Harm OCD

Written by Dr Elaine Ryan

Dr Elaine Ryan PsychD is a highly experienced Chartered Psychologist with 20+ years of experience. She specialises in Obsessive-Compulsive Disorder (OCD) and Anxiety Disorders.

What is Harm OCD?

Harm OCD is a term used to describe unwanted thoughts concerning causing harm to yourself or others. The thoughts, also known as obsessions, are a symptom of OCD. And like all forms of OCD, Harm OCD has compulsions such as avoiding things that trigger your thoughts.

The obsessions in harm OCD are intrusive thoughts. For a complete overview of intrusive thoughts, please see my guide.


10 Key Points about Harm OCD:

  1. Frightening Intrusive Thoughts: The hallmark of Harm OCD is unwanted, disturbing thoughts about causing harm to yourself or others. These thoughts can feel real and terrifying, even though they don’t reflect your true intentions.
  2. Not About Violence: While self-harm and violence are common themes, Harm OCD can also involve worries about accidental harm, emotional hurt, or causing bad luck.
  3. Compulsions for “Safety”: To manage anxiety, individuals with Harm OCD may engage in compulsive behaviours like excessive checking, avoiding situations, seeking reassurance, or performing mental rituals.
  4. Distressing, Not Dangerous: Even though the thoughts are scary, it’s crucial to remember that they are just thoughts. People with Harm OCD are no more likely to act on these thoughts than anyone else.
  5. Breaking the Cycle is Key: Recovery involves resisting compulsions and learning to tolerate the discomfort caused by intrusive thoughts. This can be challenging, but it’s essential for breaking the anxiety cycle.
  6. CBT is Powerful: Cognitive-behavioral therapy (CBT) can equip you with strategies to challenge the validity of your fears, develop healthy coping mechanisms, and overcome Harm OCD.
  7. Professional Help is Crucial: Don’t suffer in silence. Seeking help from a therapist specializing in OCD is crucial for proper diagnosis, personalized treatment, and ongoing support.
  8. Self-Care Matters: Prioritizing healthy habits like sleep, exercise, and relaxation techniques can boost your overall well-being and resilience against anxiety.
  9. You’re Not Alone: Harm OCD is more common than you might think. Connecting with others who understand can offer valuable validation and support. Online communities and support groups can be helpful resources.
  10. Hope for the Future: Harm OCD is manageable. With dedication, support, and the right tools, you can reclaim control over your thoughts and live a fulfilling life. Focus on progress, not perfection, and remember, your worth is not defined by your intrusive thoughts.

Example of Harm OCD

Several years ago, I worked with a client who had several young children, and it horrified her when she thought she could strangle her child with the tie back on the curtain. She removed the tiebacks. My client had hurt no one and did not want any harm to her children.

In terms of OCD, the thought about the tieback was an obsession. Removing the tie-backs from her curtains was the compulsion. The tieback became a trigger, as did cords, cables, and everything else like tiebacks. She removed the tiebacks just in case her thoughts were accurate and avoided or removed similar items.

Avoiding or removing triggers helped to make my client feel safer short term. Unfortunately, long term, this strengthened and maintained the cycle of OCD.

Harm OCD - open page on MoodSmith Book

Example obsessions in Harm OCD

  • What if I hurt someone?
  • What if I hurt myself?

Example compulsions in Harm OCD

  • Avoiding things that trigger your thoughts relating to harm.
  • Removing objects that could cause harm to another person.
  • Mentally reviewing past events to ensure you did not cause harm to others.
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I worked with a young man in my private practice who was convinced he had hurt someone but had no memory of it. If allowed, he would spend each session asking,

  • how I knew he didn’t hurt someone
  • what if he didn’t remember?

We could have gone around in circles for every session, and his Harm OCD would remain the same or intensified. Instead, I explained the nature of doubt and uncertainty in OCD.

I cannot know that I will not hurt someone in the future, but I do not intend to. I can leave the thought alone. However, you cannot leave the thought alone if you are plagued with doubt, uncertainty, and the false belief that the thoughts must reflect on you. Yet. With the correct treatment, you will.

How do I know my thoughts are OCD and that I won’t act on them?

In my clinical practice, this is the question I am asked the most by people with OCD when the content of their thoughts is disturbing to the person.

I shall try to pre-empt and address the most common concerns by answering the following.

What is the difference between Harm OCD and someone who commits violent acts?

People with Harm OCD do not want those thoughts in their heads and go to extreme lengths to ensure they cannot harm people via compulsions.

To answer the question fully, I need to discuss instances where one person harms another.

  • People who have committed violent acts have committed them. There are no doubt that if I do it in the future, how do I know I have not hurt someone accidentally in the past?
  • Others may have problems with anger and aggression and do not have the thoughts but cannot control their behaviours during a confrontation and physically strike another person.
  • A person with severe mental health difficulties might have a psychotic episode that results in harm.

How do I get over Harm OCD?

There are different options open to you.

You can start with self-help if you are motivated to work alone or meet with a licensed mental health professional specialising in OCD.

I usually recommend a stepped-care approach, where you start with self-help. If this is ineffective, you can progress to working individually with a therapist.

Treatment

Whether you start with self-help or meet a therapist in person, you will use the following therapy models.

The most challenging aspect at the start of treatment for any OCD is the struggle with doubt and uncertainty. This is difficult as it is the cornerstone of all forms of OCD; it is oxygen to the flame.

As a psychologist with 20 years of experience, I know that if you could readily accept that thoughts mean nothing and let them go, you would recover immediately.