Harm OCD is a subset of obsessive-compulsive disorder (OCD) in which someone 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.
What Is Harm OCD?
Harm OCD is a subtype of OCD that is marked by intrusive violent or aggressive thoughts towards others. This type of OCD can be distressing to manage as it can feel challenging to deal with thoughts about harm being done to someone you love, and that harm being perpetrated by you. It can also increase risk for self harm and suicide to stop the intrusive thoughts.
Is Harm OCD Dangerous?
People with harm OCD are usually not dangerous as they often take greater measures to ensure they are not being harmful in any of their actions. The danger lies in how these individuals cope with the symptoms they are facing.
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, and 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.
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 of harming someone or themselves.
Examples of Harm OCD Obsessions
Harm OCD obsessions can include intrusive thoughts like:
- Inflicting harm or pain on someone you love
- Having aggressive or violent images in their mind
- They are responsible for any pain that others may face
- Imposter syndrome
Examples of Harm OCD CompulsionsHarm OCD compulsions can include thoughts and behaviors like:
- Reassurance seeking, mental review, mental rituals, avoidance
- Hiding knives in the kitchen and other items which may be used as a weapon
- Avoiding watching violent movies
- Excessive confessions and prayer
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. For example, someone may fear driving into a tree, stabbing their boss, or dropping their baby from a balcony.
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 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.
What Causes 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
How to Know If You Have Harm OCD
It can be hard to know if you have harm OCD, or whether you’re experiencing another form of anxiety or negative thoughts related to another issue altogether.
Here are some questions you can ask yourself including:
- Where is this coming from?
- Why do I want to harm this person?
- How do I feel about this person?
- Do I actually want to be violent?
- Am I an aggressive person?
Getting a Harm OCD Diagnosis
Harm OCD is a subset of OCD and will be diagnosed by a psychiatrist. A therapist and psychiatrist will work together to come up with a diagnosis and treatment approach after reviewing therapy notes and having sessions together to assess symptoms.
Harm OCD Treatment
Harm OCD should be treated by a therapist who specializes in OCD.
There are three specific techniques commonly used to manage harm OCD and traditional OCD:5
Exposure and Response Prevention (ERP)
ERP is the gold standard treatment for OCD. In ERP therapy for OCD, you’re exposed 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
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.
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.
In some cases, OCD 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.
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, judgment, 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 receive 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, you could use an online therapist directory that makes 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 judgment.
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.
Here are six ways to cope with harm OCD:
- Develop 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.
- Increase 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.
- Practice 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:
- 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%)9