Harm OCD

Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.

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.

Example of Harm OCD

Several years ago, I worked with a client who had several young children, and it horrified her when she thought that 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 come 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 cord, cables, and everything else like tiebacks. She removed the tiebacks just in case her thoughts were true and avoided or removed similar items.

Avoiding or removing triggers helped to make my client feel more safe, 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.

Important point: You will want to know in absolute terms that the thoughts are not true or need a concrete answer why you have the thoughts. If you’re going to get better, you need to move past that and focus on helping yourself with obsessions and compulsions.

I worked with a young man in my private practice who was convinced he had hurt someone in the past 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 round in circles for the duration of every session, and his Harm OCD would remain the same or intensify. Instead, I explained the nature of doubt and uncertainty in OCD.

I cannot know for sure that I will not hurt someone in the future, but I know that I do not intend to. I can leave the thought alone. However, if you are plagued with doubt, uncertainty, and the false belief that the thoughts must reflect on you, you cannot leave the thought alone. 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 the 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 actually have committed them. There are no doubts 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 who specialises in OCD.

I usually recommend a stepped care approach, where you start with self-help. If this is not effective, 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 difficult aspect at the start of treatment for any form of OCD is the struggle with doubt and uncertainty. This is so 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 the thoughts mean nothing and let them go, you would recover right away.

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