you, then you are using them as intended.

A Dose of Reality In Action

So what does the Dose of Reality sound like? The Dose of Reality should follow a few guidelines. For example, you can ask yourself:

1. What is historically true about your experience?
2. What would other non-anxious/ OCD friends or family members say?
3. Is there evidence for or against this?
4. What are things I rationally know about myself, this trigger, or the world in general?
5. Is this consistent with me, or inconsistent with me?

Now that you’ve reflected, lets look at what your Dose of Reality might sound like in the face of specific Cognitive Distortions.

Catastrophizing

• “This isn’t the end of the world.”
• “It’s unlikely that this piece of trash will kill anything. Most of it will go to a landfill.”
• “There are a lot of things that could happen, and my feared thought is just one unlikely possibility.”

Emotional Reasoning

• “Feelings aren’t facts.”
• “I feel a lot of things, and feelings are OK.”
• “I’ve felt this before and havn’t killed anyone, so it’s unlikely that I’ll do it this time.”

Hyper-Responsibility

• “I’m not responsible for everyone.”
• “Checking 3 times is no more safe than checking once, and doesn’t guarantee that nothing bad will happen.”
• “Other people are looking out for the safety and wellbeing of my loved ones too. I don’t have to be the watchman/ watchwoman for everyone.”

Take The Leap of Faith

The ultimate question is whether you are willing to use these Doses of Reality as motivation to resist the compulsion and see if your feared thought is right, or if your rational brain is right and nothing will happen. Taking this risk is difficult the first time. Actually, it will probably be difficult the first few times. But, after sticking with this exercise, you’ll soon see that you can both, 1) tolerate the discomfort of uncertainty, and 2) see you do not have to bend to the will of your obsession by giving into compulsive checking, reassurance seeking, avoidance, or ritual. Additionally, you’ll likely find that nothing happens. Even better, you’ll probably find, as your rational brain suspects, that horrific violent outcome doesn’t happen. You just need to put it to the test. Are you willing to try?

If you are ready to overcome your Harm OCD and take charge of your life, please contact the California OCD and Anxiety Center to learn more about treatment options. If you would like to discuss treatment in a free 15 minute consultation, please also contact CalOCD to schedule your consultation.  

To learn more about Harm OCD, please read Part I of this series, which includes an overview of Harm OCD, common Obsessions and compulsions within Harm OCD, and a summary of treatment, including Cognitive Behavioral Therapy, Exposure and Response Prevention, and Mindfulness.