Harm OCD is a subtype of obsessive-compulsive disorder (OCD) characterized by obsessions and compulsions centered around harming oneself or others. The most effective treatment is exposure and response prevention (ERP), but medication can also be helpful for managing symptoms.
Harm OCD, a subtype of obsessive-compulsive disorder (OCD), can feel terrifying and overwhelming. You may have intrusive thoughts like: “What if I accidentally hurt someone?” or “What if I am secretly a violent person?” These obsessions can create intense feelings of guilt, shame, and self-doubt. You might feel intense fear about acting on these thoughts, even though you know you never would.
In response, you might find yourself engaging in compulsions, like mental review or reassurance seeking—which may provide temporary relief, but ultimately reinforce the cycle of OCD. This ongoing anxiety, and the compulsive behaviors meant to minimize it, can interfere with daily life—affecting relationships, work, and overall well-being. However, it’s important to understand that your intrusive thoughts are not a reflection of who you are. With the right treatment, you can reduce symptoms of harm OCD.
Read on to learn more about what harm OCD is, and how to manage it.
What is harm OCD?
Understanding harm OCD is an important first step for learning how to manage the condition. Getting clear on what these symptoms mean (and don’t mean) is important for reducing distress.
Harm OCD is a subtype of OCD, and so is characterized by the same two primary symptoms as all other OCD subtypes: obsessions and compulsions. Obsessions are recurrent and unwanted intrusive thoughts, sensations, images, feelings, or urges. With harm OCD, these concerns center on themes around harm, violence, or injury to oneself or others. Ultimately, these thoughts are not reflective of your character, nor are they indicative of any real desire to harm anyone. In fact, OCD obsessions often run contrary to what you truly value, think, or believe.
In response to the distress caused by intrusive thoughts, people with harm OCD perform compulsions. These are repetitive behaviors or mental acts, meant to try to prevent these imagined situations from happening, or decrease anxiety. But, compulsions ultimately only serve to reinforce the idea that you need these behaviors to survive your anxiety—reinforcing a difficult cycle.
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Harm OCD symptoms
Common obsessions related to harm OCD include:
- Fears of hurting a loved one or a stranger: “Every time I hold a knife, I worry that I might use it to harm someone, even though I know I would never do that.”
- Intrusive thoughts about self-harm or suicide: “What if I suddenly feel the urge to hurt myself, even though I don’t want to?”
- Worries about causing harm during routine activities: “What if I lose control while driving and cause an accident?”
- Disturbing mental images of violent acts or harm to others: “What if I push someone in front of a car?”
Common compulsions related to harm OCD include:
- Reassurance seeking: Asking loved ones repeatedly if they are safe, or if you have done something harmful, even when there is no clear reason to worry.
- Avoidance: Staying clear of certain places, situations, or objects that may trigger thoughts of harm—such as knives, cars, airports, or even certain people.
- Checking: Frequently checking doors, windows, or appliances to ensure your loved ones’ homes are sealed from potential intruders, and that there is no risk of fire or other catastrophes.
- Mental rituals: Repeating certain words, phrases, or prayers silently to try to “cancel out” the intrusive thoughts of harm.
- Thought suppression or replacement: Trying to block or replace unwanted distressing thoughts.
- Counting: Engaging in specific actions or movements, like tapping or touching objects a certain amount of times, because you believe it will prevent harm from happening.
- Self-reassurance: Mentally telling yourself, “I didn’t hurt anyone,” or “If I had hurt someone, there would be evidence.”
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How can you treat harm OCD?
Exposure and response prevention (ERP) therapy is a specialized form of cognitive behavioral therapy (CBT) specifically designed to treat OCD. It is highly effective, and has been used for decades to help people manage subtypes of OCD, like harm OCD. ERP involves working with a therapist to gradually expose yourself to fears that trigger intrusive thoughts, while resisting the urge to do compulsions. The goal is to help you build tolerance to the anxiety these thoughts trigger, and reduce the need to engage in rituals to alleviate that anxiety.
In ERP therapy, you’ll work with a therapist to create a list of exercises where you’ll face your fears and resist responding with compulsions. This list will be ranked, so you’re starting with the least challenging sounding exercises, and working your way up—all while learning to sit with discomfort and uncertainty, instead of reacting with compulsions.
For example, if you find yourself experiencing fears about harm when you see knives or other sharp tools, your ERP therapy plan may focus on slowly exposing yourself to these objects, and learning to respond differently to any anxiety that arises. You might start by visualizing holding a knife, and sitting with the discomfort that arises. From there, you’d try progressing to more difficult exercises, such as cooking with a knife, while resisting any compulsive behaviors.
ERP exercises can also look like gradually reducing the frequency or amount of time that you spend on compulsions. For example, if you tend to ask for reassurance from loved ones, you might start delaying your reassurance seeking for a few minutes, and then gradually work up to a longer period of time—such as an hour, or even an entire day. This process allows you to experience the anxiety that comes with uncertainty, while slowly reducing your reliance on reassurance to alleviate that distress.
“The key is not in trying to get rid of the thoughts, but in learning how to respond to them differently,” says licensed therapist Marybeth Overstreet, MA, LPC. “This process helps to break the cycle of anxiety and compulsion.” Over time, ERP helps diminish the power that intrusive thoughts have over you, as you become more comfortable tolerating uncertainty and anxiety without needing to immediately act.
Medication
In addition to ERP therapy, medication can play an important role in treating harm OCD. It’s important to note that medication is not a “cure” for OCD. But, it can be a valuable tool for managing symptoms while navigating ERP therapy. ERP can be difficult, especially at the beginning, as it requires you to confront distressing thoughts, without resorting to your usual coping mechanisms. Medication may help reduce the frequency and intensity of intrusive thoughts, making it easier to engage in ERP.
Selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants, are commonly prescribed to help manage OCD symptoms, including intrusive thoughts. SSRIs, such as fluoxetine, sertraline, and escitalopram, work by increasing the levels of serotonin in the brain. A boost in serotonin can help regulate mood, reduce anxiety, and alleviate the frequency and intensity of intrusive thoughts. SSRIs can also help address any symptoms of depression you may be experiencing—which can be common alongside OCD, and may make it especially difficult to engage in therapy.
Bottom line
Intrusive thoughts about harm can create intense feelings of guilt, anxiety, and shame—even when you know deep down that you would never act on them. Fortunately, harm OCD is a treatable condition; with ERP therapy, you can learn to manage these thoughts, without resorting to compulsions. Over time, you’ll feel less distress and anxiety, leaving you with more mental energy to focus on the things in life that really matter—like spending quality time with your loved ones.
Key takeaways
- Harm OCD is a subtype of OCD that is characterized by obsessions about harm that are contrary to your true values and desires.
- In an effort to relieve the distress caused by these thoughts, people with harm OCD may engage in compulsions—but these actions only provide temporary relief, reinforcing anxiety.
- The most effective treatment for harm OCD is ERP therapy, which helps you gradually confront your intrusive thoughts and fears while resisting the urge to do compulsions.
- Medications, including selective serotonin reuptake inhibitors (SSRIs) can help complement ERP therapy in some cases.