Understanding harm OCD

Throughout the course of life, we all have the capacity to experience fleeting thoughts of harming ourselves or others. For the most part, these thoughts are not evidence of something we would actually do. Rather, they are our brain’s response to feelings of stress, fear, frustration, anxiety, or anger. 

However, people living with obsessive-compulsive disorder (OCD) experience frequent intrusive thoughts (obsessions) that may lead them to wonder if they are at risk of doing real harm to themselves or others. These worries can cause a person to engage in unhelpful behaviors (compulsions) that can significantly impact their mental health and ability to function.

What is harm OCD?

You cannot be officially diagnosed with harm OCD because it’s an unofficial subtype of the condition. But many people use this term to describe the experience of someone whose OCD symptoms tend to revolve around harm — either to themselves or others. 

Two of the hallmarks of OCD are unwanted, intrusive thoughts called obsessions and resulting unhelpful behaviors called compulsions. People living with OCD engage in compulsions in an attempt to lessen their obsessive thoughts. For example, in some common forms of OCD, a person’s obsessions might revolve around a fear of germs. These thoughts occur frequently and are upsetting enough to impact their daily life. The person will typically also have trouble controlling them. In turn, they engage in compulsions — like frequent hand washing — in an attempt to rid themselves of the intrusive thoughts.

For people living with harm OCD, their obsessions and compulsions revolve around the threat of harm. Unlike common, fleeting thoughts of hurting oneself or others, these intrusive thoughts can cause a person to live in fear that they’re in real danger of seriously hurting themselves or someone else. 

While deeply concerning, the intrusive thoughts caused by harm OCD are not evidence of a genuine safety concern or threat of harm. Part of what is so difficult about living with harm OCD is that it can affect people who would never knowingly or purposely hurt themselves or anyone else.

Common symptoms of harm OCD

Every person living with harm OCD will have their own unique experience of the condition. But some common examples of the ways it manifests include:

Typical intrusive thoughts in harm OCD

• What if I all of a sudden hit a pedestrian in the crosswalk while I’m waiting at a red light?
• What if I snap and hurt myself?
• What if I hurt my kids or someone else I care about?
• What if I’m secretly a really bad person who wants to harm animals or other people?

Common compulsions related to intrusive thoughts

• Avoiding any place, person, thing, or situation that you think might cause your intrusive thoughts to arise
• Removing anything from your possession that could cause harm, like kitchen knives or medications
• Refusing to watch violent media of any kind (anything from the nightly news to movies or TV shows that portray violence)
• Seeking frequent reassurance from others that you’re a good person and you wouldn’t hurt anyone
• Spending hours online researching the history and story of people who have committed violence, looking for any comparisons to your own history or personality
• Engaging in rituals designed to ward off the threat of violent behavior
• Thinking, in detail, about harmful situations and how you would handle them or frequently checking in with yourself to gauge your true intentions

Effects of harm OCD

Living within the cycle of harm OCD obsessions and compulsions can have a significant impact on your mental health and quality of life. Left untreated, OCD can lead to:

• Isolating yourself from people you’re afraid you may harm, including friends and loved ones
• Frequent, destabilizing anxiety due to a fear of self-harm or harming others
• Relationship strain
• Financial difficulties
• Difficulty completing tasks at home, work, or school
• Increased risk for co-occurring mental health conditions like major depression
• Unhealthy substance use in an attempt to self-medicate
• Self-harm and suicidality (in severe cases)

What causes harm OCD?

There is no single underlying cause of harm OCD or other presentations of OCD. However, researchers have identified some factors that may make you more likely to have this condition, including:

• Having a close relative (like a sibling or parent) who also lives with OCD or another mental health condition
• Experiencing trauma or other major life transitions, especially at a young age
• Having certain abnormalities in the area of the brain that are responsible for regulating serotonin 
• Showing hyper-organized or meticulous tendencies (in ways that are unhelpful)
• Being a person who has experienced anxiety throughout their life
• Feeling the need to be responsible for others
• Living with another mental health condition like major depression

How is harm OCD treated?

Since harm OCD is not a recognized mental health condition, there is limited research on the most helpful treatments for this presentation of symptoms. However, the following approaches are frequently used to help people who have been diagnosed with clinical OCD:

• Self-management techniques: Most people living with OCD require professional help to achieve symptom relief. However, some self-care activities can help you strengthen your mental health throughout your treatment journey. Be sure to prioritize getting adequate rest, nutrition, and exercise, as caring for your body can support your mental well-being. Also, developing a mindfulness practice can help you cultivate more self-compassion and avoid the black-and-white thinking that often accompanies harm OCD.
• Cognitive-behavioral therapy (CBT): CBT is a form of talk therapy that helps people living with OCD challenge unwanted thoughts and replace dysfunctional behavioral patterns with healthier responses to triggers.
• Exposure and response prevention (ERP): ERP is a subtype of CBT that helps reduce OCD symptoms through an intentional, gradual exposure to triggers under the supervision of a therapist. In doing so, participants can increase distress tolerance and change the way they respond to unwanted thoughts and behaviors.
• Medication: Depending on the individual, certain medications, like selective serotonin reuptake inhibitors (SSRIs), can help minimize OCD symptoms. You can talk to your doctor or psychiatrist about whether these prescription medications are right for you.

Find the right therapist for you with Rula

Living in constant fear of harming yourself or others can be an incredibly difficult experience — especially if these fears are at odds with your identity. So if you’re finding it difficult to control your thoughts or behavior, know that you’re not alone and healing is possible. 

At Rula, we’re here to take the guesswork out of finding the right therapist for your needs so that you can begin receiving the care you deserve as early as this week. In just a few minutes, our therapist-matching program can help you connect with a therapist who takes your insurance and specializes in whatever you’re dealing with. And if medication ends up being a part of our treatment plan, we can connect you with a psychiatrist within our network too. 

Find a therapist with Rula