Harm OCD: Thoughts, Symptoms, Causes, and Treatment

What is Harm OCD?

A common subtype of Obsessive Compulsive Disorder (OCD) is Harm OCD. People with Harm OCD experience intrusive unwanted thoughts or images (also known as obsessions) of hurting others around them. They also engage in compulsions aimed at relieving the distress caused by these obsessions.

Examples of Struggles with Harm OCD

Scenario 1: A son experiencing violent thoughts.

Joe is in the kitchen cooking and holding a sharp knife when his mother enters the room. Joe suddenly experiences the thought that this same sharp knife could easily be used to stab his mother. This thought causes Joe intense fear. He starts experiencing intrusive thoughts, like:

• “Could I stab my mother?” 
• “Do normal people have these thoughts?” 
• “Am I secretly a violent person and want to kill my mother?” 
• “Should I lock myself up?” 

The experience leaves Joe highly distressed. This causes him to eventually avoid knives or sharp objects and to stay away from the kitchen. His relationship with his mother becomes strained as he struggles to be around her due to having these obsessions.

Scenario 2: A new mother dealing with unwanted thoughts. 

Lisa is holding her 3-month-old newborn son when she suddenly experiences an unwanted image of strangling him. This causes her to experience intense fear that she could act on this thought. Lisa starts to obsess:

• “Is there something wrong with me for having these thoughts?” 
• “Am I going crazy?” 
• “Am I safe to be around my son?” 
• “Could I ever lose control?” 

This leaves Lisa afraid to be around her son moving forward. She now is afraid to hold her son, seeks constant reassurance from her partner that she could not commit a harmful act, and engages in constant mental battles with herself hoping to determine if she is a safe or violent person.

What it Means to Have Harm OCD

People with Harm OCD experience great fear that they could act on their obsessions. They struggle with what having these obsessions means about their overall character. 

The reality is that it is quite natural and common for people with or without OCD to have all sorts of thoughts, including harmful ones. The difference is that people with OCD experience a brain “hiccup” in which they get stuck on these thoughts and struggle to move forward. 

These intrusive, unwanted thoughts are understandably terrifying and isolating. They seem like signs that their lives will be stuck forever – or worse, that they’re bound to do something terrible like commit a violent crime.

But individuals with Harm OCD are generally the opposite of violent offenders. They actually find violent thoughts to be extremely overwhelming and disturbing. They would go to great lengths to stop themselves from experiencing these thoughts. In contrast, violent offenders are often gratified by the idea of hurting others.

Signs and Symptoms of Harm OCD

Harm OCD is similar to all other subtypes of OCD in that there is a constant struggle with uncertainty. People with Harm OCD experience excessive preoccupation about the meaning of their harm-related obsessions, and the possibility that they could harm others. These obsessions can be quite overwhelming and can lead people with OCD to engage in repetitive behaviors or mental acts (also known as compulsions) to reduce this distress.

People with Harm OCD experience their obsessions as highly threatening. Common obsessions for Harm OCD include:

• “What if I were to accidentally harm someone?”
• “What if I were to kill my loved one?”
• “What if I am secretly a violent person?”
• “What if I were to accidentally act on my thoughts?”

As noted above, compulsions are aimed at reducing this distress. Some common types of compulsions include avoidance, reassurance, and repetitive mental acts.

Avoidance behaviors can include: 

• Avoiding items that could inflict harm on others (e.g., knives, scissors, sharp objects).
• Avoiding people or animals for fear that seeing them could be triggering.
• Avoiding locations where there is the possibility of harm (e.g., streets with oncoming traffic, balconies, kitchens with knives).
• Avoiding triggering content (e.g., reading materials, TV programs, movies).

Reassurance patterns can include:

• Asking others for reassurance that they would not commit a violent act.
• Researching online violent offenders to determine similar characteristics to them, which could indicate whether one could possibly commit a violent act.
• Excessive list-making of positive character traits to reassure oneself that they are a safe person and would not engage in harm toward others.

Mental rituals can include:

• Reviewing in one’s head evidence of prior life experiences that prove one is either a loving or violent person.
• Mentally reassuring oneself that they would not commit a violent act.
• Saying a prayer whenever a bad thought comes up.
• Replacing a negative thought with a positive thought.

What Causes Harm OCD?

OCD for most is determined by both environment and biology. This is true for all subtypes of OCD, including Harm OCD. For individuals with an OCD diagnosis, approximately 10-20% of first-degree relatives also have OCD. 

Individuals with all types of OCD, including Harm OCD, have learned that their anxiety and fear is temporarily relieved through engaging in various compulsive behaviors (e.g., reassurance, avoidance, mental compulsions, etc.). The problem with this approach is that these same compulsive behaviors need to be repeated whenever a triggering situation or anxious thought comes up. This short-term anxiety relieving approach ends up becoming a long-term deficit. 

Is Harm OCD Treatable?

The most reliable way to treat OCD is with Exposure and Response Prevention (ERP). ERP involves controlled exposure to anxiety triggers and guided work to reduce compulsions in response to those triggers. This process gradually teaches people with OCD that they can tolerate intrusive thoughts – even violent ones – without feeling the need to do something about them. 

Although this might sound straightforward, recovering from Harm OCD involves careful planning and constant adjustment. An OCD-trained therapist knows what to anticipate when you describe your thoughts and behaviors, and how to build your personalized treatment program. Their expertise is in teaching you how to manage your OCD and make positive changes in all areas of your life. 

Left untreated, people with OCD can struggle with their thoughts, fears, and behaviors for years. The most important thing that you can do if you are suffering from OCD is to seek treatment through an ERP-trained specialist. ERP provides individuals with OCD hope in moving forward and no longer being paralyzed by their fears.

NOCD therapists are trained ERP specialists. The goal of NOCD is to reduce your OCD symptoms within just a few weeks of live one-on-one video therapy. You’ll be welcomed into our supportive peer community, with 24/7 access to personalized self-management tools built by people who have been through severe OCD and successfully recovered using ERP. 

If you are struggling with Harm OCD, there is hope! The first step is finding the right help by seeking out a provider trained in treating OCD with Exposure and Response Prevention (ERP) Therapy. Schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training.

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If you believe you have genuine intent to harm yourself or someone else, please seek immediate help by calling 911.

Please note that this post is an exploration of a common question from our community members. It is not intended to diagnose.