Harm OCD

What is harm OCD?

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.

Is harm OCD dangerous?

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.

Symptoms of harm OCD

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.

Examples of Harm OCD obsessions ^[2]

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]

• Fear of intentionally harming others irrespective of a person’s inclination to cause harm and the fact they find the idea disturbing and repugnant.
• Intrusive thoughts about accidentally harming others such as causing a pedestrian to lose their balance and fall in front of a moving vehicle or crashing a car you are driving into an unsuspecting person.
• Suicidal thoughts or other thoughts related to self-harm, despite the person having no actual desire to hurt themselves.
• Fixating on the idea, they could be blamed for accidentally causing harm to others despite having no reason to believe so. For example, unwittingly running someone over and being blamed for fleeing the scene.
• Worrying about losing control and acting on violent impulses, even though the person has never acted violently in the past and has no desire to do so. Examples include going berserk in public and assaulting people or opening the doors of an airplane.
• Fear of harming vulnerable people such as children or other dependents, even though the person cares for them and wishes them no harm.
• Unwanted sexual urges, such as raping or abusing children or other adults, despite having no desire to act on them.

Examples of Harm OCD compulsions

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

• Of people or pets that trigger harmful thoughts
• Of objects, such as knives or medication, that could cause harm.
• Of locations where harm could occur, such as window ledges or isolated areas.
• Of types of media, such as action movies, horror films, or news reports on violence.
• Of negative emotional states, such as anger

Mental Rituals

Engaging in mental acts to neutralize or counteract intrusive thoughts, such as:

• Superstitious rituals
• Compulsively praying to ensure no violence occurs.
• Playing out worst-case scenarios to review how you would handle them.
• Reciting phrases to ‘un-do’ perceived harm.
• Constantly reviewing past actions or events to ensure no harm has been caused or identify any potential harm that was missed.

Reassurance seeking

• Constantly checking with others whether you have done any harm.
• Excessively researching online about whether people have committed violence.
• Excessive self-reassurance
• Checking everything to ensure nothing could be causing harm, for example, checking that the oven is off compulsively.

What causes Harm OCD?

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:

• Family history of OCD
• Serotonin imbalance in the brain
• Brain structure
• Stressful or traumatic life events

Harm OCD treatment

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]

Exposure and response prevention (ERP)

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]

• In vivo exposure – Patients are exposed to actual objects, situations, or environments where unwanted violent obsessions may be triggered. These can include exposure to sharp objects or standing close to a window ledge. The objective of this exposure is to show your brain that you can overcome these obsessive thoughts while resisting learned compulsions.
• Imaginal exposure – Patients are encouraged to use their creativity to combat their harm OCD. Assignments may include writing stories describing your fears coming to pass and how you accept the consequences without performing compulsions.
• Interoceptive exposure – Harm OCD thoughts are associated with internal physical and emotional states of being that are more conducive to violent thoughts. Therapists will attempt to artificially coax patients into these states of being, such as anger or a state of heightened tension while encouraging them to resist performing compulsions.

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

• Gesturing at others with kitchen utensils while eating
• Sitting close to other people at home while holding a large knife
• Watching stabbing scenes in films

Thoughts of hitting people

• Walking down a crowded street and brushing up against others
• Gesturing towards others while standing near them
• Patting people firmly on the back

Thoughts of molesting others

• Reading about child molesters who have been apprehended
• Standing close to children in public
• Holding your own children and showing them familial affection

Thoughts of crashing into others with your car

• Driving down dark roads at night
• Driving in crowded streets
• Reading news articles about hit and runs

Your therapist will encourage you to accept these thoughts without performing compulsions. They may: ^[2]

• Advise you to always agree with the obsessive thought, never analyze or argue with it.
• Never seek reassurance.
• Expect to have an obsessive thoughts without judgement.
• Do not involve others in dealing with your obsessions – otherwise this may become a compulsive, anxiety-inducing behavior.

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

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]

Medication

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.