Harm OCD

What is Harm OCD?

Harm OCD is where you become scared that you could harm yourself or others; and you feel compelled to do things to keep yourself and others safe. It’s a form of obsessive-compulsive disorder (OCD)  

It’s important for you to know before reading any further that

• these thoughts are 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.
• These thoughts are not wishes or desires; they are unwanted, distressing, and completely at odds with your values.  
• it has nothing to do with Violence: While self-harm and violence are common themes, Harm OCD can also involve worries about accidental harm, emotional hurt, or causing bad luck.
• 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.
• 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.
• 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.

In my clinical practice, I’ve noticed a common theme: the people most people I have worked with who have come to therapy for Harm OCD are often the kindest, most empathetic individuals, but that makes sense to me as a psychologist as I know (and the clients also know by the end of therapy) that OCD attacks the things you hold dear. It does not have a will of its own and decide to attack things; rather, if you did not hold people dear and care about their wellbeing, and intrusive thought about harm may not raise a raise a red flag, it could go unnoticed. Whereas it you have a caring disposition an intrusive thought about harming other will definitely register with you. What you do next with that determines whether you will end up with OCD or not. If you can dismiss it, chances are nothing will happen. If you analyse to the extent that you become afraid and start changing your behaviour as if the thoughts was, or could become true, you might be on your way to OCD.

These intrusive thoughts can take many forms for example, new parent terrified of shaking their baby, or images of attacking someone in public, or running someone over while driving.   Ones that I would have more commonly seen in private practice, where thoughts of jumping from a height, or impulsively grabbing a knife.
It’s crucial to understand that these thoughts are not indicative of your true character or any underlying desire to cause harm rather, as I always explained in clients first session, the lengths that a person with Harm OCD goes to (through their compulsions) to ensure that they could never harm themselves or others, means the chances of them even accidentally hurting someone are almost non existent.

Obsessions and Compulsions in Harm OCD

Understanding how Harm OCD operates within the broader context of OCD is crucial if you want to to fully understand what is happening to you. I would do this in the psycho-educational part of therapy, and most clients report experiencing relief when they start to see their thoughts in terms as obsessions and the things they have been doing to ensure safety, as compulsions; it provides distance from what had a been a real fear that they could hurt someone. I shall explains obsessions and compulsions now.

Obsessions: These are intrusive, unwanted thoughts, images, or urges that repeatedly enter your mind. In Harm OCD, these obsessions centre around the fear of causing harm, often violent harm, to yourself or others.  These thoughts are highly distressing and feel ego-dystonic, meaning they are completely at odds with your values and who you are as a person.   

Compulsions: These are repetitive behaviours or mental acts that you feel driven to perform in response to obsessions.  Compulsions aim to reduce anxiety, prevent the feared harm from happening, or seek reassurance. In Harm OCD, compulsions can take many forms, such as:   

Avoidance: Staying away from situations, people, or objects that trigger your obsessions (e.g., avoiding knives, crowds, or being alone with a child).   
Checking: Repeatedly checking to make sure you haven’t harmed anyone or that something isn’t dangerous (e.g., checking the stove, locks, or that a loved one is safe).
Mental rituals: Engaging in mental acts to neutralize or counteract the intrusive thoughts (e.g., counting, repeating specific phrases, or replacing a “bad” thought with a “good” one).   
Seeking reassurance: Constantly asking others for reassurance that you won’t harm anyone or that you haven’t done something wrong.   
Hiding or getting rid of “dangerous” objects: Removing items from your environment that you fear you could use to harm yourself or others.   

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 to 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.

By understanding this cycle, you can start to identify your own obsessions and compulsions. This awareness is the first step towards breaking free from their grip. Remember, these thoughts and behaviours are symptoms of OCD, not a reflection of your true self.