Harm OCD: Symptoms and Treatment – Part 1

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Harm OCD is a manifestation of Obsessive Compulsive Disorder (OCD) in which an individual experiences intrusive, unwanted, distressing thoughts of causing harm. These thoughts are perceived as being ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s values, beliefs and sense of self. Harming obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act.

It is not fair to say that one form of OCD causes more pain than another. In my experience of treating individuals with OCD, those with compulsive hand washing appear to be in no less pain than those who live in fear of being sexual deviants or psychopaths. What sets Harm OCD apart is the way in which it attacks the things we love the most, and does so with such brutality and lack of mercy as to astound even the most creative minds. The moments that we most want to be highlighted by memories of peace and contentment suddenly become contaminated by mental imagery of horrific violence and feelings of relentless guilt.

Common Obsessions in Harm OCD

The mind is a landscape. Being conscious means wandering (mostly aimlessly) around this landscape and encountering the wonderful, the terrible, and the mostly irrelevant. As owners of the mind, we are entitled to go anywhere we wish. In the case of Harm OCD, we find ourselves visiting places in the mind that we would rather do without. However, like any landscape, places we avoid become overrun with weeds, their growth intruding into the well-groomed, peaceful areas of the mental garden, and becoming a relentless burden.

In Harm OCD, as in all forms of OCD, individuals experience obsessions, and in response, perform various compulsive behaviors designed to relieve the discomfort associated with those obsessions. Here is a list of common intrusive thoughts associated with Harm OCD:

• I will suddenly snap and violently attack:
  • My significant other or ex
  • My child (especially common in Perinatal and Postpartum OCD)
  • My parent or other family member
  • My nephew/niece/godchild
  • A disabled or ill person
  • A baby
  • A friend
  • A stranger
• I will fail to respond to disgusting violent or sexual thoughts appropriately and will reveal myself to be a monster.
• I will suddenly have an uncontrollable urge to push someone into traffic, jump out a window, or experience some other impulse that will result in me being responsible for my death or someone else’s death.
• I will be overwhelmed by harming obsessions and have to act on them to relieve the pressure.
• I will lose consciousness somehow and commit violent acts that I do not remember.
• I will fail to wash or turn off something appropriately and I will be responsible for someone being horrible hurt or killed.
• I will accidentally poison someone.
• I will hit someone with my car and not know it until the police track me down.
• I will lose my sanity and commit suicide.

Common Compulsions in Harm OCD

Because the compulsions in Harm OCD often go unnoticed by others, it is generally considered to be a type of what is colloquially referred to as “Pure Obsessional OCD”, or “Pure O”.   But individuals with Harm OCD almost always exhibit various compulsions that fall into four categories – checking, avoidance, reassurance seeking, and mental rituals.  Here are some common compulsions typically seen in Harm OCD:

Checking

• Excessively looking in the rear-view mirror to make sure you did not strike someone with your car.
• Looking back at people you walk past or examining them for signs that they have may have been harmed by you.
• Checking your body for signs of a struggle or any indication that you have harmed yourself or someone else.
• Checking to make certain that no items which could be used for harm are visible. For example, locking up tools or placing knives out of reach.

Avoidance

• Avoidance of people that trigger the unwanted thoughts. For example, avoiding being left alone with your young relative for fear that you will hurt them, or avoiding taking a hike alone with your girlfriend.
• Avoidance of places that trigger the unwanted thoughts. For example, avoiding crowded bus stops where you fear you might push someone into traffic.
• Avoidance of items that trigger the unwanted thoughts. For example, staying away from sharp objects such as knives for fear that you might use them to harm someone.
• Avoidance of information that triggers unwanted thoughts. For example, avoiding watching or reading the news where you think you might possibly hear about murder, or avoiding movies or TV programs that you believe might have violent scenes in them.

Reassurance Seeking

• Asking others to confirm to you that they believe you would not do a horrible thing.
• Asking others to confirm that you did not hurt someone and somehow fail to remember it.
• Confessing unwanted thoughts in the hopes that their response will indicate they do not believe you are a dangerous or bad person.
• Repeatedly researching the difference between OCD and sociopathy.

Mental Rituals

• Mental review/mental checking. This is a form of self-reassurance seeking that involves reviewing thoughts and memories of events in an attempt to gain certainty that you have not harmed anyone. This also involves mentally reviewing various reasons why you would or would not commit a violent act.
• Compulsive flooding – Trying to force yourself to imagine violent acts in an attempt to prove that you are disgusted by them and would not do them.
• Thought neutralization – Purposefully forcing yourself to think a positive or otherwise contradictory thought in response to a harm thought.
• Compulsive prayer/magical rituals – Repeating prayers or mantras by rote in response to unwanted thoughts.
• Repeating behaviors – A combination of physical and mental compulsivity, this would typically involve repeatedly starting tasks over or extending them in an attempt to complete the task without having an unwanted “bad” thought.

Harm OCD might be experienced as an extension of a lifelong battle with the disorder, or it may develop spontaneously later in life. It is not uncommon for children with OCD to struggle with intrusive thoughts of causing harm to their parents, siblings, or peers, either through thoughts of literally attacking them or through the distorted belief that “bad” thoughts may cause bad health or bad luck to someone they care about.

Late onset Harm OCD can be particularly unsettling because without the context of understanding OCD and the various ways it can interfere in one’s life, it may appear that you have simply gone insane. It is not uncommon for someone who previously displayed little or no signs of OCD to suddenly become aware of a harm thought in the middle of some stressful experience, and to then find themselves engaging in compulsions all day trying to suppress thoughts of hurting someone they would never dream of hurting.

OCD sufferers may also discover violent obsessions appearing only after extended battles with other forms of OCD have run their course. Untreated, OCD naturally gravitates toward whatever is most likely to produce compulsive behavior. So when one obsession stops producing, another one often takes its place until treated. In fact, it is the intensity with which we experience love for our children, partners, relatives, etc. that makes them targets for OCD – they are the most likely to stir in us the greatest motivation to protect.

Self-Harm in OCD

Some individuals may also experience intrusive thoughts of self-harm, often brought about by imagining ways to escape anxiety, and then being terrified of what their brain came up with. It is important to note that fear of self-harm is an entirely different phenomenon from actual self-harm behaviors such as cutting. Similarly, the fear of committing suicide is a different issue than genuine suicidal ideation. Some with Harm OCD experience an obsessive fear of self-harm, often related to unwanted intrusive thoughts of losing control, while actual suicidal thinking has to do with the fantasy of ending one’s life. It is important to note that individuals with Harm OCD are at no higher risk of acting violently than the general population, and that having Harm OCD does not indicate that one is a danger to themselves or others.  That said, treatment providers should discuss these types of thoughts with their clients to clarify and determine issues of intent.

Treatment of Harm OCD

As with other forms of OCD, it is important that the sufferer seek treatment with a psychotherapist who specializes in Cognitive Behavioral Therapy (CBT) specifically for the treatment of OCD. The primary CBT technique used in treating Harm OCD is the same as that used in treating other types of OCD, and is called Exposure and Response Prevention (ERP). Unfortunately, many individuals with harming obsessions seek out traditional talk therapy or psychodynamic therapy, both of which can swiftly worsen a Harm OCD sufferer’s condition by encouraging them to further examine these meaningless thoughts, which only serves to unnecessarily inflate their importance.

In the next installment of this series, we will discuss in-depth the treatment of Harm OCD using Cognitive Behavioral Therapy. For now, if you are experiencing Harm OCD, remember that you are not alone, that your condition is very treatable, and above all, that you are not crazy.

To read part two in our series of articles on Harm OCD, click here.

•Jon Hershfield, MFT, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  Jon can be contacted at jon@ocdla.com.

Tags: Anxiety, Cognitive-Behavioral Therapy (CBT), Compulsions, harming obsessions, Health, Mental Health, Mindfulness, Obsessions, Obsessive-Compulsive Disorder (OCD), Pure O, Pure Obsessional OCD, Self-Harm Obsessions, violent thoughts

24 Comments to Harm OCD: Symptoms and Treatment – Part 1

1. 

   This is such a great article! I feel so more reassured about my OCD and can relate to nearly everything written here. I look forward to the next installment.
Andrew on February 22nd, 2012
2. 

   Thanks for the feedback, Andrew and I’m happy the article resonated with you! I’m working on section two (treatment for Harm OCD) right now and hopefully we’ll get it online soon.
Jon Hershfield, MFT on February 23rd, 2012
3. 

   Wonderful article! My son suffered from severe OCD, specifically harm obsessions, when he started college. You are so right about talk therapy exacerbating the problem, as this is exactly what happened to him. I also love your analogy of the mind to a landscape, with the avoided areas becoming overgrown with weeds.

   We are so thankful our son got the right treatment (ERP Therapy) and is now doing great. He is currently a senior in college, living life to the fullest. Thanks again for this informative post!
Janet Singer on February 25th, 2012
4. 

   Thank you for the comment, Janet! It’s unfortunate that so many people suffer needlessly when they reach out for help from those who do not know how to appropriately treat OCD. That’s fantastic that your son was able to get the right treatment and win his freedom back from OCD!
Jon Hershfield, MFT on February 26th, 2012
5. 

   What an informative article! Much of it resonated with me. I’ve suffered from OCD on and off throughout my life, but only recently being diagnosed and treated (I’m 31 years old and recently had a baby, which triggered an awful episode of harm OCD).

   I’m going to read your article re Perinatal/Postpartum OCD.

   Keep ‘em coming!
Tania on March 7th, 2012
6. 

   Thanks or the comment, Tania, very happy the article rang true for you. It’s extremely common for harm ocd to kick in around pregnancy as it is a perfect storm of hormonal changes, life-stage changes, stressors, and of course the arrival of something of such great value that ocd cannot resist targeting it. But like any other ocd, it is treatable with cbt and the hard work pays off.
Jon Hershfield, MFT on March 7th, 2012
7. 

   Thanks. Great article. I’ve been diagnosed with OCD for 15 years and BPD in the last 7 but i read some things here that really made me think and i’m gonna try to talk about this with my therapist. Thanks.
P.Nuts on March 7th, 2012
8. 

   Thank god! I thought I was insane! I keep going into trances where I think about killing people that I love.(I know its not real but it feels so real) I have had OCD symptons since 3rd grade, but this was over the top. My thoughts are mainly me putting people through torture, killing them, and then eating them or piling up bodies. Its making my life hell.

   I don’t know if this ties in with it but ever since 5th grade I have believed that whenever I miss anything on a test I hurt someone and this grew to thoughts of killing in 7th grade. But, its gotten so much worse this 8th grade year, its so horrid. This is a great article thank you for writing it! But,do you know how I could get rid of these thoughts!
Christina on March 13th, 2012
9. 

   Christina, thanks for your comment and I’m glad you connected with the article.

   The fear that a minor mistake (such as missing an answer on a test) will result in someone being hurt or your harm thoughts coming true is a common experience in this kind of OCD. When you’re uncomfortable, your OCD starts promoting what we call “magical thinking” and you end up feeling compelled to address the thoughts instead of whatever else is going on (like the test!).

   You ask how to get rid of the thoughts and the answer is to stop trying to get rid of them and start working on viewing them as thoughts, not threats. This can be learned with Cognitive Behavioral Therapy (CBT). You can learn more about treatment for OCD using CBT at http://www.ocdla.com/cognitivebehavioraltherapy.html

   If you’re in California, you could ask your parents about doing online treatment at OCDLA or perhaps they could find you a local OCD specialist who does CBT. Getting a handle on the OCD before high school would be very wise if you can access appropriate treatment.
Jon Hershfield, MFT on March 14th, 2012
10. 

    Thank you for this informative article. I’ve suffered with OCD and differing themes since the 8th grade. After accidentally causing a minor injury to my first child, the harm OCD reared it’s ugly head. Two weeks after my son was born the theme switched to self harm. He is almost 3 and it’s a daily battle. I know these thought make no sense because of my strong religious values and how much I love my family. I am hoping that others who fight this battle might find this page and find a little bit of peace.
Taylor on March 14th, 2012
11. 

    Taylor,

    Thanks for the comment! You mention that part of what helps you understand that the unwanted thoughts are senseless is that they don’t coincide with your morals and religious beliefs. This is what the term “ego-dystonic” means. I would take it even further to point out that the reason why your ocd focuses on these types of thoughts is specifically because they represent the opposite of what you hold so dear.

    One way of understanding unwanted thoughts in ocd is to note that our understanding of a thought requires an understanding of its opposite. I know something is dark because I know what “light” means. For most, this understanding of the opposite is not paid attention to and goes unnoticed. For ocd sufferers, this awareness of the opposite is intensified, which leads to compulsive attempts to analyze or suppress it. Therefore treatment necessarily involves acceptance of the awareness of the thoughts without doing compulsions.
Jon Hershfield, MFT on March 15th, 2012
12. 

    P.nuts,

    Thanks for your comment and I’m happy to hear you picked up some new ideas for treatment by reading this article. If your therapist is knowledgeable about treating ocd, the two of you could work together on establishing a treatment plan that can help you overcome these harm fears.
Jon Hershfield, MFT on March 15th, 2012
13. 

    Have been struggling with postpartum OCD The guilt I feel is overwhelming . OCD has made doubt who I am as a person , wife and mom. I had OCD thoughts in the past but never like this until the birth of my child . I think it’s so hard because the trigger for harm thoughts is the stress of being a mom . I ruminate 24/7 How do others cope with this after having a baby
Mo on March 19th, 2012
14. 

    Hi Mo,

    Post-partum ocd is very common, particularly with Harm OCD. It’s a combination of hormonal changes exacerbating the ocd and the sudden presence of the most important thing to you in the world (and thus the biggest target for ocd). Plus the sleep deprivation doesn’t help.

    Guilt is a common response to these types of ocd symptoms, but I would encourage you to consider that “guilt” is a word you are using to describe a kind of discomfort. OCD’s objective is to get you to do compulsions and it does this manipulation by presenting you not only with uncomfortable thoughts, but also uncomfortable feelings. Instead of responding to this feeling of “guilt” by trying to absolve yourself, try responding to it as something just as meaningless as the harm thoughts themselves.

    As with other avenues for harm ocd, post-partum ocd is best treated with cognitive behavioral therapy from an ocd specialist.
Jon Hershfield, MFT on March 24th, 2012
15. 

    I have recently started having these thoughts after a couple traumatic events happened to me. I find myself thinking about them all day 24/7. I’m currently unemployed which doesn’t help. I feel like a monster. I think up scenarios in my head where I go crazy and act on these thoughts. It is making me extremely depressed. I also had fears that I was developing schizophrenia, and after I didnt hear voices or see things it moved onto this. I have urges when I am driving to drive through red lights and stuff, I would never do it but the feelings are disturbing.

    I can relate to the feeling that “I will suddenly lose control and do these things” and now the new one that “I will feel relief if i just do it” I feel like that constantly and have not gotten out of bed in 3 days because of it. I was never like this in my whole life until i had a nervous breakdown a few months ago.
Amanda on April 12th, 2012
16. 

    Thanks Jon. This article was great at reafirming what i hadnt heard for a long time, and giving me peace of mind. your the best!!!!!
Michelle Cory on April 30th, 2012
17. 

    Amanda, sorry for the delayed response, just getting caught up here. Sounds like you have many clear symptoms of Harm OCD. The “urges” to do things like run lights or other impulsive acts often comes from over-attending to thoughts about what would happen if you lost control of yourself. Also, thoughts of being or becoming schizophrenic are common in this form of ocd. They both have to do with over-attending to the issue of control and compulsively trying to prove that you would never lose it.

    You’re absolutely right that being unemployed, or having unstructured time, does not help the matter. Without things that keep you engaged, it can be even more difficult to resist the mental review and analysis that fuels this obsession. I would look for ways to make your time more structured, scheduling activities in your day, perhaps volunteering. It can then be easier to talk back to the ocd, saying, “I don’t have time to address this thought right now.”

    You did not mention if you are getting treatment or what kind, so I would strongly recommend seeking out an ocd specialist who does cognitive behavioral therapy if you haven’t already. Feel free to email me if you need help locating treatment options.
Jon Hershfield, MFT on May 1st, 2012
18. 

    Thanks for the feedback, Michelle! Keep standing up to your ocd!
Jon Hershfield, MFT on May 1st, 2012
19. 

    this is a excellent and informative article.thank you for this information. I would also like to know with this type of ocd do people tend to develop false memories? Like when mentally reviewing a situation after it has occurred?
alexis on May 10th, 2012
20. 

    Hi Alexis, thanks for your comment and great question! I think the term “false memories” is tossed around a lot in the psychodynamic community, but has a somewhat different meaning when applied to the treatment of ocd. The more you review something, the more distorted it becomes. This is not only true of obsessions, but of anything. If I review the word “purple” over and over enough, it will eventually start appearing unclear to me what “purple” even means and whether my understanding of the color is accurate or whether I was really thinking of blue the whole time.

    So in the case of Harm OCD, it is very common for someone to have an intrusive thought about harm, and then review it to such an extent that they start feeling as if the images in their head are really memories. This is especially common in hit-and-run types of harm ocd, where the sufferer has mentally checked their memory so much, they start finding thoughts that feel like memories of car accidents, etc.

    Short answer: yes. But I think a better way of describing “false memories” is as over-valued ideas distorted by compulsive mental review.
Jon Hershfield, MFT on May 11th, 2012
21. 

    Hi I have had pure o for about 8 years now, it comes and goes and changes forms from harm to relationship OCD, it gets me really down at times and the article on self harm had given me tremendous relief as I was thinking I was cracking up and going do something to my self, how do you no it is OCD and is it common to change from one form to another like it has with Rocd to hocd, I love my wife and kids more than anything and I never want to leave them but can’t stop the thoughts
Brett on May 12th, 2012
22. 

    Hi Brett, I think the most important thing to understand about ocd is that attempts to control what thoughts you have function as fuel for your disorder. You cannot control your thoughts. Thoughts are just what your brain presents to you. Your job is to choose behavioral responses to those thoughts that reflect your personal values.

    If you want to feel like you are not a danger to others, then you need to behave as if thoughts and feelings about this danger are not important. If you avoid things that trigger harm thoughts, you are only telling your brain that you believe you are at high risk of causing harm. If instead you accept that harm thoughts may happen and don’t make efforts to shut them down, this is the behavior of a person who believes themselves to be at low risk of causing harm.

    Yes, it is very common for ocd to switch themes, generally in the direction of wherever you are doing the most compulsions. It’s important to recognize that the term “pure o” is a label meant only to identify that you are doing more covert or mental rituals than physical ones.
Jon Hershfield, MFT on May 12th, 2012
23. 

    I’m glad I found this, during my second pregnancy I was dreaming that I was abusing my first child, I have had OCD since I can remember, but never been told about hurt OCD, I was so disgusted with myself but now I know it’s part of the OCD. thank you
Lisa on May 17th, 2012
24. 

    Lisa, thanks for your comment and I’m happy the article touched home for you. It’s really unfortunate that so many women struggle with this form of ocd during or after pregnancy, and even more unfortunate that they so rarely are informed that it’s ocd and that there is treatment for it. Recognizing that it’s not a personality flaw or some moral issue, but a treatable disorder is so important.
Jon Hershfield, MFT on May 17th, 2012

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