All intentions of suicide or self-harm should be taken seriously. If you or someone you know has reported an intent to self-harm, please call 911 or contact your local emergency room number immediately. In the United States, you may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or text the Crisis Text Line. This line is available to you all day, every day.
Self-harm OCD is a subtype of obsessive-compulsive disorder that causes intrusive, distressing thoughts about self-inflicted harm, even when there is absolutely no desire to act on them.
Everyone has intrusive thoughts about getting hurt from time to time. You might briefly imagine getting a paper cut while flipping through a book, or picture yourself tripping on the sidewalk and scraping your knees. Most people can brush these thoughts off without a second thought. But for people with obsessive-compulsive disorder (OCD), these thoughts can become graphic and feel impossible to ignore.
When intrusive thoughts about self-harm—whether accidental or intentional—become persistent and overwhelming, they may be a sign of self-harm OCD. This subtype of OCD causes distressing thoughts, sensations, images, or urges related to self-inflicted harm, even though the person experiencing them has no desire to act on them.
Although self-harm OCD can be upsetting, it is highly treatable with exposure and response prevention (ERP) therapy. Read on to learn more about the symptoms of self-harm OCD, how it can affect your daily life, and the most effective way to treat it.
What is self-harm OCD?
Self-harm OCD is a subtype of obsessive-compulsive disorder (OCD), a mental health condition that involves intrusive thoughts, feelings, images, sensations, or urges—known as obsessions. These thoughts can be distressing and difficult to ignore, leading people to engage in compulsions, which are repetitive physical and mental behaviors that are performed in an attempt to find relief from anxiety or to prevent a feared thing from happening. However, this relief is only temporary, and compulsions ultimately reinforce the OCD cycle, making obsessions feel even more significant.
Self-harm OCD can manifest in a variety of ways, but at its core, it involves scary, unwanted thoughts about self-inflicted harm. Self-harm OCD is similar to suicidal OCD, in that it is extremely upsetting—the person experiencing these intrusive thoughts and images does not actually want to harm themselves, but the obsessions persist.
“These thoughts are ego-dystonic, meaning they are not in line with a person’s beliefs, values, or morals,” explains Danielle McDowell, LCSW. Because thoughts of self-harm feel so misaligned with a person’s values and sense of identity, they create intense fear, guilt, and anxiety.
To cope with this distress, people with self-harm OCD may engage in compulsions such as seeking reassurance, mentally reviewing past actions, or avoiding anything that could be remotely dangerous. While these behaviors may feel necessary, they do not prevent obsessions from returning—instead, they keep the cycle going.
Common obsessions in self-harm OCD
- Fear of losing control and killing yourself
- Worrying about becoming so depressed that suicide feels inevitable
- Thoughts about driving off a bridge or into oncoming traffic
- Disturbing mental images of jumping off a bridge or balcony
- Fixating on the idea of swallowing a whole bottle of pills
- Analyzing thoughts to determine if they indicate suicidality
- Fear of accidentally or purposely cutting yourself with a sharp object
- Repeated intrusive images of self-mutilation
These obsessions can feel relentless, making it hard to trust yourself or find peace of mind.
Common compulsions in self-harm OCD
In self-harm OCD, compulsions are meant to provide a sense of immediate relief from the fear of harming yourself.
Some common compulsions in self-harm OCD include:
- Hiding perceived dangerous objects from sight or reach (knives, razors, lighters, ropes)
- Avoiding any movies, shows, books, music, or articles that mention self-harm or violence
- Excessive praying for safety
- Constantly monitoring thoughts and actions to ensure they are safe
- Avoiding being alone out of fear of losing control
- Seeking reassurance from others about their thoughts or safety
- Performing rituals (counting, tapping, touching, etc.) to prevent harm from occurring
- Excessive online searching to prove or disprove their fears
While these compulsions may seem like a way to stay safe, they actually keep OCD in control by reinforcing the idea that intrusive thoughts are dangerous or meaningful.
Common triggers for self-harm OCD
People with self-harm OCD may be triggered by situations involving dangerous items or locations, as well as media depictions of self-harm.
Triggers for people with self-harm OCD can include:
- Using or being near kitchen knives or other sharp tools
- Using or being near dangerous chemicals
- Standing near high, open ledges or balconies
- Reading, viewing, or listening to media about self-harm, depression, or suicidality
How can I tell if I have self-harm OCD vs suicidal intent?
Self-harm OCD is confusing because the obsessions and compulsions feel so intense, making it hard to tell whether or not they’re real. Tracie Ibrahim, Chief Compliance Officer at NOCD explains,“The main difference is questioning and feeling upset about suicidal thoughts versus actually wanting to act on them. So the key thing here is the intrusive doubt,” she says. In other words, people with self-harm OCD do not want to hurt themselves—they’re terrified of the idea.
Having these intrusive thoughts can trigger intense anxiety and fear, making them difficult to dismiss. However, the thing to look out for is the intent behind the thought. Active suicidal ideation involves a deliberate contemplation of self-harm as a means to end your life, often including specific plans. If you have intentions of harming yourself, you should reach out for help immediately. You can call the National Suicide Prevention Lifeline at 1-800-273-8255, text the Crisis Text Line, call 911, or visit the closest emergency room.
If you’re struggling with distressing thoughts about self-harm that are related to OCD, effective treatment is available.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
How is self-harm OCD treated?
The most effective treatment for self-harm OCD (and all forms of OCD) is exposure and response prevention (ERP) therapy, a form of cognitive behavioral therapy (CBT) created to disrupt the OCD cycle.
What does ERP look like for self-harm OCD?
ERP for self-harm OCD involves facing obsessions about hurting yourself rather than avoiding them or the situations that trigger them. Since these fears vary from person to person, therapists tailor the process to each individual’s experiences and triggers.
For example, someone who avoids kitchen knives out of fear of self-harm wouldn’t be expected to start by washing them right away. Instead, their therapist would guide them through gradual steps to reach a point where handling knives no longer feels overwhelming or requires compulsions. “You start really low, and it’s very individualized depending on how harm is coming up for you,” explains Ibrahim.
Some common exercises your therapist might work with you on include:
- Keeping sharp objects in sight instead of hiding them out of fear
- Reading or watching content that mentions self-harm rather than avoiding it completely
- Practicing being alone instead of seeking constant reassurance from others
- Writing down intrusive thoughts rather than trying to push them away
- Reducing checking behaviors, such as analyzing thoughts to make sure they aren’t suicidal
Ibrahim, who experiences suicidal OCD, shares a personal example of an ERP exercise: “Since I have intrusive thoughts about stabbing myself a lot of the time, I keep a knife on my work desk as an exposure all the time.” This helps her realize that even though the knife is there, it doesn’t mean she will act out on her intrusive thoughts. Some therapists may guide people through exercises like holding a knife and verbalizing thoughts like, I could use this if I wanted to, to break the association between the thought and actual danger.
Bottom line
Self-harm OCD can be scary, but it does not define who you are. The thoughts and fears that come with this condition may feel real and distressing, but they are a product of OCD—not a reflection of your true intentions.
Self-harm OCD is highly treatable with exposure and response prevention (ERP) therapy. With the right treatment, you can learn to navigate these fears, build confidence, and regain control over your life.
Key takeaways
- Self-harm OCD involves intrusive thoughts about self-inflicted harm, but these thoughts are unwanted and do not reflect a true desire to cause harm.
- Common compulsions include avoidance, reassurance-seeking, and mental checking, which may provide short-term relief but ultimately reinforce OCD.
- Exposure and response prevention (ERP) therapy is the most effective treatment, helping individuals face their fears without engaging in compulsions.