Understanding Harm OCD and How to Know If You Have It

What Is Harm OCD?

Harm OCD can be a terrifying experience, and it can be hard to know where to turn for help. If you or a loved one suffer from harm OCD, learn about this condition and available treatment.

Obsessive-compulsive disorder (OCD) can take on many forms. It can involve excessive cleaning, a preoccupation with order or with avoiding certain numbers, or intrusive thoughts. Harm OCD is a term used to describe OCD when intrusive thoughts focus on the possibility of harming others.

The thoughts can take the form of fear you’ll harm someone close to you, a fear you’ll harm a stranger, or a fear you’ve harmed someone in the past and didn’t realize or don’t remember it.

It’s not uncommon for people to have a thought about harming someone, even if they don’t actually want to. What makes harm OCD a problem is when you take these thoughts (or impulses or images) to be a dangerous sign. In other words, you interpret the thought to mean that you’re likely to act on it.

Someone without harm OCD might, for example, have a passing thought about stabbing a family member, and react by thinking, “I’m not going to do that,” and never think about it again. By contrast, someone with harm OCD who has that thought will become preoccupied with the possibility they will act on the thought. This often turns into a preoccupation with preventing the harm from happening — more on this below.

What Is OCD? What Are Compulsions?

OCD is a clinical psychiatric disorder that is marked by the presence of obsessions and/or compulsions. Obsessions are typically thoughts that are unwanted and produce marked anxiety. Often obsessions are about a taboo topic, e.g., what if I jumped in front of that subway train? or maybe I find that child sexually attractive. Harm obsessions are considered to be taboo thoughts, as they typically involve thoughts of harming someone vulnerable, a loved one, or someone clearly undeserving of harm. Examples would include thoughts of punching/killing/stabbing/assaulting any of the following:

Your own child
A newborn baby
Your elderly parent or relative
Random passerby
An elderly person in public
Any small or frail person
Pedestrians (if you’re driving)
Any unsuspecting stranger who would not be able to defend themselves

What Does It Mean to Have Thoughts of Hurting Others?

It’s a scary thing to think you might hurt a loved one against your will! So why do people have these thoughts?

The answer is the same whether or not one has OCD — our minds have all kinds of thoughts. Some are warm and fuzzy, some are ugly, and most are pretty uninteresting. We cannot control which thoughts come up in our minds.

Thoughts are like the content on TV as we flip channels; we have no say over what comes on the screen — all we can do is choose whether to change the channel or not.

Ultimately, the thoughts, images and urges associated with harm OCD are insignificant and do not reflect on character. In fact, a closer look suggests that people with harm OCD are quite unlikely to act on these thoughts.

Why Do the Harm OCD Thoughts Happen?

As mentioned above, the thoughts happen for reasons beyond our control. What makes these thoughts into obsessions is the meaning we attribute to them. For example: if you believe your thought of punching your father means you’re likely to do it, and you don’t want to do it, then you’ll experience anxiety. You’ll also be watchful for the thought happening again since you see it as a significant event. Being on the lookout for a thought is nearly a guarantee that you’ll have the thought again.

Trying to suppress a thought typically has the opposite of the desired effect. For example: for the next 5 seconds, try not to think of a pink elephant. Typically when trying hard to do this, people think of a pink elephant. Why? Because trying to suppress a thought inadvertently creates that thought, and then we are unable to “get rid of” it.

Trying to suppress a thought typically has the opposite of the desired effect. For example: for the next 5 seconds, try not to think of a pink elephant. Typically when trying hard to do this, people think of a pink elephant. Why? Because trying to suppress a thought inadvertently creates that thought, and then we are unable to “get rid of” it.

It’s the combination of a) not wanting to punch your father (as in the above example), b) interpreting having the thought as a sign you might do it, and c) trying to suppress the thought, that ultimately create the obsessive cycle of harm OCD.

How to Know If You Have Harm OCD

OCD is a condition that can be diagnosed by a mental health professional. If you want a definitive answer then please consider doing a consultation with a therapist experienced in exposure and ritual prevention therapy (more on this below). However, there are some signs that increase the chances that you have OCD with harm obsessions. They include:

Prior history of obsessions, compulsions, or a prior OCD diagnosis (whether or not there were harm obsessions at that time)
Thoughts, images, or impulses of harming someone despite fervently wanting this not to happen
No prior history of violence
Repetitive anxious thinking about the fears of hurting others
Taking steps to prevent harming someone that feel helpful but would be unlikely to work in real life if you really wanted to harm someone
Avoiding situations where you worry you might harm someone against your conscious wishes

What Is the Treatment?

Exposure and Ritual Prevention
The preferred treatment for harm OCD is exposure and ritual prevention therapy (ExRP). ExRP is a form of cognitive-behavioral therapy that helps you gradually become less reactive to situations or thoughts that cause OCD symptoms. It does so by making systematic use of exercises called exposures. These exercises, when done in the context of therapy, are conducted in a planned and systematic fashion. They produce gradual progress that helps two-thirds of those who attempt ExRP make significant improvement.

The reason that ExRP is considered the treatment of choice for harm OCD is because it works. It has been demonstrated over decades of clinical research to be the gold standard treatment for OCD. There are many forms of psychotherapy available, but most of them are not considered helpful for OCD. ExRP is an exception in that way.

Mindfulness-Based Treatment

Another therapy that can be helpful for harm OCD is CBT that incorporates mindfulness. Mindfulness is the type of awareness that we have when we are truly focused and relaxed. This type of awareness is strengthened most effectively through the practice of mindfulness meditation, but can also be practiced in other ways.

Mindfulness helps you change your relationship with your thoughts. Instead of being at their mercy every time they pop up, you become able to take them less seriously. Mindfulness helps you respond, rather than react, to your thoughts. With regular practice, mindfulness can help you feel less anxious, become more patient, and feel more poised.

When harm OCD thoughts or urges occur, being mindful enables you to avoid assuming the thought or urge means something disturbing about you. Instead, you can use the thought as an opportunity to practice tolerating a disturbing thought, knowing that the thought is temporary and ultimately insignificant.

Medication

Medication is approximately as effective as ExRP for OCD. Some people benefit from doing both types of treatment simultaneously. The most commonly used medications for harm OCD (or any type of OCD) include a class of medications called SSRIs (Prozac, Zoloft, Lexapro, Luvox, and others) as well as Anafranil.

These medications can be prescribed by a physician (psychiatrist or otherwise) or a psychiatric nurse practitioner.

Conclusion

Harm OCD can be a significant problem for those who suffer from it. It can lead people to avoid their loved ones or even to visit the emergency room. Fortunately, there are effective treatments available!

Please contact us

if we can help you in your efforts to find therapy for harm OCD here in New York. Our CBT therapists are doctoral-level psychologists. We also have student therapists who offer reduced-fee services. Our offices are in midtown Manhattan, but we offer teletherapy services to people elsewhere in New York State, New Jersey, and Florida. If you’re looking for therapy for harm OCD in another part of the country or world, please contact us — we are happy to help!