OCD subtypes
Harm OCD

Can You Overcome Harm OCD?

4 min read
Keara Valentine
By Keara Valentine
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety

Everyone has passing thoughts of hurting other people. It’s just part of being human. Once in a while, everybody thinks, “Ugh, I could just kill her,” or, “If she doesn’t stop talking, I’m going to stab her with this butter knife.”

‌For people without obsessive-compulsive disorder (OCD), these thoughts come and go without much distress. They know they don’t mean it. But when you have harm OCD, your mind fixates on those thoughts and you wonder if you could actually follow through.

It’s a frustrating way to live, especially when it restricts your activities because you feel like you have to avoid certain situations. Fortunately, there is a way to overcome the distress of harm OCD and take control of your day-to-day life.

What does harm OCD look like?

People with harm OCD aren’t violent. Most of the distress associated with harm OCD usually centers on doing everything the person can to avoid being in a situation where they might follow through on thoughts of hurting others. If you have harm OCD, you might ask yourself questions like:

  • ‌Could I truly kill or hurt my family member?
  • ‌What if I couldn’t stop myself from acting on this violent thought?
  • ‌Am I a violent person and don’t know it?

One common scenario is a fear of being around knives. Someone with harm OCD might worry they could pick up a kitchen knife and stab their partner, so they avoid being in the kitchen when anyone else is around, or they remove all knives from their home kitchen.

Someone with harm OCD might also avoid train platforms because they’re worried they could push someone in. They might even avoid spending time with people they love, because they can’t escape the feeling they might hurt them. 

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The intrusive thoughts of harm OCD are extremely distressing, and the need to escape or avoid those thoughts can interfere with your ability to live the life you want. Fortunately, there is a reliable way to manage your OCD symptoms and gain control.

The challenge of harm OCD therapy is learning to face intrusive thoughts without compulsive behaviors. Photo via Josh Gordon/Unsplash

What is the treatment for harm OCD?

The gold standard for harm OCD therapy is exposure and response prevention (ERP) therapy. ERP is a form of cognitive behavioral therapy (CBT) that gives you a gradual, safe and controlled way to face your intrusive thoughts.

The challenge of harm OCD therapy is learning to face these situations without compulsive behaviors. You’ll usually start with something middle-of-the-road in terms of intensity — not your most extreme anxiety-producing fear, but not the mildest. You want it to be a challenge, so you have to work at it.

In ERP therapy, you work with an experienced and trained therapist who works with you to designs your exposure exercises specifically for you. They’ll work with you to make sure the scenario is something you can tackle at each stage of treatment. 

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You’ll often work your way up to a particular goal. For example, if you avoid any media that might have a potential weapon or violent situation in it, you might start by watching a few seconds of a cooking show featuring knives. Or, if seeing your 5-year-old nephew triggers intrusive thoughts of hurting him, you might start by walking by a playground and eventually working your way up to a visit.

By facing your OCD triggers without performing compulsive rituals, you teach yourself that you can tolerate distress and choose your response. 

Can ERP therapy “cure” OCD?

Right now, there’s no way to make OCD go away completely. It’s not something you can “cure” — but it is something you can manage, and that’s what makes ERP so powerful.

Other forms of therapy, like standard cognitive behavioral therapy, ask you to reason with your intrusive thoughts with the ultimate goal of eliminating your worries and anxieties. This may work some of the time, but OCD worries have a nasty way of cropping up when you least expect them. Further, trying to logic your way through anxiety can itself become a compulsive behavior, and actually reinforce the obsessive-compulsive cycle.

If you only learn to eliminate and avoid your intrusive thoughts, you’re left without defenses when one of these thoughts arises. When it does, you feel compelled to get out of the situation or perform a compulsive ritual because you’ve convinced yourself that you need it to handle the anxiety. 

With ERP, you learn the skills to help you move through an anxiety-provoking situation. You can use those skills any time your harm OCD symptoms crop up, even if it’s a scenario you’ve never faced before. ERP isn’t a cure, and it doesn’t guarantee your anxiety will go away. What ERP does is give you the tools to manage your anxiety so you, not your OCD, control your life.

NOCD has caring therapists trained in ERP therapy for harm OCD. Schedule a 15-minute call and find a therapist to meet your needs today.

Keara Valentine

Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.

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Adriana Delgado

Adriana Delgado

Licensed Therapist, LMHC

My journey as a therapist has brought me in front of more and more cases of OCD, which has led to specialization in OCD treatment. My experience working at intensive in-home services for children & families, and intensive outpatient programs, has prepared me for even the biggest challenges. During sessions, I use Exposure and Response Prevention (ERP) therapy because it’s one of the most effective treatments for OCD, and works for any OCD subtype.

Alyse Eldred

Alyse Eldred

Licensed Therapist, LMFT

I’ve been a licensed therapist since 2017, and as an OCD specialist, I only use Exposure and Response Prevention (ERP) therapy. Research shows that ERP is the most effective OCD treatment available. I truly enjoy helping people understand themselves through ERP and I’m grateful to be part of a process that helps people gain control of their lives.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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