Harm OCD: A Journey Through Intrusive Thoughts

Obsessive-Compulsive Disorder (OCD) is a mental health condition that manifests in various forms. Harm OCD, a subtype that is characterized by intrusive thoughts and fears about causing harm to oneself, friends, family or strangers,  is particularly disturbing and often misunderstood.  Here, I’ll explore how we define Harm OCD,  the symptoms of this type,  ways to manage symptoms, and how treatment works.   

What is Harm OCD?

Harm OCD is distinguished by unwanted, intrusive thoughts or obsessions about causing harm.  Intrusive thoughts have no relation to the individual’s actual wishes, intent or a reflection on their character.  People with Harm OCD are typically caring and compassionate, which makes these repetitive thoughts even more disturbing, particularly if individuals don’t recognize it as OCD.  It’s very important to note that a significant portion of the general population experiences intrusive harm thoughts, some estimates are as high as 85%.  The difference is that people with harm OCD may mistakenly assign meaning to aggressive or violent thoughts, leading to rumination and the belief that they may lose control and commit a violent act. There can be a great deal of shame associated with intrusive harm thoughts, at times this shame may keep people from sharing the issue with parents or other loved ones and prevent them from receiving proper treatment. 

Symptoms

Individuals with Harm OCD can experience a  broad range of symptoms, including:

Thoughts – Fears of accidentally or intentionally harming someone, such as pushing a person downstairs, stabbing someone with a knife, or causing a car accident.

Avoidance – To prevent the perceived risk of harm, individuals often avoid certain situations or activities, like being around sharp objects or certain people, going to crowded places or driving.

Rituals/Compulsions –  People will perform repetitive behaviors or mental acts performed to neutralize the thoughts or help them feel reassured that nothing bad will happen. Examples include hiding potentially harmful objects, seeking reassurance from others, reciting certain phrases to themselves or doing a mental review of their actions to ensure no harm was caused.

Anxiety: The constant worry and fear can lead to significant anxiety, depression, feelings of shame, guilt or self-loathing. 

The Impact The effect on an individual’s life can be profound. Their avoidance and ritualistic behavior can damage relationships and diminish the overall quality of life. The fear of acting on these intrusive harm thoughts can lead to diminished capacity for work, a decrease in social activity and connectedness and a state of perpetual anxiety.

Managing Harm OCD    Exposure and Response Prevention (ERP) is a very specific approach, considered a form of Cognitive-Behavioral Therapy (CBT) is the gold standard treatment. ERP involves gradually exposing an individual to feared thoughts or situations while ensuring that they don’t engage in their typical compulsive behavior or avoidance.  If the obsessions and associated rituals that help the individual to function, have been around for a long time, the process can be more challenging and may require the assistance of medication, such as Selective Serotonin Reuptake Inhibitors (SSRIs).  Medication can make it easier for people to actively participate in and benefit from ERP. 

As with any health issue, Education is critical to promote understanding and demystify the condition.  With Harm OCD, education is especially impactful, to ameliorate the fear of judgement, validate people’s experiences and decrease shame, guilt and isolation. 

Practices such as meditation, yoga, and breathing exercises can help regulate intense emotions and decrease overall anxiety. 

Breaking the Stigma     Many with Harm OCD may avoid treatment out of a fear of judgement, or the belief that there is something much deeper going on.  Public education and awareness are critical to promote the understanding that these symptoms have no relation to people’s true nature or personal character but are a common symptom of a treatable mental health condition.

Harm OCD is a disturbing and often misunderstood condition, but with proper treatment and guidance, individuals can overcome their symptoms and find relief. If you or someone you know is struggling with Harm OCD, it’s crucial to seek a well-trained professional, to offer the proper diagnosis, information and compassionately guided treatment. Remember, having intrusive thoughts does not define you.  The right help is out there.