You're going about your day—the next moment you are haunted by sudden thought. What if you drive off the side of the road? Does that thought mean you actually want to? You're filled with dread. What you're experiencing is Harm OCD, a subtype of obsessive-compulsive disorder focused on fears about being harmed, or harming yourself or others.
If you're looking for answers, please know that not only are there countless other people going through similar struggles, but that there's hope for recovery—as an OCD specialist, I've guided many, many people through their recovery journey from Harm OCD. Keep reading to find out exactly what harm OCD is, how it manifests, and how to treat it so you can live a life free from its grip.
Harm OCD is a common subtype of OCD that causes intrusive, unwanted thoughts, images or urges about harm to oneself or others—these are called obsessions, the “O” in OCD. In general, thoughts about harm should always be taken seriously, which can make symptoms of harm OCD especially frightening. But make no mistake: People with harm OCD are not more likely to harm themselves or others than anyone else.
Rather, they view their intrusive and unwanted thoughts as an indication of a desire to act. This fuels their anxiety and drives them to engage in compulsions aimed at eliminating this fear. For example, they might remove all sharp objects from their kitchen, out of fear that they can't trust themselves not to harm their spouse while cooking.
Harm OCD can strike any time, anywhere—even in your own home.
Compulsions can also be completely invisible to others, occurring mentally. For instance, someone might repeatedly think “I love my wife” in their head after experiencing an intrusive thought that they could hurt their spouse.
All forms of OCD can potentially become debilitating and even life-threatening when they're left untreated, and here's one big reason why: OCD tends to fixate on what is most important to you. In the specific case of harm OCD, you may value being caring, loving, and responsible above all else. As a result, OCD will latch on and cause you to have obsessions and compulsions in opposition to this core value. This leads to intense anxiety: “How can I be absolutely sure I won't act on the impulse I just had to drop my baby? Do I secretly actually want to hurt him?”
The Harm OCD cycle
Another reason that OCD tends to get worse over time is that obsessions and compulsions work in a vicious cycle: obsessions lead to compulsions, which then make obsessions even more frequent and intense in the future. Until the cycle is broken by learning to resist engaging in compulsions, the cycle reinforces itself.
Truly understanding the OCD cycle isn't easy, but it can help you better identify how OCD shows up for you. This is a critical part of getting on the road to recovery, as OCD treatment works by breaking the cyclical relationship between obsessions and compulsions.
Common Symptoms of Harm OCD
Just like any other theme of OCD, harm OCD is primarily defined by two groups of symptoms: obsessions and compulsions
Contrary to how most people understand OCD, however, these symptoms aren't always visible to others, and many of them can even slip by unnoticed by people suffering from OCD themselves. But learning to recognize your symptoms is a vital first step to getting on the road to recovery. Here are some examples of obsessions and compulsions involved in harm OCD.
By definition, intrusive thoughts are what's known as ego-dystonic. This means that they don't align with your beliefs, values, or character. Put simply, they are unwanted and unpleasant.
Moreover, the fact that you're so worried about causing harm can be a good indicator that, in fact, you're unlikely to do so. You are not wanting your thoughts to come true or intending to have them—you are afraid of your thoughts being meaningful.
So, do these obsessions mean the person having them will likely act on them? No—and I know from personal experience. In fact, ego-dystonic intrusive thoughts completely contradict what a person would want to happen.
I'm so confident that people with harm OCD aren't a threat to themselves or others that I've stood on a train platform in front of a patient who had obsessions about pushing someone onto the train tracks, knowing that I was as safe as ever.
Patrick McGrath, PhD
Chief Clinical Officer at NOCD
For that reason, I'd say that someone who has obsessions about stabbing someone is actually less likely to act upon them than someone who doesn't. I'm so confident that people with harm OCD aren't a threat to themselves or others that I've stood on a train platform in front of a patient who had obsessions about pushing someone onto the train tracks and told them to push me for three hours, knowing that I was as safe as ever. OCD focuses on the last thing you'd ever want to happen, so I felt very confident that I'd be unharmed—and, well, I'm still here!
It's customized for each person and their unique needs, but here's how ERP generally works: After asking you about your specific symptoms, a trained therapist who specializes in OCD creates your ERP therapy plan. Based on that, you'll work together to rank your fears or triggers based on how stressful they seem—this way, you can gain management skills gradually without getting overwhelmed.
To begin with, your therapist will typically prompt you to face a fear that's not too scary—maybe you start by simply saying the word “knife” or looking at a picture of a knife. When you start feeling anxious or distressed, instead of responding with a compulsion, you gradually learn to tolerate the discomfort you feel. As you progress through these exercises with your therapist and between sessions, you'll gradually move on to more difficult ones—eventually, your goal may be to actually chop vegetables with your partner, learning to accept any uncertainty or anxiety you feel.
There's science at play here, because when you see that you handled the discomfort better than you thought you could, your brain learns that you can live with uncertainty and anxiety—they don't need to rule your life. And as a result, you feel less of an urge to engage in compulsions to feel better.
For some people with Harm OCD, ERP therapy is most effective when accompanied by prescribed medication. This may be due to the severity of symptoms, a person's unique needs, or other conditions that occur alongside OCD, such as depression. In these cases, a specialized treatment plan combining therapy with medication can provide the best chance at long-term recovery.
Medications called selective serotonin reuptake inhibitors (SSRIs) are most often used to treat OCD, though other types of medication are also used, including certain tricyclic antidepressants (TCAs) and atypical antipsychotics. While SSRIs are also used to treat anxiety and depression, the dosage tends to be much higher for the treatment of OCD.
Specific SSRIs commonly used in OCD treatment include:
For people who aren't able to make progress in ERP, medication helps reduce their anxiety or distress to more manageable levels so they can engage fully in the difficult work of ERP therapy. And while prescription medications have been shown to be highly effective for reducing OCD symptoms, these symptoms are likely to return if you stop taking medication for any reason and do not use your ERP skills. That's one reason why the skills learned in ERP therapy can be so important for long-term recovery.
A final word on recovering from Harm OCD
By some estimates, it can take an average of 14-17 years from the onset of symptoms for someone who is struggling to get the appropriate diagnosis and effective treatment for OCD.
You don't need to struggle with harm OCD for a decade or more, and neither does anyone else. Effective treatment exists, and ERP is—for the majority of people—the most promising option for them to regain their lives.