Intrusive thoughts about harm to yourself or others can be a type of OCD known as harm OCD. Therapies like exposure and response prevention (ERP) can help you learn how to cope with this disorder.
Obsessive-compulsive disorder (OCD) is a mental health disorder. Symptoms of obsessions and compulsions define it, but the main theme of OCD can vary between individuals.
When obsessions and compulsions center on experiencing or causing harm, it’s often called “harm OCD.”
While OCD is a diagnosable term, the subtypes of OCD, including harm OCD, aren’t recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM). Despite a lack of official recognition, these subtypes can still help clinicians understand how a patient’s OCD manifests.
Harm OCD isn’t a diagnosis separate from OCD. Harm OCD is still OCD but with a theme of obsessions and compulsions about harm to yourself or others.
OCD affects approximately
Part of the reason we do not have a clear understanding of the prevalence of harm OCD is it is still being defined and studied, and those who harbor the symptoms often find the themes difficult to share with their doctor or mental health professional.
Harm OCD shares the same core symptoms of obsession and compulsions as other manifestations of OCD.
Obsessions are persistent thoughts or urges. They’re usually unwelcome and distressing, and they’re not within your control.
Compulsions are ritualistic mental actions or repetitive behaviors in response to an obsession. They help relieve negative emotions like fear or anxiety and adhere to a rigid set of personal rules, like needing to perform an action a specific number of times.
It’s possible to live with harm OCD and experience obsessions and compulsions with other OCD themes, such as:
- cleaning and fear of contamination
- other forbidden or taboo thoughts
Obsessions and compulsions are the primary features of harm OCD, but you may notice other symptoms, including:
- panic attacks
- extreme guilt
- negative thoughts of self
- need for constant reassurance
- a sense of unease in places where things don’t look or feel just right
- avoidance of situations related to triggers
- social withdrawal
Some people living with OCD also live with a tic disorder, a condition of uncontrollable, brief moments of motor or vocal expression.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), you can be aware intrusive thoughts in OCD are probably not going to happen. This is known as your level of insight into the condition.
A lack of insight, where you are completely unaware or disbelieve you may be experiencing a disorder, is called anosognosia.
Any obsessions and compulsions involving harm can be a part of harm OCD.
They can come in the form of violent mental images, for example, inner voice commands to act out or fantasies about what would happen if you were to harm someone or yourself.
Harm OCD obsessions
Examples of harm OCD obsessions include:
- visualizing cutting or hitting yourself or attacking others
- thoughts of purposefully jumping or falling from too-high places
- imagining running people over with your car or jumping into traffic
- having thoughts about sexually assaulting or raping someone
Harm OCD compulsions
Compulsions in harm OCD are there to neutralize the intrusive thoughts you’re experiencing. They’re typically actions opposite in nature to obsessions because you don’t really want to cause anyone harm, you just can’t help thinking those thoughts.
Examples of harm OCD compulsions include:
- driving the same route multiple times to ensure you didn’t hit anyone
- avoiding public places that might trigger an obsession. For example, avoiding subway stations due to thoughts of pushing someone into the tracks.
- strict avoidance of situations or objects that could cause harm. For example, throwing away your kitchen knives.
If you have a loved one living with this condition, the warning signs may not be obvious, especially in children who may not yet be able to explain or express what they’re experiencing.
Even though harm OCD involves thoughts and urges that may be violent in nature, the warning signs are not usually outwardly aggressive.
“It’s crucial to understand that people with harm OCD do not want to act on their intrusive thoughts. They are, in fact, typically horrified by them,” says Dr. Ryan Sultan, board certified psychiatrist and professor at Columbia University in New York City.
He explains warning signs of harm OCD tend to include:
- spending excessive time seeking reassurance
- intense feelings of guilt and distress over harm-related thoughts, even when they haven’t been acted on
- engaging in avoidance behaviors, such as staying away from loved ones for fear of hurting them
- heightened anxiety, especially when exposed to potential triggers like media stories about accidents or violence
Is harm OCD dangerous?
Harm OCD is not considered a condition that makes you dangerous to yourself or others.
People living with harm OCD do not want to cause harm, even though they may have thoughts of that nature. In fact, harm OCD behaviors stem from an intense fear of causing harm.
Jeanne Cross, a licensed clinical social worker from Lakewood, Colorado, states, “People who suffer from harm OCD are not at any greater risk than the general population of harming others.”
She explains that harm OCD is ego-dystonic, which means that the fear you’re a threat to yourself or others is triggered biochemically in the brain specifically because it goes against your deeply held beliefs and values.
The exact cause of OCD, or why OCD can have specific themes, is unclear.
Sultan indicates a combination of factors, including genetics, brain structure, and environmental factors, might play a role. Exposure to traumatic events or high stress levels may also increase your risk.
“Harm OCD, like other forms of OCD, may arise from abnormalities in some regions of the brain that regulate fear and anxiety,” he says.
All themes of OCD are treated based on your individual symptoms and how they affect daily life.
Your primary doctor or psychiatrist may recommend medications called selective serotonin reuptake inhibitors (SSRIs), which can help reduce symptoms
In addition to medications, psychotherapy is the other main treatment option for harm OCD.
Exposure and response prevention (ERP), a type of cognitive behavioral therapy(CBT), is the go-to framework for OCD treatment. It involves structured exposure to situations and experiences related to obsessions.
During each session, a psychiatrist, psychologist, or equivalent mental health professional slowly presents you with fearful situations. According to the theory behind the process, by not experiencing negative consequences after facing an obsession, you can re-train your brain to view thoughts as just thoughts, not inevitable outcomes.
You can then learn alternative ways to cope with intrusive thoughts that don’t rely on ritualistic behaviors.
When medications and ERP aren’t significantly helping, some people may benefit from deep brain stimulation therapies.
Harm OCD is a subtype of OCD, but it is not an official diagnosis. It involves obsessions and compulsions that center on thoughts of — and fear of — causing harm to yourself or others.
While harm OCD may involve violent thoughts or urges, people living with this type of OCD are not seen as dangerous to others. If you live with harm OCD, you don’t want to act on obsessions, and that fear is what drives your compulsions.
All themes in OCD can be treated through medications and psychotherapy based on how symptoms affect your daily life.