OCD Center of Los Angeles California
OCD Center of Los Angeles

Harm OCD Treatment With ERP

Tuesday, July 23rd, 2013 Obsessive-Compulsive Disorder (OCD)

    

A discussion of Harm OCD and its treatment using Exposure and Response Prevention (ERP).  Part four of a series.

Harm OCD treatment

Exposure and Response Prevention (ERP) is the key component to effective treatment for Harm OCD.

In our three previous articles in this series, we discussed the primary symptoms of Harm OCD, along with how one can use mindfulness and cognitive therapy to address unwanted harming thoughts.  In this installment, we focus on directly challenging the behaviors associated with Harm OCD by using Exposure and Response Prevention (ERP).

What is Exposure and Response Prevention

The primary behavioral therapy tool used when dealing with Harm OCD is called Exposure and Response Prevention (ERP).   While cognitive therapy challenges the content of our intrusive thoughts, and mindfulness addresses our perspective towards those thoughts, ERP directly confronts the behaviors done in response to those thoughts While mindfulness and cognitive therapy set the table, ERP is the main course.  This is where the real work gets done.

The basic thesis of ERP is that by gradually facing your fears, you will become used to them and hence less afraid of them.  In clinical terms this is called habituation or desensitization.  In other words, if you face your fears, they will cease to be so scary.

Treating Harm OCD with ERP is quite similar to how one uses exposure therapy to treat a phobia.  For example, if a young girl is afraid of the swimming pool, she can usually be helped in overcoming this irrational Harm OCD testfear by gradually exposing her to swimming in the pool.  At first, you may want to have her merely look at the pool.  When she becomes less afraid of being near the pool, you might then have her dip her toes in the pool.  Then you would introduce her to wading in the shallow end of the pool, and eventually to the deeper parts of the pool.  Gradually, over time, you work up to the point where she feels so comfortable in the pool that she can do back flips off the high dive!

Now, anyone with Harm OCD who is reading this is likely to be thinking “That sounds great for someone with a swimming phobia, but I am afraid of killing people.  I don’t do any compulsions and there is no way for me to expose myself to killing people!”

If that sounds like you, it is important to know that you are almost certainly doing compulsions related to your harm thoughts, and that once you identify those compulsions, you can do exposures that will help you to stop doing them.

Compulsions in Harm OCD

Harm OCD is generally considered a type of Pure Obsessional OCD (Pure O).  The basic thesis of Pure O is that some people with OCD experience obsessions without doing observable compulsions.  But this idea is extraordinarily misleading.  I have been treating OCD for nearly 20 years, and have yet to meet anyone with any type of OCD, including Harm OCD, who doesn’t do compulsions.  Simply put, people say they aren’t doing compulsions, but they are.  This misunderstanding is to a great extent a function of how people define the term “compulsion”.  Some people think of compulsions in OCD as being limited to only the most obvious physical behaviors, such as hand washing and door checking.  But there are many different ways of doing compulsions, which can be loosely categorized into four types:

  • overt compulsions
  • avoidant compulsions
  • reassurance-seeking compulsions
  • mental compulsions

A brief description of each of these will help to clarify how those with Harm OCD perform compulsions.

Overt compulsions are obvious physical behaviors done in an effort to reduce anxiety related to an unwanted thought.  In Harm OCD, this might include any of the following common overt behavioral compulsions:

  • Compulsively washing hands after exposure to insecticide for fear of accidentally killing your child.
  • Throwing away your sharp knives for fear of stabbing your spouse.
  • Repeatedly driving around the block to ensure that you haven’t killed a pedestrian.

Avoidant compulsions are behaviors you avoid in an effort to reduce anxiety related to unwanted thoughts.  Some common avoidant behaviors seen in Harm OCD include:

  • Not driving for fear of running someone over.
  • Not eating with your family because you want to avoid thoughts of killing them.
  • Not watching certain TV shows or movies with strong violence such as The Sopranos, Dexter, or movies like Saw or Hostel.

Reassurance-seeking compulsions are any attempt to relieve your anxiety by searching for information that will provide you with reassurance that you did not (or will not) cause harm.  Some examples of reassurance-seeking compulsions in Harm OCD are:

  • Repeatedly asking your parents whether you poisoned the neighbor’s dog.
  • Going online to check if any accidents have been reported in the area you where you were driving earlier today.
  • Discussing a bloody murder with friends in an effort to see if anyone suggests that you may have had a role in it.

Mental compulsions are the most misunderstood of the four compulsive categories.  In fact, clients often ask what the difference is between an obsession and a mental compulsion.  An obsession is an unwanted thought that comes into your mind unbidden, while a mental compulsion is any active mental effort put into resolving that thought.  Put another way, an obsession is the  “what if…” question that your mind produces, while a mental compulsion is a volitional internal attempt to answer or silence that question.  It is any attempt to prove or disprove the validity or accuracy of the “what if…” thought.  Some examples of mental compulsions seen in Harm OCD include:

  • Mentally reviewing your entire drive home from work in an effort to prove to yourself that you didn’t run anyone over.
  • Consciously trying to think “good” thoughts, either preemptively or in response to an unwanted thought such as a thought of stabbing your wife.
  • Saying prayers in a ritualized manner to make sure that your mother doesn’t die in a plane crash.

All of these various behaviors are compulsions.  Simply put, a compulsion is any repetitive behavior (mental or physical) that one does in a conscious effort to reduce, eliminate or control the feeling state of distress they experience when faced with an obsession.  Regardless of which type of compulsion one does, the process is the same – an unwanted harming thought leads the sufferer to take action in order to relieve their distress.

ERP For Harm OCD

When clients tell us that there is no possible way for them to do ERP for harm thoughts, it is usually because they have read just enough about Cognitive Behavioral Therapy (CBT) to get the wrong impression of what an “exposure” is.  If by “exposure” you mean that you must kill somebody for therapy to be effective, then no, you obviously can’t do ERP for Harm OCD.  When clients bring this concern to us, we immediately clarify three basic ground rules of exposure therapy:

  1. We won’t ask you to do anything we wouldn’t do ourselves.
  2. We won’t ask you to do anything illegal, immoral, or dangerous.
  3. We will never force you do anything.

Unfortunately, some people have the idea that ERP involves bizarre exposures to things that nobody in their right mind would do.  This is usually because they have seen talk shows and reality TV programs in which ERP has been twisted to the dictates of TV producers who want to make ERP look exotic and over-the-top.  That might make for good television, but it makes for terrible therapy.

Conversely, our approach at the OCD Center of Los Angeles is to do exposures based on the client’s actual, real life obsessions and compulsions.  With that as a guiding principle, there are plenty of ways to implement ERP without actually doing harm to anyone or anything.  In fact, most of the exposures we do with clients who have Harm OCD involve mundane activities that people without OCD do every day.  For example:

  • If someone can’t drive because of their fear of hitting a pedestrian, we will do therapy sessions in a car with the client driving.
  • If a mom must wash her hands compulsively before preparing food for her children for fear of poisoning them, we will have her prepare meals for her kids without compulsively washing.
  • If a man can’t hug his children for fear of strangling them, we will assign him to regularly and consistently hug his children.
  • If a child repeatedly asks his parents for reassurance that he did not harm any of his peers with his science project, we will help the child to learn how to better tolerate their anxiety without asking for reassurance.

In each of these cases, the individual has harming obsessions and compulsions that can be addressed by Exposure and Response Prevention.  The actual process of doing ERP is fairly straightforward.  The client and therapist create a list of the client’s compulsive behaviors.  That list is then rank-ordered starting with the least Mindfulness Workbook for OCDanxiety provoking behavior.  This list, called a hierarchy, is then used throughout the course of treatment to gradually challenge all of the client’s OCD behaviors.

The key word here is “gradually”.  Many times, clients call us because their OCD has gotten so overwhelming that they are incapacitated.  They are at the end of their rope, they want relief, and they want it now!  While this is understandable, the process takes a certain amount of time, mostly because anxiety doesn’t go away just because we face it once.

Early in treatment, we may have a client do exposures to seemingly simple things such as writing the word “killer” on a piece of paper and carrying it around with them in their wallet.  This may seem ridiculously easy to someone without Harm OCD, but to someone who fears that they may secretly be a serial killer, this assignment can be terrifying.

Over time, we gradually have clients with Harm OCD expose themselves to stimuli that are more anxiety-provoking. For example, we may show them crime scene photos or have them read certain news articles about murders or people being killed by hit and run drivers.  These sorts of exposures are particularly helpful for those who compulsively avoid exposure to the news media for fear that their harm thoughts will be triggered.  We frequently ask clients with with Harm OCD to watch a TV show or movie that has scenes of violence that trigger anxiety for them.  When a client identifies a particular scene that significantly exacerbates their anxiety, we will assign them to watch that scene repeatedly, until such time that it becomes tedious to them.

For clients with stabbing obsessions, I may ask that they hold a butcher knife or an open pair of scissors to my throat.  At first glance, this may seem insane to clients with Harm OCD (and to readers without it).  After all, why would anyone ask a person with thoughts of stabbing people to hold a sharp knife to their throat?  And doesn’t this violate the principle of not doing anything dangerous?  Well, the simple truth is that I don’t ask clients to do this until we have spent enough time together that I am confident the client is not a genuine risk of stabbing me.  I can usually tell within minutes of meeting a new client whether that person has Harm OCD, and thus, whether they pose an actual threat of killing someone.  In point of fact, clients with Harm OCD are so horrified by the idea of committing some sort of violent atrocity that I can safely safe they are less likely to purposely harm someone than just about anyone I’ve ever met.

Mindfulness Workshop in Los Angeles ideal for Harm OCDIt should be noted that clients with Harm OCD often need to face particularly scary fears repeatedly in order to see a significant reduction in their anxiety levels.  Conversely, if an individual with Harm OCD feels that they are being pushed too fast or too hard, they are likely to feel overwhelmed and to abandon treatment.  So moving at a pace that doesn’t result in too much anxiety is critical.

It is also important to stress here that there are two parts to ERP – the exposure and the response prevention.  If you do exposures, but then follow them with compulsive behaviors, you are unlikely to see much, if any, improvement.  In fact, this can actually be worse than doing no exposures at all!  When you do exposures, but then respond to the inevitable anxiety they produce by doing compulsions, you reinforce in your mind that you are not up to the challenge of ERP – that your OCD is bigger than you and stronger than you, and that you have no choice but to capitulate ad infinitum.  The goal is graduated exposure, in which you allow yourself to develop your capacity to tolerate anxiety by preventing yourself from doing your customary compulsive response.   Think of it as exercising you anxiety-tolerance muscle.

Also, keep in mind that obsessions tend to change – to morph.  As Phil Jackson said, “problems never cease, they just change.”  And as your obsessions and compulsions change, you will need to adapt in kind.  Today’s thought about killing a stranger may turn into next month’s thought about killing your newborn child.  This is not unusual for Harm OCD – it is the norm.  When change happens, your goal is to change with it.  Once you have learned to challenge a specific Harm OCD symptom, you can generalize that to all Harm OCD symptoms.  So, when you get blindsided by a new, unexpected obsession or compulsion (and you will), use the ERP tools that have worked previously for you to challenge that new symptom.

Imaginal Exposure

With Harm OCD, there are times when it is beneficial to do exposures specifically for an obsession (as opposed to a compulsion).  For this purpose, we utilize what are known as imaginal exposures.   Our next installment of this series will focus on the use of imaginal exposure for the treatment of Harm OCD.

To take our free confidential online test for Harm OCD, click here.

To read part one in our series on Harm OCD, click here.

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

To read part three in our series on Harm OCD, click here.

•Tom Corboy, MFT is the founder and executive director of 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 anxiety based conditions.  In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.

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68 Comments to Harm OCD Treatment With ERP

  1. Fantastic article

    I have suffered with harm OCD for many years, it morphed from General anxiety about my health into harm OCD. The thought of holding a sharp knife or open pair of scissors to someone’s throat scares the living day lights out of me! I sometimes sit on my hands while having dinner with family – I long for the day when ocd doesn’t ruin happy occasions.

    Thank you for this article, it has helped a lot.

  2. Marion on July 24th, 2013
  3. This is one of the best articles I’ve read about treating harm OCD with ERP. It’s easy to understand and addresses a lot of common misconceptions about Pure O as well as ERP Therapy. Keep up the great work! I plan on sharing this post with my readers as well.Looking forward to the next installment on Imaginal Exposure.

  4. Janet Singer (ocdtalk) on July 24th, 2013
  5. Hi Marion,

    Your experience of symptoms morphing is extremely common. In fact, health anxiety is very common in those who have various types of “Pure O” such as Harm OCD and HOCD. Part of your recovery will be to accept this natural shift, and in fact, to be prepared for it. Just keep in mind that you can challenge any new symptom with the same ERP tools that have previously helped you with another symptom.

    I certainly understand that you would be terrified to hold a knife to someone’s throat as part of treatment. That is the first response of pretty much every client to whom we suggest this as an exposure. But your discomfort with the idea is further evidence that you are not a person who would stab someone. If you were actually a sociopathic killer, the idea of stabbing someone wouldn’t bother you!

    Take care.

  6. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 24th, 2013
  7. Hi Janet,

    Thanks so much for your comments. We always appreciate hearing that our articles are helpful. And thanks in advance for sharing the article with your readers as well. Take care.

  8. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 24th, 2013
  9. Hello,

    I have harm OCD-I am scared I will say or yell racist or sexist comments at people. I never have, but for some reason, the thoughts come to my head, and I’m always scared they will come bubbling up. For several years, I was seeing a therapist who was not an OCD expert, who made me feel more guilty about the thoughts. Last year, I switched to an OCD expert, and slowly I am getting my life back.

  10. fal on July 27th, 2013
  11. Hi Fal,

    Thank you for your comment.

    Obsessions about the possibility of yelling racist or sexist comments are actually quite common in OCD. While some would not conceptualize this type of fear as Harm OCD, I think you are right to do so. In my experience, people with this fear are concerned that such inappropriate comments would be hurtful to the person on the receiving end.

    I am not surprised that your prior therapist was unable to help you, as most therapists are clueless about Harm OCD (and OCD in general). It’s good to know that you have found an OCD specialist. Keep up the good work.

  12. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 27th, 2013
  13. Thanks Tom.

  14. Marion on July 28th, 2013
  15. URGENT :i desperately need guidance to help my young 21 yr old child who’s suffering from what seems to be ‘harm ocd’ symptoms. i am petrified of losing her. shes been a brialliant child academically and otherwise, a source of immense happiness and pride to the entire family. But am taking her to a psychiatrist for the last 5 months but nothing of what i have read in your four-part series has been mentioned by him. where as i FIND ALL OF WHAT U HAV MENTIONED SO true and so USEFUL and so relevant. she has obsessive thoughts of harming herself and an irrational fear of being left alone at any point .scared to hole knives/sharp object.

    she has her ENTIRE FUTURE ahead and i worry whether she will be able to manage – i DONT KNOW HOW TO DEAL with her problems OR CURE her of it,
    PLEASE HELP….

  16. Mrs.r.s on August 2nd, 2013
  17. Mrs. RS,

    Thank you for your email.

    While I cannot provide a diagnosis via a blog comment, I can say that the symptoms you describe being experienced by your daughter sound very much like Harm OCD. Unfortunately, you are running into a problem that is experienced by many people with OCD – namely that most psychiatrists and therapists know almost nothing about OCD and its proper treatment.

    I strongly encourage you to find a psychotherapist who specializes in treating OCD with a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP). This approach to treatment has repeatedly and consistently been found by researchers to be the most effective treatment for all types of OCD. As you indicate that you live in India, you may have difficulty finding such a specialist. The best resource in India is the OCD clinic at NIMHANS in Bangalore. Click here to visit their website. If traveling to the US is an option for treatment, please feel free to contact us via our website. Take care.

  18. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 4th, 2013
  19. Great article! I don’t have harm OCD myself, but I enjoy reading up on these things just in case… Also, will you be writing articles on treatments for other types of OCD? Because I’m pretty sure I do have a different kind..

  20. Hannah Pierce on August 18th, 2013
  21. Thanks so much for this article – it was very informative, and gives me hope for my own situation. I have intrusive thoughts related to being a terrible parent, and worry that I may be something horrendous like a paedophile. My ocd has taken many forms over the years from worry about health, to my relationship, to now intrusive thoughts about my children. It’s truly hell in earth and I feel that it may ruin my life. Does ERP work for these types of thoughts and how do you possibly treat this using this technique?
    Thanks for your advice!

  22. Lyndsey on August 19th, 2013
  23. Hi Hannah,

    Thanks so much for your comment and your kind words. We love hearing that our articles are helpful. And yes, we will be writing many more articles about OCD and its numerous permutations. We have already written over 65 articles that you can read on our blog at http://www.ocdla.com/blog/ . You can also visit our website at http://www.ocdla.com, which has another 30 or so pages about OCD, related conditions, and evidence-based treatment.

  24. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 21st, 2013
  25. Hi Lyndsey,

    Thank you for your comment. I am glad you found it helpful.

    First, it is worth noting that it is extremely common for those with OCD to experience their obsessions changing over time, just as your obsessions have morphed from health to your relationship to harm and now to pedophilia.

    Second, rest assured that there absolutely is hope for your situation. Harm OCD and Pedophile OCD are both very common manifestations of this condition, and both respond quite well to ERP. Simply put, the principles of ERP are the same, regardless of the specific type of OCD being experienced. I encourage you to seek out a treatment provider who specializes in ERP for OCD. If you would like to discuss online tretment with one of our staff therapists, you can reach us here. Take care.

  26. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 21st, 2013
  27. Can harm ocd make you think that you may actually want to harm someone even though you don’t. I have never hurt a thing in my life and i w ould rather die than hurt anything but I feel like the ocd is tricking me

  28. rachael on September 20th, 2013
  29. Thank you for this series. I have recently been “flung” into a very bad state of harm OCD after a very dramatically bad reaction to a medication. When I was younger I feared that having thoughts about my family getting into car accidents or somehow getting hurt meant that I wanted them to die secretly, and that because I thought about it, it would surely happen. Those thoughts never involved ME hurting them myself though, so they never sent up red flags. However, after my reaction to the meds, I felt like my ONLY thoughts were of me hurting my family, myself, my pets… not knowing what it was, I ended up in the ER because I feared I could not control myself. That was about a month ago, and through reading things like this I better understand what I am going through.

    My biggest fear now is that I have become calm while having the thoughts, so I am afraid I am getting used to them and therefore closer to making them happen. I worry because I now feel very disconnected from my family who, up until a month ago when this happened, were my very best friends. It is a horrible feeling. I feel that since I am so removed from the feelings I used to feel for them, I may somehow find it easier to harm them in the awful ways my mind projects it happening. I believe I am showing some of the common signs of depression and I think that is adding to the issue.

  30. Kali on September 26th, 2013
  31. Hi Rachael,

    Yes, OCD can lead one to believe they actually want to harm someone. That is one of the defining symptoms of Harm OCD.

  32. Tom Corboy, MFT ~ OCD Center of Los Angeles on September 30th, 2013
  33. Hi Kali,

    Thank you for your comments.

    As with many people with Harm OCD, you are experiencing numerous cognitive distortions. In your case, the two most noteworthy appear to be the following:

    1) Your fear of causing bad things to happen because of your thoughts is an example of “Thought-Action Fusion”. For those with Harm OCD, this is a fairly common cognitive distortion in which one believes that an event is likely to occur because they thought it, and that they will actually cause that event to occur. But our brains are not that powerful. Just because we think something does not mean it will occur, and it certainly doesn’t mean that we can cause it to occur. You can read more about Thought-Action Fusion here.

    2) Your fear that, because you have become more calm while having the thoughts, then you must be getting used to the thoughts and are actually closer to making them happen is called a “back-door spike”. This is an extremely common thought process in those with sexual obsessions and harming obsessions. A back-door spike occurs when a person becomes less anxious about an unwanted thought, and then obsesses that their reduced anxiety is evidence that they are like to do the very thing that previously terrified them. Basically, the thinking is “if I’m not as worried as I used to be about this horrible thought, that must mean I am actually more comfortable with the idea, and thus more likely to do it”.

    Though-Action Fusion and back-door spikes are complex cognitive distortions that involve lots of over-attending to, and over-valuing of, otherwsise mundane thoughts. I encourage you to seek a therapist who specializes in Mindfulness Based Cognitive Behavioral Therapy. This should help you not just with your Harm OCD, but with your depression as well. Take care.

  34. Tom Corboy, MFT ~ OCD Center of Los Angeles on September 30th, 2013
  35. My ocd starts last 2 months ago but it leads to harm ocd. Can harm ocd be cure without medication. I don’t want to take medication.

  36. Phyo on October 21st, 2013
  37. Hi Phyo,

    Thank you for your comments.

    It is important to realize that “Harm OCD” is just a slang term for a specific set of thoughts commonly seen in OCD. So your OCD didn’t lead to Harm OCD, because Harm OCD is just OCD.

    It is equally important to recognize and accept that there is no “cure” for OCD. But there is no need for a “cure”, as OCD is at its core nothing more than over-attending to unwanted thoughts. The goal of treatment is not to “cure” OCD, but rather to manage these unwanted thoughts, primarily by stopping the unnecessary compulsive behaviors that reinforce and exacerbate these thoughts. I strongly encourge you seek treatment with a therapist who specializes in Cognitive Behavioral Therapy for OCD, with a strong focus on Exposure and Response Prevention (ERP).

  38. Tom Corboy, MFT ~ OCD Center of Los Angeles on October 21st, 2013
  39. The past couple of days I’ve been having recurring violent thoughts about harming people around me. Which obviously led me to compulsively check the internet for symptoms… I was convinced I was becoming a sociopath/schizophrenic. Got to point where i would analyze a thought where I was thinking : ”Is this how a sociopath would think? Maybe i want to do these things?” Then I started fearing thoughts you see in movies where someones mind is saying ”Do it!” so it would pop in my head and i would instantly have my stomach churn and avoid all knifes etc. I even fear my own anger now so let’s say I’m having a silly argument with someone i instantly get scared that i will snap and get violent. I fear hearing “do it” voices in my head and listening to them..to the point where these two words flash in my head…

  40. Marcus on November 4th, 2013
  41. Hi Marcus,

    Everything in your comments suggests that you are experiencing Harm OCD. Note that you have been having these thoughts, analyzing these thoughts, fearing these thoughts, and responding to these thoughts with avoidance behaviors. Yet, you have never actually acted on these thoughts. Sociopaths don’t analyze and fear their sociopathic thinking. They think their thoughts are just fine.

    I encourage you tot take our free, confidential, online test for Harm OCD at http://www.ocdla.com/harm-ocd-test.html. And if these thoughts continue to bother you, I encourage you to seek treatment with a therapist who specializes in Cognitive Behavioral Therapy (CBT) for OCD.

  42. Tom Corboy, MFT ~ OCD Center of Los Angeles on November 12th, 2013
  43. I don’t know whether or not I have Harm OCD or not. I have the violent thoughts, and I really, really dislike them and don’t want to act on them because I know it’s wrong. But I don’t have regular panic attacks over the thoughts like most people do-usually I clench my fist and try to convince myself that I wouldn’t do such a thing, but I don’t have a panic attack. Yesterday I cried a little bit over it, but I was in a really emotional mood anyway. If I don’t have the panic attacks, and don’t feel much at all about the thoughts other than I know that they’re wrong, is it still Harm OCD? I have panic attacks about pretty much everything else, but not the thoughts…
    I am really, really ashamed of this, but about a year ago now,one night I had thoughts of killing my little cousin, and of luring her upstairs and then stabbing her. I really didn’t want to do it, but I was afraid I would, because at that time she was really annoying me. I can’t remember what I did then, but I didn’t have a panic attack. Then I forgot about it, and then one night about two months ago, my little cousin was coming round the next day so we could go somewhere together. I suddenly remembered having that really detailed thought last year, and I still didn’t have a panic attack. Instead I went upstairs and picked at my skin for ages, telling myself that if I drew blood, nothing bad would happen. I didn’t draw blood, but one of my cuts got infected. I panicked more about that than I did about maybe killing my little cousin.
    I really, really don’t want to hurt anybody.

  44. RU on November 21st, 2013
  45. Thank you so very much for this thoughtful series of articles on Harm OCD. Frankly, I’ve just stumbled upon this term tonight and I can’t even express the relief I am feeling knowing that I’m not crazy, lol. I’m not to far from L.A., so I might actually call to see if you have time in your schedule. In my case – I’ve never had these thoughts up until this year (in my 40s) – I started smoking pot earlier this year and started to get them…which is a real bummer as I believe MJ has many useful benefits, just apparently not for me. I stopped smoking MJ and it decreased significantly. Over the summer, I realized I was depressed and started on Wellbutrin. I noticed a very sharp uptake in these thoughts – and the distress of having them and not understanding what any of this all meant is truly terrifying. I stopped the Wellbutrin (doctor put me on Lamictal – last 6 weeks have been great, but sadly today I realized I’m getting “the rash” – and I’m sure I’ll be pulled from the drug immediately…the rash is not something you play around with)… so I’m slightly apprehensive about that. Anyway, I am curious if you had any insight into drugs like MJ, or Wellbutrin exacerbating these issues? As a side note, I’ve had some tremendous stressors put on my in the last couple of years, very serious ones that have spiked my anxiety – so it makes sense to me that my brain is trying to cope with those feelings/thoughts in a different way as a way of escaping that pain, but throwin myself into a new type of pain. Anyway, I know this isn’t a therapy session, haha, but was curious if you had any thoughts regarding the above. And again, thank you so very, very much. I will follow up with my own therapist who is a CBT and frankly, I’m sort of disturbed he has not recognized it as this…warm regards, NS.

  46. NS on November 22nd, 2013
  47. I’ve had harm OCD for over 20 years and my current obsession is of the thought of wanting to harm my mother.
    I sometimes get a sharp strange excitement feeling the moment I remember the intrusive thought before any actual intrusive visualizing. I don’t know what this feeling is. I am so worried that if I posted this on a forum someone would say I don’t have ocd and I have a deep down desire of wanting to hurt her. If I had to guess what that sharp strange excitement emotion really is, i would say either a form of anxiety that I’m misinterpreting or a subconscious relief thought of “I know this is just OCD”. But I just simply can’t convince myself this. It feels too much like excitement and It scares me to death. I ritualize and ruminate over and over this feeling and I’ve read nowhere online of anyone else with this problem and that scares me even more (it’s always about OCD unwanted thoughts not unwanted feelings).

    I also woke up today angry at my mother for wanting me out of bed. For wanting me to go out with her today and not letting me be alone to do my own thing. I was worried I was going to get more intrusive feelings around her. I was angry at her. I also felt angry at her for in-directly making me worry about wanting to harm her. I was blaming her and that thought itself quickly turned to more guilt and anxiety. So before spending the day with her, I decided to do some Imaginal Exposure therapy to myself by visualizing harming her. As i visualized stabbing her with a knife I felt calm and no emotion. This turned to mild anxiety (for feeling calm, not for the visualization). So then I visualized a second time exactly the same thing only this time I actually felt a bit of anger while visually stabbing her to death. I knew that instant, I was done for. That’s it. That’s the proof I’ve needed all along. I am now plagued constantly with anxiety from this one feeling I had. Why did I feel angry? I love her so much I don’t understand! Why do I want to kill my mother? The thing I must reiterate and emphasis on is that I am not worried of actually committing any harm or violent acts towards my mother. Not at all, I’ve passed that stage a long time ago (remember I’ve had this for over 20 years). I know it’s not possible to act on thoughts. It’s the thought that I ‘want’ to harm her or want her dead. This is the worry that plagues me. She is such a good person and the guilt is killing me. The compulsion I have is the mental ritual of convincing myself that the feelings are misinterpreted or I was just angry at the time. Though the reassurance is very short-lived and I’m stuck in this loop. Maybe because I’m not worried that I will actually hurt her I should change my Imaginal Exposure technique? Do you think I should try focusing on thought “I want to kill my mother” as exposure to desensitize myself from this thought? Is this a better idea then actually visualizing it?
    Any advice will be Immensely appreciated.

    I have read your reply comments and saw your reply to Kali regarding Back-door spikes and cognitive distortions. It explains my feelings of calm though it still doesn’t explain my anger or “misinterpretation” of excitement. If you could help anyway I would be so thankful. I’m dying over here

    Alen

  48. Alen on November 27th, 2013
  49. Hello, I recently had to put my dog to sleep. I am very upset over this but all I can think is that I may have tried to cause the death of my dog by spraying the floor cleaner i use to clean up after him in his water. or that if i didn’t directly cause his failing liver that possibly spraying the water bowl with cleaner may have exacerated his preexisting condition. initially when he got sick, I was afraid i shook him too hard when i was frustrated with him but the vet said his chiropractic workup was fine. after his death, i then began thinking that maybe i kicked or hit my dog alot over his life with me. i tried to analyze if i did this but felt that maybe my brain wasn’t letting me acknowledge that I actually did these things. I tried to think logically and figure out if i could remember a specific time i did, etc. then this past weekend, which is weeks after my dogs death. I am concerned i poisoned him and now that maybe i gave him an Aleve instead of his medication i gave him daily. I have tried reviewing the entire few days around his death to get a specific answer but i keep having the image of spraying the water or maybe giving him a pill. I initally thought of these couple things but then dismissed them, but now they are back in full force. I keep thinking if I think hard enough, i will get an answer as to whether i poisoned him. i also am afraid that even though i have thought things in the past, .like maybe i sabotaged my boyfriends boards when i was helping him with them, that my trying to attribute them to ocd is just a cover so i don’t have to acknowledge i didn these things. I see a therapist, but it doesn’t seem to help much.

  50. Katie Thorne on December 2nd, 2013
  51. RU,

    Thanks for your comments.

    I’m not sure where you got the idea that one needed to have panic attacks in response to unwanted harm thoughts in order to qualify for a diagnosis of OCD. Many people with OCD, including Harm OCD, do not have panic attacks. Everything in your comment sounds like textbook Harm OCD, specifically:
    ~ You have the violent thoughts
    ~ You really, really dislike them
    ~ You don’t want to act on them
    ~ They are so upsetting to you that you have cried about them
    ~ You are afraid you will act on these thoughts
    ~ You have done compulsions (in your case picking at your skin), while telling yourself that the compulsions would prevent you from doing the harmful thing you fear doing

    I encourage you to seek out treatment with a therapist who specializes in Mindfulness Based Cognitive Behavioral Therapy, as this is the approach that will most likely lead to a long-term reduction in your symptoms.

  52. Tom Corboy, MFT ~ OCD Center of Los Angeles on December 9th, 2013
  53. NS,

    Thank you for your comments.

    First, allow me to note that I am a therapist, not a physician, and as such I cannot provide you with medical advice. You will need to direct your questions about medication to the doctor who prescribed the meds.

    As for Marijuana, we have treated many, many people over the years who have had negative reactions to cannabis. If it causes you to feel more anxious, then I encourage to continue staying away from it.

    As for the impact of stress, it is a rule of thumb in OCD treatment that more stress = a higher likelihood of spikes in OCD and anxiety.

    Finally, allow me to note that any therapist can say that they specialize in CBT, but that doesn’t mean that they really do. Simply put, most therapists are ridiculously unaware of how to effectively treat OCD, and have no business providing services to clients suffering with it. I encourage you to find a therapist who actually specializes in treating OCD with CBT. It sounds like you are not far from LA, so please free to contact us through our website at http://www.ocdla.com if you would like to discuss treatment options. Take care.

  54. Tom Corboy, MFT ~ OCD Center of Los Angeles on December 9th, 2013
  55. Hi Alen,

    Thank you for your comments.

    Everything you have written sounds like textbook OCD. You are getting into OCD trouble when you analyze your thoughts and feelings in an attempt to get certainty as to why you have them and what they mean. The bottom line is that people have all sorts of thoughts – they just happen 24 hours a day and they don’t necessarily mean anything important. Also, and you needn’t feel guilt for any thought. After all, thoughts are not the same as actions – you haven’t actually done anything to your mother – you just had some thoughts.

    Likewise, just as people have all sorts of unwanted thoughts, they also have all sorts of feelings. Being angry at your mother doesn’t mean you want to kill her – it means you had an emotion. Welcome to the club – we all get angry.

    My suggestion is that you allow these unwanted thoughts and feelings to exist without over-attending to them and with out over-valuing them. Their existence doesn’t mean they are important, nor does it mean that they deserve any of your time and energy. I also encourage you to seek treatment. While it is laudable to try doing imaginal exposures on your own, you would likely be better served if you did so under the guidance of a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT).

  56. Tom Corboy, MFT ~ OCD Center of Los Angeles on December 9th, 2013
  57. Hi Katie,

    Thanks for your comments.

    Everything you write sounds very much like classic Harm OCD. It is extremely common for people do have unwanted harm obsessions about their pets. After all, people have very strong feelings for their pets, so it makes sense that OCD would aim for them.

    Your attempts to get certainty about your thoughts and actions are the problem, not the solution Simply put, you cannot get certainty because it doesn’t exist. You will never know with 100% certainty if you didn’t secretly or accidentally poison your dog or sabotage your boyfriend.

    Acceptance is a far more effective strategy that certainty-seeking. That doesn’t mean accepting that you harmed your dog or your boyfriend – it means accepting that you have thoughts about those things. You have a creative brain that comes up with creative thoughts, but that doesn’t mean that those thoughts are true. Let them exist just as you let a scary book exist on your bookshelf – it’s there, but you needn’t pay a whole lot of attention to it.

  58. Tom Corboy, MFT ~ OCD Center of Los Angeles on December 9th, 2013
  59. I always ask myself will I get rid of this or this will follw me my whole life..

    Such irrational thoughts pop on my mind that I am freaked…I feel that I am loosing touch with reality. I received new offer for job with one big Israeli company which will be very good and I was first satisfied but after that thoughts started to come to my head…what if they are trying to trick me…why did they called me on interview to Israel..etc.. I know that it is irrational and that nobody is trying to do that but I was so anxious and still am because I had that thoughts…I started to think yes you are psychotic these are the signs, this is paranoia…normal people dont think on that way…I must say with all irrational thoughts I start to obsess as I see them as a schiz sign

    I had a CBT with very good psychiatrist and also before him during last 15 months I visited 5 and all of them told me that I am not psychotic and that this is OCD. I stopped CBT in October because I felt great and stopped meds in July.

    I had a very stressed things at work after I returned from my honeymoon…I had to move my office on other location, release the employees and I saw big decrease in business I dont know if this is the reason of relapse.

    I still cant convince myself that I dont have schiz and always have doubt :(

  60. vekiqf on December 25th, 2013
  61. Vekiqf,

    Thanks for your comment.

    The fear of having or developing a serious mental illness is quite common in OCD. And for people with this type of OCD, the primary obsession is almost always the fear of having Schizophrenia. You can think of this obsession as being similar to Hypochondria, only instead of being afraid of having a “physical” illness, you are afraid of having a “mental” illness.

    Visiting five different psychiatrists in one year to inquire about the same concern is compulsive. And as you can see, compulsions don’t work – you continue to have these obsessive thoughts, despite repeated assurance from all of these psychiatrists that you do not have Schizophrenia. I encourage you to accept the existence of these unwanted thoughts about having Schizophrenia, without defining them as evidence of Schizophrenia. Instead, identify them as evidence of OCD.

    The bottom line is you will never be able to convince yourself that you don’t have Schizophrenia, and your efforts to do so are the compulsions of your particular form of OCD. Accepting uncertainty will do you far more good than seeking certainty through compulsive psychiatrist visits.

  62. Tom Corboy, MFT ~ OCD Center of Los Angeles on December 25th, 2013
  63. Hi Tom,

    many thanks for your comments. I must say that in the past I had a fear of having AIDS(after unprotected sex..fellatio), cancer, DT after few months of drinking…also I had an obsession that I was pedophile. Also I always have doubt and say maybe doctors made mistake, maybe they dont want to tell me…which I know is totally stupid. All this above passed and I was 8 years totally free. As I told you this obsession started 15 months ago and I cant feel relaxed. Can you advise me what is the best CBT to use on myself and if it is ERP what type.

    Main problem is that I cant accept the thoughts as I am scared that I will start to believe in them

    Thanks

    V

  64. vekiqf on January 6th, 2014
  65. V,

    You note that you “cant accept the thoughts as I am scared that I will start to believe in them”. At the core of all OCD is anxiety related to uncertainty about something one considers unacceptable. You mention numerous examples of anxiety-provoking thoughts that you have experienced related to uncertainty about things you find unacceptable, including:

      ~ uncertainty about having AIDS
      ~ uncertainty about being a pedophile
      ~ uncertainty about having the DTs after a bout of drinking
      ~ uncertainty about a doctor’s diagnosis

    All of these thoughts are classic symptoms of OCD. Now you have obsessions about developing schizophrenia. This is a common obsession in OCD, and it fits with your pattern of being anxious related to uncertainty about something you find unacceptable. This fear is nothing new – it is just the last incarnation of your OCD.

    There are not different types of ERP. Exposure and Response Prevention (ERP) is a specific type of CBT, and it has repeatedly and consistently been found to be the most effective treatment for OCD. I encourage you to find a therapist who specializes in ERP, as this is the approach that is most likely to provide you with the best results.

  66. Tom Corboy, MFT ~ OCD Center of Los Angeles on January 7th, 2014
  67. I’ve had ocd for over twenty yrs. most times the harm o is gone but it recently popped back up. It is almost always about my son who is my heart. He is 11. I am very protective over all family and I just can’t make sense of these violent thoughts that spark up sometimes. It always causes anxiety and depression. Is it normal to feel shut off and void during an episode? I have a bad problem of analyzing every thought. Then I constantly try prove to myself that I don’t want to harm anyone in any way. I ask myself questions that doesn’t help. And I seek reassurance. That doesn’t help. These thoughts are so different than the actual me. I can never answer my questions in a way to provide myself relief. When the thoughts leave and anxiety goes away I can say with certainty that I don’t and never would want to harm a flea. I have classic ocd symptoms as well. Checking locks switches health etc. it’s not new to me but it scared me just as bad every time. Can ocd make you doubt your own self?!!! Thanks

  68. Nw on January 14th, 2014
  69. Hi NW,

    You ask if OCD can “make you doubt your own self”, and the answer is a resounding “yes”! OCD is colloquially known as “the doubting disease” precisely because doubt is the way it causes so much distress – it leads people to doubt all sorts of things, including things about their own personality, character, and actions. But as you also note, your unwanted thoughts are “so different” from the real you.

    The main problem is that you are doing compulsions in an effort to rid yourself of the distress caused by these intrusive harm thoughts. For example you mention four compulsions you are doing that may provide short-term relief, but which are guaranteed to reinforce your OCD in the long-term:

    ~ analyzing your thoughts
    ~ trying to prove to yourself that you don’t want to harm anyone in any way
    ~ asking yourself questions about the thoughts
    ~ seeking reassurance

    Your best long-term strategy is to accept the existence of these unwanted thoughts without taking them seriously. That means tolerating the discomfort of these thoughts, including the feelings of being “shut off”. If you tolerate and accept the existence of the thoughts, without doing compulsions, your mind will over time come to view these thoughts for what they truly are – annoying, but ultimately unimportant thoughts just passing through your mind.

  70. Tom Corboy, MFT ~ OCD Center of Los Angeles on January 15th, 2014
  71. Thanks for the reply! This weekend was tough as far as ocd goes. I had my son. I always have had the what if thoughts about harming but they sometimes up the ante by changing to I want to thoughts. That scares me so bad even typing those words. Can ocd change like that just to keep you anxious? I also worry sometimes that I believe the harm thoughts even though I know that’s not possible. I am strongly opposed to anyone harming another especially my own child. A week ago I was fine this week miserable and questioning my own sanity. Seems after being diagnosed 3 different times by 3 different psychs I wouldn’t fall for this sh”t anymore but each time it feels new and real. I love my child family and life and these thoughts just make me feel horrible and nuts. It’s like I do not wanna ever want to harm a soul if that makes sense. It’s just not me. It’s against my very being so why do I worry???!!!!!! Thank u

  72. Nw on January 20th, 2014
  73. I usually can end an episode pretty quickly but it seems this time the I want to harm_____, not what if thoughts make me more scared. In my mind I thought they had to be what if. Also I find myself believing but not believing them. If that makes sense. I am a loving dad and I know these thoughts about my dear child are totally opposite of me. I have taken every psychology test possible and I don’t have anything but ocd. I just don’t see how it can make me unable to answer the questions I ask myself. It’s like a brick wall that blocks everything except the very thought that’s keeping my anxious depressed sad scared and guilty. Is it abnormal for the thoughts to come in the form of I want to? And almost like you believe them but don’t?? I’m not nuts or violent. I’m the total opposite. Loving caring fun dad and son. Who would gladly give my life for anyone in my family if I had to. That’s why these thoughts scare me so bad.

  74. NW on January 26th, 2014
  75. NW,

    In reply to your two most recent comments, the answers are…

    Yes, it is normal for your doubt-filled thoughts to shift from “what if I want harm my son” to “I want to harm my son”. This is the very nature of OCD – to plant seeds of doubt in your mind about things that you think are unacceptable.

    The reason that you worry about these thoughts is because you have Harm OCD. Wondering why you worry about them is like an diabetic wondering why they have problems with blood sugar. It is the nature of your condition.

  76. Tom Corboy, MFT ~ OCD Center of Los Angeles on February 4th, 2014
  77. Thank u tom. It certainly is the doubt that keeps gnawing at me. Reassurance does no good. I see that now just like I’ve seen it in the past. Because say for instance I tell myself “I am so anxious” ocd makes me doubt it. If I ask myself “do you want to harm anyone”? Ocd won’t let me answer. Even though it’s plain to see how much the very thought of harming anyone just throws me into a sea of sadness and fear. It’s really weird this time how I know it’s ocd just like I’ve known that for 20 years but for some reason I can’t accept it. But then again if it leaves if only for a few minutes or a few hours I KNOW for a fact it’s all ocds lies. But it’s like I can’t let it go. Thanks tom

  78. NW on February 17th, 2014
  79. I had suffered from harm OCD for almost a year about 2 years ago. It all started with me getting really upset with my cat and smacking him. After doing this I immediately had a panic attack and within 24 hours convinced myself that I could never have children with my husband because I would one day get mad and hurt them or worse, kill them. Pretty soon I was overwhelmed with unwanted thoughts and got depressed. I lost 20 lbs and even thought about suicide. I started seeing a therapist who specializes in OCD and I got better. So much better in fact that I am now pregnant with my first child. I was doing great until the other day when I was wiping the mud off my dog’s paws. I couldn’t get them clean and she kept moving and I all of a sudden got really mad at her and these feelings of wanting to hurt her for making me mad just overtook me and I pushed her. I could actually see myself hurting her more but it scared me and I didn’t. It makes me sick even writing this and I worry that because I acted on my feelings of anger by pushing her (just like before with my cat) it means that I really don’t have OCD and I am just a psycho who was able to control myself before it got too bad. I worry about my unborn baby. Will I do that with him? I know its probably just a flair up of my OCD but I keep telling myself that because I acted on the feelings I’m really not an OCD sufferer.

  80. Vic on February 22nd, 2014
  81. Glad to help NW. Remember, OCD is all about doubt. So you need to accept not just the thoughts, but that you will have doubts about the thoughts, and doubts about OCD itself. The ultimate goal is to accept that our brains can come up with just about anything, and to accept whatever our brains conjure up without taking it seriously. They are just thoughts…

  82. Tom Corboy, MFT ~ OCD Center of Los Angeles on February 27th, 2014
  83. Hi Vic,

    Thanks for commenting.

    Just because you have acted harshly a few times in your life doesn’t mean that you are doomed to a life of always acting harshly. Furthermore, there is a HUGE gap between hitting your cat, and murdering your child.

    It sounds like treatment with an OCD specialist has helped you significantly in the past, and I encourage you to have a booster session with that same therapist. Take care.

  84. Tom Corboy, MFT ~ OCD Center of Los Angeles on February 27th, 2014
  85. This blog is amazing. Thank you for the extensive writeup. I’ve only had Harm OCD for a little bit (it’s mostly fear of self harm) but it’s been making me anxious regardless. I’ve actually successfully resisted 99% of my compulsions (I have what you call “magical thinking” compulsions) but they still make me anxious sometimes. I’m going to see a therapist to basically find ways to make me less anxious and be more mindful. Your mindfulness techniques are very interesting and I am really trying to learn how to do it effectively to tell myself that these thoughts literally have no extra meaning other than the fact that they are just thoughts. It’s challenging but I think I am slowly getting there. What else do you recommend?

  86. Victor on March 12th, 2014
  87. Hi Victor,

    Thank you for your comments and for your kind words.

    You note that you are resisting 99% of your urges to act compulsively, and that is fantastic. This is the single most important step one can make in learning to manage OCD thoughts. If you continue to effectively resist your compulsive urges, you will likely see a profound decrease in the impact of OCD on your life.

    It sounds like you are also in therapy, or at least planning to start therapy. My recommendation here is that you seek treatment with a therapist who specializes in treating OCD. Most therapists are well-meaning, but utterly clueless about OCD. You should put your time and resources into treatment with someone who really understands OCD and how to treat it.

    Hope that helps. Take care.

  88. Tom Corboy, MFT ~ OCD Center of Los Angeles on March 31st, 2014
  89. Hey guys, I’ve had this for around 7/8 weeks now and have become de sensitized and can let the thoughts run through after much difficulty most of the time, but on occasion I still feel as though I may harm my partner even though I have not had the thoughts for a while in the particular day. Is this an example of backdoor spiking or a reaction to not having the thoughts? I know I would never harm anyone I just find it difficult to interpret as it seems to wind me up when I am not experiencing the thoughts. Many thanks

  90. Andrew on April 4th, 2014
  91. Hi Andrew,

    Thanks for commenting. First, let me say that it is great that you have quickly become so skillful at letting unwanted harm thoughts run through your mind without paying them much attention. This is one of the most important skills one can develop in managing OCD thoughts – to simply not give the thoughts any importance. That said, it is worth noting that developing this skill does not mean that you will stop having these types of thought. Everybody has these types of thoughts.

    A back-door spike is slightly different – it is when your obsession becomes “OMG, why am I not freaked out by these unwanted thoughts – that must mean I really am (fill in the blank)”. Your “occasional” unwanted thoughts are just run-of-the-mill OCD thoughts.

  92. Tom Corboy, MFT ~ OCD Center of Los Angeles on April 22nd, 2014
  93. Hi,
    I know I battle OCD–my current issue is fear of losing control and self harm. When I have the thoughts, I think: I would never do that to my family. But then the thought shifts to: maybe they wouldn’t be hurt or you wouldn’t be sad because your reality would be altered. I HATE all of the self-harm thinking and know I want another baby, to travel…It wears me out and makes me wonder if I am depressed and maybe I should just lay in bed until my brain clears. Is my second thought about never doing that to my family a mental compulsion? Should I stop responding to self harm OCD with a thought about why I wouldn’t do it? How can a person tell if they are really depressed enough for self harm? The thought of self harm scares me–is that evidence of it being OCD?

  94. Mel Wright on May 11th, 2014
  95. Hi Mel,

    Thanks for your comment.

    Laying in bed until your brain clears would be a counter-productive waste of time. All it would do is reinforce your belief that you cannot function while having unwanted thoughts of self-harm, and give you lots of time to obsess even more. As an alternative, I propose that you: a) accept that your brain produces unwanted thoughts about self-harm; b) pay these thoughts little or no attention; and c) get on with the business of living. If you want to travel and have another baby, then by all means do these things!

    If your thought about never doing that to your family is a volitional thought that you consciously call up in an effort to reassure your self that you don’t want to kill yourself, then yes, it is likely a compulsion. On the other hand, if this thought comes without any effort and with no intent, it is likely just part of the obsession. Either way, I think it is normal to find self-harm thoughts undesirable, and it makes sense that you would feel unhappy about having them. I don’t know which came first, the chicken or the egg – the thought or the feeling. Either way, analyzing the self-harm thoughts doesn’t seem to be providing you with any relief, so I encourage you to stop analyzing and start living the life you want to live. Travel, have a baby, and do all of the other things you want to do, even if these unwanted thoughts are regularly floating around in your consciousness.

  96. Tom Corboy, MFT ~ OCD Center of Los Angeles on May 12th, 2014
  97. Hi,
    So for the past couple years I have been hugely concerned with my health. I’ve noticed a couple more bruises appearing on my legs, Google what easy bruising is a symptom of, and then immediately ask my doctor for blood work to make sure I don’t have cancer, for example (even though I know it’s most likely because I’m anemic). I never considered this to be OCD, everyone’s just always told me that I’m overly dramatic.

    Lately though it’s changed; I’ve had thoughts of hurting people in my sleep. Like, what if I wake up and realize I’ve killed someone? I’ll be locked away forever and I won’t have a future, I’ll never travel, etc. I told my boyfriend about it and he tells me it’s ridiculous, but I still analyze my thoughts and they still keep me awake at night.

    I’m also convinced that the minute I let my guard down and say that this is all ridiculous and go to sleep easily, I’ll wake up a killer, or something. Is that ‘normal’? I’m not sure how to go about this. Do you think constantly worrying about my health was a precursor, or something?

    Any reply would be greatly appreciated,
    K

  98. K on June 25th, 2014
  99. Hi K.,

    Thanks for commenting. The line between OCD and Hypochondria (health anxiety) is very thin. Some argue that Hypochondria is really just a sub-type of OCD. In any case, the symptoms are quite similar, and we have treated many people with OCD who also have exaggerated health concerns. I encourage you to stop researching health issues on the internet, as this is a compulsion that will just make things worse. You may want to read our earlier article on this issue at http://www.ocdla.com/blog/hypochondria-health-anxiety-335.

    As for your harming thoughts, they sound very much like textbook Harm OCD. Rather than analyzing these thoughts, the best thing to do is to accept that your brain is very creative and loves to come up with new ideas. In your case, you have come up with some ideas that you are, or will become, a killer (despite the complete lack of evidence to support this thesis). These thoughts don’t require or deserve any analysis whatsoever. They are just thoughts. If you continue to be plagued by these thoughts, I encourage you to seek out the services of a therapist who specializes in Cognitive Behavioral Therapy (CBT) specifically for OCD.

  100. Tom Corboy, MFT ~ OCD Center of Los Angeles on June 26th, 2014
  101. This article is the best and most accurate description of my harm obsession and mental compulsions that I have found anywhere. This is so valuable as I have not been able to properly explain to my wife exactly how I am suffering. By simply having her and other family members read this article, it is explained. Thank you for defining this awful disorder. Just reading this accuracy gives me hope for treatment.

  102. Matt Johnson on July 8th, 2014
  103. Omg! I am so happy right now. After reading this I feel better than I have in over a year. I have always had ocd but mine was always more of not wanting to think about a word. I was hospitalized in 7th grade and had stomach issues. When I went back to class I was scared of getting a stomach ache and bc I didn’t want to think that word it would continuously pop on my head. I have had many intrusive thoughts or “words” between 7th grade and college then I got to college bam same thing but with headaches. Its like that word is hanging in the back of my head. This took longer because I started associating a headache with homework so when I did my homework bam that thought would knock me down. So im surprised this ocd waited until I was 22 and pregnant with my second child. my 2 year old was having a tantrum and the words “kill little” popped into my mind. I had noticed myself getting depressed before this. Let me tell you that night starred hell on earth. I knew nothing about ocd I thought was crazy.

    Then i linked the thought to work. I work in the billing dept doing data entry and i listen to books all the time so omg my brain is going to make me think these words over and over every night at work.i can deal with anything because they are like you say just thoughts but why cant i get this damn word out of my head. I have been successful before by not feeding the thought and trying to rationalize it. The process in my head goes something like this “everyone thinks intrusive thoughts the problem is you are fighting this thought” i know why its coming back but damn here it comes again!!!!ugh please help i would put a “bullet to my head before i “killed little” by the way. And by the way if i insert his name “mill mason” nope doesn’t bother me!!!! Or anything else! Why does my brain do this to me! I have the biggest heart i cant even spank my children! Helppppppp!!!!!

  104. lauryn on July 12th, 2014
  105. Hi Matt,

    Thanks for your kind words. It means a lot to know that our articles are helpful. There is definitely hope for treatment of Harm OCD. The key is to find a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT), as this is the treatment approach that has consistently been found to be the most effective approach to managing OCD. Take care.

  106. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 29th, 2014
  107. Hi Lauryn,

    Thanks for commenting.

    When you ask “why can’t I get this damn word out of my head”, you are asking a version of the question that virtually everyone with OCD asks – “why can’t I make this obsession stop”. And the answer is simple – because you have OCD! Your brain has a glitch that makes it get stuck on thoughts.

    The better question is “what should I do about this thought”, to which the answer is “nothing”. Just let it be without viewing it as important and worthy or a response. It really is just a thought. Furthermore, as you noted, you “know why it’s coming back, but damn, here it comes again”. When you resist the presence of a thought you make it much more likely to reappear. The bottom line is that you need to accept the existence of this thought, without valuing it as being important.

    For a good book on this, I encourage you to read White Bears and Other Unwanted Thoughts.

  108. Tom Corboy, MFT ~ OCD Center of Los Angeles on July 29th, 2014
  109. Thank you so much for these amazing articles. I just developed a pretty intense case of harm OCD over the past year and a half. It started when I fell into an emotional crisis due to uncovering abuse that I had experienced as a child and had buried deep in my mind. I fell apart, and because of the sadness, depression and anxiety from all of that I began doubting myself. The thoughts came first as self-harm OCD – thinking that because I was depressed and in a crisis that I would kill myself. Then, when I began understanding that this was ludicrous, the thoughts ‘morphed’, as you say, into harming others. My spouse has been very supportive, not helping me to feed any kind of meaning behind the thoughts but instead to encourage me to not worry about them, but it is not enough. I feel that I would like to try CBT/ERP.

    I’m 30, and this is very difficult for me because I’ve never experienced anything like it before. I’ve had unwanted thoughts but they never seemed to bother me until now. Is it common for Harm OCD to arise out of an emotional crisis?

  110. DHW on August 1st, 2014
  111. This article is really helpful and lets me know that I’m not alone in this issue of mine, however mine is different than harming others I’m more concerned about harming myself. So how would I go about helping myself with that? I don’t do anything to avoid the thoughts other than just tell myself they’re ridiculous.
    But the thoughts are so incredibly horrifying, even though I know that I would never harm myself or others.

  112. Madi on August 4th, 2014
  113. Hi Madi,

    You are not even close to alone. Harm OCD is extremely common – just look at all of the people who have commented on our articles about Harm OCD.

    Unwanted thoughts of harming one’s self are no different from unwanted thoughts of harming others, and the treatment is the same. I think telling yourself that the thoughts are ridiculous is a good start (so long as you don’t turn that into a compulsion). The bottom line is that we all have unexpected, unwanted thoughts, and the best response is to do nothing – recognize what they are (just thoughts) and get on with your day. If one is unable to do that, then I encourage seeking help from a therapist who specializes in treating OCD with Cognitive Behavioral Therapy (CBT), which has consistently been found by researchers to be the most effective treatment for all types of OCD.

  114. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 5th, 2014
  115. Hi DHW,

    It is not unusual for any type of OCD to first exhibit itself (or to worsen) in response to a crisis. It is also quite normal for OCD to morph into different manifestations – for example to start as Harm OCD and to shift over time to other obsessions such as HOCD or health obsessions.

    It sounds like you are considering CBT to help you better manage these thoughts. If you would like to speak with one of our staff therapists, please contact us through our website at http://www.ocdla.com.

    Take care.

  116. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 5th, 2014
  117. Hey. I am petty sure I have Harm OCD. I’ve spent the last year fantasizing about harming/killing my ex girlfriend amongst other people. The thing that triggers it seems to be mostly related to other people being unfair/ignorant or misuse their power. I can not watch videoes of police brutality for example. Such a relief to find this site. However the relief was shortlived as I quickly remembered that I also have a fear of hurting animals and that I have actually acted out those thoughts, kicking my cat on many occasions. I think I did it to relieve the pain of having those thoughts but it only brought shame and disgust. In the end I had to give him away to someone else. So it’s not that reassuring after all to hear that these thoughts are not harmful, because they can actually lead you to act violently…. How do you explain that??

  118. Robeatnik on August 7th, 2014
  119. You mentioned that ERP for OCD remains the same in principle no matter what the fear. I think part of my ocd is doubting that the exposures I come up with are acceptable and a way I should continue to do things to make the ocd get better.

    I have a fear of handling raw meat. I always wash my hands after handling it but I feel that I should not be afraid to take an empty raw meat container to the trash can in the garage, touch the top of the soap dispenser with my hand to get soap or handle the refrigerator/freezer handles to return raw meat to that area after touching it BEFORE I wash my hands. I’ve been doing all those things and I decided I would only wipe (not disinfect) those items if I SEE or FEEL any residue from raw meat on those items without actively looking for it.

    Does this sound like a good exposure and a way I should continue to handle this fear? I would truly appreciate your input.

  120. Cody Castill on August 11th, 2014
  121. Hi Robeatnik,

    The fact that you repeatedly kicked your cat does not rule out the possibility that you have Harm OCD. It is quite possible that one can have Harm OCD and also do bad things. Perhaps your kicking of your cat was a function of some other issue – anger, frustration, etc. It is also worth noting that kicking your cat resulted in “shame and disgust”, which is a healthy response to that sort of behavior. If you were a violent sociopath, you likely would not have had that sort of emotional reaction to your behavior. Perhaps your fear of hurting animals is related to the fact that you know you actually have hurt your cat.

    You do not report that you have acted out on your unwanted thoughts of hurting/killing your girlfriend and other people. You use the word “fantasy”, which suggests that you may like the thoughts – there is a difference between an unwanted thought that causes revulsion, and a fantasy that one enjoys. If these thoughts of harming/killing your girlfriend are repetitive and unwanted, and cause you distress and discomfort, they are probably a sign of Harm OCD. If that is the case, you should seek out treatment with a therapist who specializes in Cognitive Behavioral Therapy (CBT) for OCD. On the other hand, if you enjoy these thoughts about harming your girlfriend, then you should seek out longer-term treatment to address why you enjoy the idea of harming people.

  122. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 13th, 2014
  123. Hi Cody,

    It is extremely common for people with OCD to doubt the appropriateness and efficacy of their exposures. This is part of the disorder – to doubt anything related to what one sees as “important” (i.e., harming people, sexual orientation, cleanliness, religious faith, etc.). This is why it is often beneficial to seek the counsel of a professional therapist who specializes in treating OCD who is able to objectively prescribe exposures.

    As for handling raw meat, you are on the right track. That said, some would argue that an even better exposure would be to purposely spread raw meat residue around the kitchen (or even the entire house). But I believe that in most cases, we do not need to create artificially exaggerated exposures – we just need to do what people who don’t have OCD would do. People without OCD don’t purposely spread raw meat juice around their house. But they also don’t compulsively wipe, clean, and disinfect their houses. I suggest you treat raw meat the same way a person without OCD would treat it. While wiping without disinfecting is good, I bet that many people would not even wipe many of the surfaces you are wiping. So don’t actively check for residue, don’t disinfect, and don’t even wipe in situations where others without OCD would not wipe. And tolerate the doubt that things are clean and safe.

  124. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 13th, 2014
  125. Thank you so much for your response. I am a little confused. I’m not wiping anything because I have not noticed any meat residue but I worry a lot that I should. Are you saying that even if I notice something I should not wipe it? Also are you saying that some therapists would say to spread meat residue around the entire kitchen or house and NOT wash hands after contacting it?

  126. CC on August 15th, 2014
  127. Hi Cody,

    Yes, there are therapists who specialize in treating OCD who would suggest that you purposely spread meat residue around your kitchen (and your entire house) and then suggest that you not wash your hands.

    As for wiping, I am suggesting that you stop paying so much attention to meat residue. You do not need to actively check for meat residue. If you just happen to find some, ask yourself “what would someone without OCD do?”.

    My guess is that:

    a) most people would not spend any time at all searching for meat residue;
    b) if they accidentally found “something”, they would not assume it is meat residue;
    c) and if they determined that it was meat residue, many people would do nothing, while some would wipe it off.

    Oftentimes, when humans worry about things, they have an exaggerated idea of the risk involved. Your fears of meat residue seem to me to fall into that category. I believe you are over-concerned with the potential harm that may occur by people being exposed to meat residue.

  128. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 19th, 2014
  129. Hi Tom,
    I found this intriguing set of questions and your responses after searching for ‘ERP for mental health obsessions.’ I checked in before googling to determine whether I was seeking reassurance or simply an ERP option. I was in the process of adding a bullet point to my notecards, as the notion of developing a serious mental illness (completely unbeknownst to me, of course:) is the latest in a string of ‘the things that just cannot be’ doubts. It has been twenty years. I have covered a gamut from fear of harming my family to fear of suicide/homicide/driving off the road or into traffic to, today and most recently, serious and profound mental illness.

    For these twenty years I have gotten by on periods of time with lulls in OCD, avoidance and reassurance. This year I said, no more. I am working with a therapist at Dr. Phillipson’s center in NY and learning, for the first time ever, to exist with doubt. To accept it — a notion that struck me as completely absurd all these years. Accept the existence of doubtful thoughts that overwhelm and shake me to the core? Never! My goal – when I acknowledged OCD enough to claim one – was to be rid of OCD once and for all. OCD… what is OCD? I have spent a good deal of time wishing for a ‘cure’ if you will.

    No more. I have OCD. It is odd, it can be funny, it has caused me no end of pain as I have, at different points in my life, fought it tooth and nail, it is sneaky, it can morph, it will wiggle between two doubts you may have chosen to allow to find a secret passage to yet another doubt… but it can be rooted out. It fabric (betting on you providing endless relevance to its many questions, different manifestations, brand new questions, novel mysteries to solve) can be torn. The rug of relevance can pulled out from under OCD. And Tom, reading your kind, balanced, spot on, measured and informative responses only reminds me of this anew.
    So many thanks for your good work and message not of reassurance… but of hope.
    Jessica

  130. Jessica on August 26th, 2014
  131. Hi Jessica,

    Thank you so much for your comment and your kind words. It is gratifying to hear that our articles have been of service to you.

    You are in good hands at Dr. Phillipson’s clinic. Acceptance of doubt and uncertainty is essential to effectively managing OCD, and it sounds like you are doing a good job in this area. Keep up the good work, and you will indeed pull out the rug of relevance from under your OCD.

  132. Tom Corboy, MFT ~ OCD Center of Los Angeles on August 27th, 2014
  133. I have had harm/suicidal thoughts for awhile now. Morphing is right, I’ve had checking to hit someone with car to I have cancer to I’m a pediphile, to I’m suicidal. Peace is usually not on the menu. The anxiety is not a big deal any more. I can feel it rise sometimes but it’s always at a reasonable level i can handle. It’s the thoughts themselves, I don’t believe I can have a happy life thinking that I want to hurt myself or others. From what I’ve experienced so far is that I cannot be happy when I constantly think about opening a vein and calling it quits. I mean how can you want to do what your suppose to how are you suppose to have fun with your friends, not be miserable all day when suicide is racing in your brain.

  134. Matt on October 2nd, 2014
  135. Hi Matt,

    You you write “I don’t believe I can have a happy life thinking that I want to hurt myself or others”, but I think that thought is a classic Cognitive Distortion. You are giving these thoughts so much value that you believe they will determine the course of your entire future. But they are just thoughts. We have treated many clients with harm and suicide obsessions who were happy and had full lives.

    I strongly encourage you to find a therapist who specializes in treating OCD with Mindfulness Based Cognitive Behavioral Therapy (MBCBT). I think you would get particular benefit from a specific kind of MBCBT called Acceptance and Commitment Therapy (ACT), which focuses on acting based on your values rather than on your fears.

  136. Tom Corboy, MFT ~ OCD Center of Los Angeles on October 16th, 2014

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