Last reviewed:
Aug 22nd 2023
M.A., LPCC
Harm OCD is a sub-type of obsessive-compulsive disorder (OCD) characterized by obsessive, intrusive thoughts of harmful behavior towards oneself or to others.
Like other sub-types of OCD, these obsessions trigger compulsive behaviors intended to alleviate the anxiety felt from the initial intrusive thoughts.
In this article we’ll discuss what Harm OCD is, how it is experienced, what is thought to cause it, and treatment options.
Harm OCD is a sub-type of obsessive-compulsive disorder that causes sufferers to experience unsolicited thoughts, urges, or fears about causing harm to others or themselves. [1]
You may know these thoughts are irrational and have no bearing on reality. However, it does not stop them from incessantly coming up. Harm OCD may leave you feeling terrified; you could be a danger to yourself or to others.
Our society is built on a mutual understanding that you cannot carelessly cause harm to others, especially violent harm. So, it can feel challenging and distressing to experience unwanted thoughts or images about doing harm to someone you care about. The distress and anxiety caused by the symptoms of harm OCD can significantly impact an individual's quality of life and mental well-being.
Harm OCD is not inherently dangerous to individuals or other people surrounding them. People with Harm OCD experience intense distress regarding the content of their thoughts and often find themselves avoiding situations that involve subjects or situations related to their harmful obsessions.
Having intrusive thoughts about harm does not mean someone with Harm OCD is more likely to act on those thoughts. Research suggests that individuals with OCD are not at a higher risk of acting violently or impulsively than the general population.
Harm OCD is a disorder of thought patterns and anxiety, not a reflection of a person's character or intentions.
There is an overlap between symptoms of harm OCD and symptoms of other sub-types of OCD in that all are marked by the presence of obsessions and compulsions.
In harm OCD, obsessions relate to causing harm to others and/or themselves, and compulsions are performed to reduce the anxiety felt by the idea of causing harm.
It is important for both sufferers and unaffected people to know that these obsessive thoughts are just thoughts. Sufferers do not act out on these ideas or urges and typically have no history of violence. [2]
In response to their Harm OCD obsessions, people may perform ritualized compulsions to help relieve symptoms of anxiety, which can, in turn, exacerbate the cycle of anxiety and distress.
Compulsions seductively offer sufferers the illusion of relief from anxiety. However, any relief experienced is temporary and short-lived as compulsions become increasingly time-consuming and a major anxiety-inducing problem [2].
In reality, treatment for OCD requires sufferers to break the obsessive-compulsive cycle by not engaging in compulsive behaviors and working on reducing the significance given to obsessive thoughts by striving to recognize that the thoughts are not a reflection of reality, and they will not cause harm to others. [2]
Compulsions felt by sufferers of Harm OCD may include: [1]
Avoidance
Engaging in mental acts to neutralize or counteract intrusive thoughts, such as:
The exact cause of harm OCD, like other forms of OCDs, is not fully understood. OCD is a complex condition influenced by a combination of genetic, neurobiological, environmental, and psychological factors.
Common factors that may lead to OCDs, including harm OCD, include:
Obsessive-compulsive disorders, such as Harm OCD, can be chronic, debilitating mental health conditions that require treatment.
Treatment for harm OCD, like other OCDs, typically involves a combination of cognitive behavior therapy (CBT), mindfulness strategies, and medication. A successful treatment plan is imperative for someone with harm OCD to manage their symptoms successfully.
Therapeutic treatment for OCD is centered on getting sufferers to break the OCD cycle by detaching from the emotional distress caused by thoughts and accepting that their compulsive behaviors do not solve their problems. [2] This is best accomplished by a form of CBT called exposure and response prevention (ERP). [2]
ERP is considered the front-line treatment for harm OCD, with 80% of people finding it an effective way of managing their symptoms. [3]
A patient and therapist conduct sessions, typically in the therapist’s office, in a systematic step-by-step manner. [2] Patients are gradually exposed to their violent, obsessive thoughts and encouraged to sit with the fears and anxiety these obsessions provoke without performing compulsions. [2]
An ERP treatment plan can include three approaches: [1]
Examples of behavioral assignments to combat unwanted thoughts related to harm OCD include. (Note: These assignments would only be requested of an individual after meeting with a therapist and determining that they were properly supported for this level of exposure, as jumping into these activities would be overwhelming and ineffective): [2]
Thoughts of stabbing people
Thoughts of hitting people
Thoughts of molesting others
Thoughts of crashing into others with your car
Your therapist will encourage you to accept these thoughts without performing compulsions. They may: [2]
Working with a therapist during ERP is the most effective way of dealing with harm OCD. [3] Trying to combat intrusive thoughts on your own can be self-defeating as it can be difficult to stop ‘testing’ yourself to see how you are reacting to different stimuli.
For example, you could be watching a violent movie while constantly self-reassuring, e.g., telling yourself ‘Look I’ve watched a portion of SilenceoftheLambs and I haven’t killed anyone yet’. This performative behavior negates all important ‘response’ part to your ERP and is detrimental to your treatment plan. [1]
Mindfulness techniques can help individuals become more aware of their thoughts and feelings without judgment. This awareness can reduce reactivity to the distressing thoughts and foster a more accepting attitude towards them.
Developing mindfulness skills is thus useful in dealing with everyday distressing thoughts related to harm OCD and resisting the compulsions you’ve learnt to perform. [1]
SSRIs, the frontline class of antidepressant for treating OCD, can be effective in reducing OCD symptoms. SSRIs, such as fluoxetine, sertraline, or fluvoxamine, are often prescribed for individuals with Harm OCD who may find relief from medication.
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