Harm OCD is a subset of obsessive-compulsive disorder (OCD) in which the individual experiences intrusive thoughts of engaging in harmful behavior toward themselves or others. This is often accompanied by compulsive behaviors designed to decrease the anxiety associated with those disturbing thoughts. Without assistance from a trained mental health professional, symptoms of harm OCD can increase or worsen over time.
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Harm OCD vs. Traditional OCD
OCD is an anxiety-related disorder characterized by obsessions and/or compulsions. Obsessions are recurrent, unwanted, and distressing thoughts, images, or impulses.1 Harm OCD is specific to a fear of harming oneself or others and subsequent checking compulsions. For example, your harm OCD could manifest as a fear of running someone over with your vehicle; the compulsion would be checking to make sure you haven’t.
People can typically discern fleeting thoughts from a desire to cause harm, but with harm OCD, you may interpret the thought to mean you will act on it. Or, you will need reassurance that you’re a good person, and then engage in compulsive behaviors to reduce anxiety and protect yourself against these feared behaviors.
Signs of Harm OCD
Harm OCD can occur at any age, but while it can be upsetting, intrusive thoughts are not a sign of homicidal or suicidal intent. In children, harm OCD might present as intrusive what-if scenarios — “What if I accidentally cut myself with a knife?” or “What if I kill my parents in their sleep?” The thoughts are upsetting because the individual doesn’t want to engage in them.2
The illness is much the same for adults, but feared scenarios often differ due to circumstance. For example, they may fear driving into a tree, stabbing their boss, or dropping their baby from a balcony. Also, while children generally seek out reassurance from their parents that they won’t engage in harmful behavior, adults tend to engage in compulsive reassurance or checking behaviors.
Symptoms of Harm OCD
Symptoms of harm OCD overlap with some symptoms of traditional OCD, often dealing with obsessive thinking and/or engaging in compulsive behavior to reduce the anxiety associated with these thoughts.
Other symptoms of harm OCD include:
- Fear of causing harm to self or others
- Intrusive thoughts (obsessions) of engaging in violence against self or others
- Self-doubt regarding whether you will act on obsessive thoughts
- Avoidance behaviors (compulsions) to prevent violence against self or others
Causes & Triggers of Harm OCD
Researchers and mental health professionals don’t know a lot about what causes or triggers the symptoms of traditional and harm OCD, but there are theories based on observable and recorded common factors.3
Common factors that may lead to, trigger, or be associated with harm OCD include the following:4
- Family history of OCD
- Stressful or traumatic life events
- Co-occurring mental health disorders
- Learned behaviors
- Brain chemistry
Treatment of Harm OCD
Cognitive behavioral therapy (CBT) is the most commonly used and impactful form of therapy to treat all forms of OCD. When individuals seek out therapists or treatments not designed to address OCD, their condition can be made worse by reinforcing unhelpful obsessions.5
Harm OCD should be treated by a therapist who specializes in OCD and is trained to utilize CBT. There are three specific techniques commonly used to manage harm OCD and traditional OCD. They are mindfulness-based CBT, cognitive restructuring, and a behavioral therapy technique called exposure and response prevention(ERP).5
Mindfulness-Based CBT
Mindfulness-based CBT is designed to teach an observational vs. judgmental stance regarding thoughts, feelings, urges, and physical sensations. Those with harm OCD learn that the mere existence of a disturbing thought is not indicative of their character and doesn’t point to an intent to cause harm to self or others.
Cognitive Restructuring
People with harm OCD may struggle with cognitive distortions, including all-or-nothing thinking, catastrophizing, and perfectionism. Cognitive restructuring helps you to identify and challenge those thoughts with more rational, objective, evidence-based thinking. The goal is for automatic thoughts to become rational and less distorted.
Exposure and Response Prevention (ERP)
ERP uses exposure over time to desensitize you to anxiety-provoking stimuli. You and your therapist will formulate a list of feared items (hierarchy of fears). Gradually, you will be exposed to those items with the therapist’s guidance to avoid the usual compulsive responses.5
Medication
In some cases, medication may be recommended in addition to therapy. The therapist will likely refer you to a psychiatrist or psychiatric nurse practitioner who can prescribe the appropriate type and dose. Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft) are all approved by the U.S. Food and Drug Administration (FDA) for treatment of OCD. Note that selective serotonin reuptake inhibitors (SSRIs) have a less troublesome side-effect profile than clomipramine.
Lifestyle Changes
In addition to therapy and medication management, you can make lifestyle changes to better manage harm OCD and its symptoms.
- Stress Management/Reduction: OCD symptoms are exacerbated by heightened stress and anxiety, so anything you can do to reduce stress helps.
- Practice Mindfulness: Mindfulness will help you manage your obsessional thinking. As it becomes more natural, the automatic thoughts you react to as a part of your OCD will be easier to manage.
- Support System: Joining a support group or increasing your circle of trusted friends can help with feelings of loneliness, judgement, or isolation.
- Healthy Habits: Engaging in self-care is crucial for anyone dealing with a mental health condition. Well-balanced meals, regular movement, and adequate sleep are all necessary to manage stress, mood, and anxiety.
How to Get Help For Harm OCD
To recieve help for harm OCD, locate a trained mental health professional. Your primary care physician (PCP) may have a list of therapists and psychiatrists in your area. Also, there are online provider directories like Choosing Therapy that make it easy to look up specific criteria for a therapist, including insurance coverage, populations treated, and types of treatment offered. Consult your insurance carrier by calling the customer service number on your card or looking on the online portal.
How to Get Help For a Loved One
If you have a loved one with harm OCD and they give you permission, you can assist them by calling providers and insurance companies. It may also be helpful for you to attend certain appointments or provide transportation. Additionally, reassure them that you support them without judgement.
How to Get Help For a Child
Ask your child’s pediatrician for a list of therapists and psychiatrists who not only specialize in OCD but also treat children. A family therapist is also helpful to assist families dealing with mental health issues such as OCD. These conditions impact the entire family, and a family therapist can help you manage.
Online provider directories and insurance portals can help you locate a family therapist in your area. Search provider websites to see what types of services they offer, what insurance they accept, and what types of patient populations they treat. Many therapists offer telehealth services, making treatment even more accessible.
6 Ways to Cope With Harm OCD
In addition to therapy, prescribed medication like SSRIs, and lifestyle changes, there are several other ways to cope with harm OCD. These methods of coping may lessen the negative impact of symptoms.
Six ways to cope with harm OCD are:
- Flexible routines: Learning to be less rigid about daily routines can help improve relationships and encourage a willingness to try new things.
- Resist avoidance: Avoidance may sometimes seem logical, but it perpetuates the OCD cycle by intensifying the desire to avoid.
- Set realistic expectations: One way to manage self-doubt and frustration is by being realistic about goals and expectations. You and your team can discuss what treatment will achieve and how long that may take to accomplish. For many cases, the goal is a reduction in symptoms and not the total elimination of them.
- Manage stress: Stress has the potential to worsen symptoms, so learning new ways to reduce it is important.
- Social interaction: Social interactions can have a positive impact on our physical and mental health. They reduce stress and increase an overall sense of well-being.
- Mindfulness & meditation: Practicing mindfulness and meditation can assist those with harm OCD to shift focus from over-thinking to a less judgmental stance.
Harm OCD Statistics
Here are several relevant statistics according to available data regarding OCD and the subset of harm OCD:9
- 85% of the population report graphic or violent thoughts from time to time6
- 25% of those with OCD have a family member with OCD6
- 30% of the population are perfectionist, but only 2.5% have OCD6
- OCD is over twice as common in adults than in children6
- 1.2% of adults in the US were affected by OCD last year7
- 1 in 100 adults (2-3 million) and 1 in 200 children (500,00) are affected by OCD in the US8
- Rates of OCD are higher in females (1.8%) than in males (.5%)
Additional Resources
- International OCD Foundation
- The TLC Foundation for body focused repetitive behaviors
- TeenMentalHealth.org
- National Institute of Mental Health
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
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