Harm OCD

Harm OCD is a subtype of Obsessive Compulsive Disorder focusing on a fear that one is a danger to others or themselves and may intentionally or involuntarily inflict physical or emotional harm. Harm OCD can present independently or along with other OCD subtypes.

What is Harm OCD

Harm OCD includes violent thoughts and mental images.
Harm OCD thoughts and mental images can make people doubt whether they are a good person and believe they may actually harm someone.

Harm OCD is a common manifestation of Obsessive Compulsive Disorder (OCD). Similar to other OCD subtypes, such as Sexual Orientation OCD (HOCD), Scrupulosity, and Pedophile OCD (POCD), sufferers with Harm OCD experience intrusive thoughts that are counter to their character and values. The pervasive and sometimes grotesque nature of the Harm OCD thoughts cause people to feel distressed, avoid triggering situations or objects, and question their intentions and actions.

Despite what people may think, harm related thoughts are common. People without Harm OCD experience violent or anti-social thoughts throughout the day, yet do not follow through on these thoughts or spend time questioning themselves as a result. This is evident in the way people talk about common stressors:

  • “That guy who cut me off in traffic made me so mad I could just punch him.”
  • “Studying for this test is so exhausting; just shoot me.”
  • “10 points for running over the slow walker in the cross walk.”

The popularity of TV shows, movies, and podcasts depicting true-crime stories highlights that people are not only thinking about violence, they are fascinated with it and can hardly get enough! Moreover, TV shows like Game of Thrones and video games like Call of Duty illustrate the commonplace nature of violence as entertainment. 

Despite this evidence, people with Harm OCD scrutinize their thoughts and fear the mere presence of these thoughts say something about their true character, or will result in violent acts.

Harm OCD Symptoms

Common Obsessions for Harm OCD

OCD exists as a cycle of thoughts and actions. Harm OCD is no different. Even though every object, thought, or action is neutral, the OCD thought process will overlay an interpretation onto that thought, action, or object, and tell a story. This feared story results in something that the sufferer does not want to happen or is otherwise anxiety provoking. Very often, these feared stories occur as an “If ____, then ____” or “What if…” thought. Examples of feared stories are:

  • What if I stab my husband with this kitchen knife?
  • Did I just smile a little while watching that horror movie?
  • What if I actually follow through on my violent thoughts?
  • Do I like true-crime shows too much?
  • If I’m ever alone with someone, then I might end up killing them.
  • I just thought about running someone over with my car; does that mean I might do it?
  • How do I know I’m not going to ever kill someone?
  • What if I’m so depressed I end up killing myself?

Common Compulsions for Harm OCD

Man kicking a woman off a cliff. People with Harm OCD can fear that they will unintentionally harm someone.
People with Harm OCD can fear that they will act on their violent thoughts, however people with these obsessions are unlikely to act in violent ways.

Compulsions are an attempt to deal with the anxiety that comes from the feared story. Attempts to control the feeling, the presence of the thought, or the outcome of the thought can be either physical or mental.

Reassurance

  • Asking friends or family “You don’t think I could kill anyone, right?”
  • Reading articles about murders and self-comparing for similarities/differences

Avoidance

  • Refusing to use knives or other perceived dangerous objects
  • Not driving or asking others to drive

Checking

  • Checking for violent thoughts or impulses when around loved ones
  • Looking at the stove to make sure it is off before leaving the house

Ritual

  • Confessing any occurrence of a violent thought
  • Superstitious behavior to ensure non-violence

Effects of Harm OCD

Woman holding scissors, pins, and sewing thread. Harm OCD can make people fear they will harm loved ones with seemingly common objects.
Harm OCD can make sufferers view common objects as dangerous weapons and subsequently avoid them to “protect” others.

Harm OCD sufferers often find their compulsive behavior escalating. While compulsive behaviors are sometimes rationalized as a benevolent attempt to protect the safety and lives of others, in reality compulsions are an over-reaction to distorted and irrational thoughts. Checking routines, both mental and physical, can slowly increase from periodic to taking hours out of the day. Similarly, avoidances can result in sufferers quitting jobs or hobbies in order to “protect” themselves, their loved ones, or the public.

In some circumstances, misguided attempts to ensure safety or check that no violent act was committed can actually increase the danger to one self or others. For example, a person with Harm OCD might worry that they have run someone over with their car and then repeatedly look in their rear-view mirror to check for evidence of a hit-and-run or side-swiped car. Continual checking prevents them from looking at the road ahead of them and therefore increase the chances of an actual car accident.

Treatment for Harm OCD

Harm OCD can be effectively treated with Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness training, such as Acceptance and Commitment Therapy (ACT). These treatment approaches help clients take a different approach to their thoughts and help them learn that thoughts do not need to be feared. Clients work to challenge the content of their feared stories while learning to trust more rational and evidence based lines of thinking.

Through repeated exposures to their thoughts and feared situations, clients further reinforce that they can face their fears head on and realize that the presence of a thought is not the same as the action, nor does it lead to an action. In other words, the Harm OCD sufferer learns that thoughts are just thoughts! Most importantly, clients learn to extend compassion to themselves while accepting that they are not at the mercy of their violent thoughts.

Click here to read Part II of this series on Harm OCD

To learn more about Harm OCD treatment in the office in Fullerton, Orange County, treatment via Teletherapy, or to schedule an assessment, please contact Kevin Foss here.

For more about OCD and OCD treatment, including Harm OCD symptoms and treatment, visit the FearCast Podcast.

The California OCD and Anxiety Treatment Center offers specialized therapy for Harm OCD in its Fullerton offices. In addition to serving North Orange County, Los Angeles, and the Inland Empire, CalOCD offers online therapy, group therapy, and Intensive Out-Patient treatment.


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