Harm OCD is a subtype of Obsessive Compulsive Disorder characterized by intrusive thoughts of hurting yourself or others. Importantly, people with Harm OCD never have an actual desire to hurt people.
The intrusive thoughts of Harm OCD are unwanted and distressing. Often, they go against the very values and morals one holds. People with Harm OCD are not a danger to others.
If you are struggling with Harm OCD, remember that your intrusive thoughts do not determine your worth or goodness. They are not telling you anything truthful about yourself.
This article covers the symptoms, treatment methods, and coping mechanisms for Harm OCD.
What Is Harm OCD?
Harm OCD is composed of intrusive thoughts, images, and urges of hurting yourself or others, and compulsions to soothe those thoughts.
The intrusive thoughts of Harm OCD are usually highly disturbing, graphic, and even horrifying. For example, a new mother with Harm OCD may have an intrusive thought of throwing her baby.
This does not reflect her actual desire or intent. People with Harm OCD are deeply horrified by their thoughts and seek to stop them through compulsions.
Harm OCD vs Self-Harm
Self-Harm OCD is a subtype of Harm OCD. With Self-Harm OCD, the intrusive thoughts are about how you may hurt yourself. For example, being unable to use a knife without the thought of stabbing yourself, even though you do not want to actually hurt yourself.
Self-Harm OCD is not self-harm behavior. The two are very different mental health issues and require different treatment methods.
Let’s look at some differences between the two:
- Self-harm OCD thoughts are intrusive, unwanted, and carry no intent of actual self-harm. Self-harm thoughts do carry intent, and their purpose is to soothe emotional pain or distress.
- Self-harm behavior often brings emotional relief or release. For example, the pattern of self-harm might look like: emotional distress, urge to self-harm, behavior to self-harm, and emotional relief. Self-Harm OCD does not have this emotional relief. The compulsions that come from it (like counting to 7 or putting away all sharp objects) do.
The point of self-harm OCD is to be obsessively sure you will not hurt yourself. The point of self-harm behavior is to hurt yourself, to satisfy emotional distress.
If you struggle with self-harm, help is out there. Contact a hotline to talk with a crisis counselor. If you’re in immediate danger, call 911.
Harm OCD Symptoms
Harm OCD is composed of intrusive thoughts and compulsive behaviors. Let’s take a look at some examples of each so we can better identify Harm OCD:
Obsessions (intrusive thoughts or images)
- Unwanted thoughts of hurting someone (e.g., pushing, stabbing, or hitting a loved one or stranger).
- Fear of hitting someone with your car
- Worry that simply thinking about harm means it could happen.
- Doubts about whether one has already caused harm (“Did I run someone over?”).
- Fear that one’s thoughts reveal them to be a “bad” or “dangerous” person.
- Mental images of violent or gory scenes
Compulsions (mental or behavioral responses to anxiety)
- Reassurance-seeking: Constantly asking others for reassurance that they didn’t hurt anyone or won’t.
- Mental reviewing: Replaying memories to check whether harm occurred.
- Avoidance: Staying away from knives, tools, or situations where harm could happen.
- Confession: Admitting thoughts or imagined wrongdoings to feel relief.
- Checking: Looking for signs that someone is okay (e.g., checking the news or contacting people).
- Neutralizing rituals: Trying to “cancel out” bad thoughts with good ones, like praying or counting.
Remember that Harm OCD carries no actual intent of violence. People with Harm OCD do not want to hurt others. It’s quite the opposite: They are afraid that they want to hurt others or will accidentally hurt others.
Harm OCD makes it difficult to do daily things such as:
- Drive a car
- Hold your child
- Cook in a kitchen
- Give hugs or engage in physical contact
These are just some examples. People with Harm OCD can have many different types of intrusive thoughts and are limited in different ways. Therapy helps them face their fears and engage in these activities safely.
Is Harm OCD Dangerous?
There is no correlation between Harm OCD and bringing harm to other people. People with Harm OCD do not actually want to hurt people. Their compulsions are never to hurt other people, either.
Harm OCD is only dangerous to the people who have it, because it is a mental health disorder. Compulsions can be destructive and time-consuming. Harm OCD is also commonly comorbid with depression and anxiety. Self-isolation and low self-esteem are also common results of Harm OCD.
How is Harm OCD Treated?
Harm OCD is treated using Exposure and Response Prevention (ERP) therapy. This is the same technique used to treat most types of OCD. The basic principles are simple:
- Expose yourself to something that triggers your intrusive thoughts.
- Sit with the feeling of discomfort without engaging in compulsive behavior.
- Use other self-soothing and coping techniques.
- Increase the difficulty of the trigger or the time before engaging in compulsiveness.
With Harm OCD, the ERP progression can be a little bit tricky. Some examples of what ERP might look like include:
- Using a sharp knife to cook.
- Writing or saying out loud, “I might hurt someone.”
- Visualizing accidentally hurting someone
- Driving around the block.
- Watching a graphic video and not asking for reassurance that you have done no harm.
The goal of ERP is to engage in behaviors without using your compulsions. A therapist will usually be with their client as they engage in the behavior (like driving). Visualizations are used to address intrusive thoughts that cannot be acted out, like harming someone.
Therapists will never ask you to harm someone. A good therapist will also slowly ramp up the intensity of your ERP. For example, starting with something simple like visualizing knives before working your way up to using a knife.
ERP will be specific to you, your intrusive thoughts, and your goals. For example, maybe you can't watch horror movies because they trigger your Harm OCD. If you don’t care that you can’t watch horror movies, then it isn’t an issue. However, if you work in a movie theater and see posters of possibly graphic movies, then it might be an issue for you.
ERP and other supporting therapies are proven to be effective at treating OCD. If you’re ready to start treatment for your harm OCD, talk to Lifebulb. We have therapists who take insurance with availability this week.
