What Is Harm OCD? Signs, Symptoms, and Treatment

One minute you are performing a mundane activity—driving a car, playing with your kid, or taking a shower. The next you are haunted by a fixation that you will drive off the side of the road, do something to hurt the child, or dig a razor blade into your skin until you bleed. What these examples all have in common is that they are all possible manifestations of Harm OCD, a subtype of obsessive-compulsive disorder that leaves many people afraid that they could be a danger to themselves or to 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.

What is Harm OCD?

Harm OCD is a common subtype of OCD that causes intrusive, unwanted thoughts, images or urges to harm oneself or others. Thoughts of harm should always be taken seriously, which can make symptoms of harm OCD especially frightening. People with harm OCD are not more likely to harm themselves or others than people with other OCD subtypes. However, they may view their intrusive and unwanted thoughts as an indication of a desire to act. This fuels their anxiety and drives them to engage in various compulsions aimed at eliminating this fear (e.g., removing all sharp objects from their kitchen). 

OCD tends to fixate on what is most important to an individual. When a person values being caring and responsible above all else, OCD will latch on and cause them to have obsessions and compulsions in opposition to their core values. This makes the doubting thoughts all the more anxiety-provoking (“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?”). 

Harm OCD symptoms

People with harm OCD generally experience their obsessions and compulsions in two different ways. They either worry that they will harm themselves or someone else by accident, or that they will act on an involuntary impulse or urge to harm themselves or others. 

In the first scenario, someone may fear they would accidentally leave their stove on and burn the whole building down. They may be afraid to drive because they don’t want to potentially cause an accident. In the second scenario, someone may experience an involuntary impulse to harm another person and be terrified they would actually act on it. (“I just had an image of punching my spouse. It felt so real. I love her more than anything and I would never ever want to act on this. But how can I be certain I won’t?”)

Although it might sound surprising, it is relatively common to have a thought, impulse or urge to harm oneself or someone else, but for people without harm OCD, these thoughts generally only last a few seconds at most. For example, someone might be going about their day and wonder, “What would happen if I put my hand on this burning-hot cooking pan?” When this happens, people will generally think, “That was a weird thought. Definitely a bad idea and not something I want to do,” and forget about it. 

Common Obsessions in Harm OCD 

Obsessions include thoughts or mental images related to harming themselves or others. These obsessions may include:

• A person could be in the kitchen and preparing vegetables, and suddenly have an image that the knife in their hand could be used to stab their friend next to them. They might begin thinking, “Could I stab my friend? What if I act on this? Is there something wrong with me? Should I see a doctor?”
• A mother could be holding her baby and suddenly have an unwanted impulse to drop her. This would come as a complete shock, and she might start thinking, “Do I want to drop my baby? What if I actually did? There must be something wrong with me. Is my baby safe with me? What if I’m not meant to be a mother?”
• Someone may be excessively concerned with making sure they don’t take too much medication. They might think, “What if I accidentally took too much medication and harmed myself? What if I count the wrong number of pills by mistake?”
• Someone may be very angry and suddenly experience an urge to punch their spouse. This would scare them and feel terrifying. They might think, “What if I actually punched my spouse? I can’t bear the thought of it. Am I going crazy? Why did I just have this thought?”

Common Compulsions in Harm OCD 

Compulsions are done in an effort to neutralize or reduce the distress caused by a person’s anxiety, whether triggered by OCD thoughts, mental images or urges. Harm OCD compulsions can include:

Seeking reassurance

It’s common for people with harm OCD to seek reassurance from a friend, loved one or religious or community leader. They might ask, “Do you think I would actually harm another person or myself?” They may hope to receive the response, “Of course you wouldn’t. You’re the kindest person I know. You’d never hurt a soul.” This will relieve their anxiety temporarily, but it’s only a matter of time before the doubting thoughts return.

Mental review

Someone with harm OCD may review past experiences over and over in order to reassure themselves they are not in danger of harming anyone. For example, they may think, “I have never harmed anyone in my life. I have nothing to worry about.” They may search their mind for past experiences when they were kind to the person they are afraid of hurting and continually replay these memories in their minds. They may replay the moments when they’ve experienced an impulse to harm themselves in an attempt to rewrite this memory (“I didn’t have an urge to drop my baby. That’s not what happened. I actually just wanted to throw her up in the air and catch her, as a playful game.”)

Mental rituals

Some people may engage in mental rituals to reassure themselves that they will not act on their thoughts, impulses or urges of harm. For example, they might count to seven or another lucky number every time a thought comes into their head as a way to reassure themselves they don’t act on their thoughts (“I just blinked three times, so now I can be sure I won’t hurt myself.”). A person might force themselves to think one positive thought for every intrusive negative thought they have, as a way to “cancel out” the bad thoughts.

Avoidance

Someone may avoid certain scenarios or people where they think they will experience thoughts of harm. For example, they might avoid a specific coffee shop because they experienced a disturbing impulse to throw their coffee on the barista the last time they were there. They may avoid interacting with particular people for fear of experiencing unwanted thoughts, images or urges. They may remove sharp objects from their home or stop engaging in certain activities, like cooking, as a way to avoid the possibility of obsessive thoughts about harm.

How Harm OCD is treated

The best course of treatment for harm OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment, and is backed by decades of scientific research proving its effectiveness. As part of ERP therapy, you’ll work with your therapist to slowly conquer situations that bring on your obsessions and the accompanying anxiety or discomfort. 

The idea behind ERP therapy is that compulsions only strengthen your fears over time. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety as you provide yourself with opportunities to change your learning and practice living with uncertainty.

Here’s a specific example from my work with therapy members. Let’s say someone has continually experienced fears of accidentally hurting someone while driving. It’s never happened before, but the fear of the possibility has become so great that this person no longer feels safe driving. During an ERP session, this patient might practice going for a drive with their therapist. At first, this might feel impossible. They might think, “I want to drive, but I just can’t. I’m too afraid.” The next steps in the process are very active: they work with their therapist to gradually, intentionally face their fears, resisting compulsions along the way. For example, they may start with simply sitting in the car during a therapy session and allowing the uncomfortable thoughts and fears to come up.

Doing an exposure like this, without resorting to compulsions, shows the patient that they can tolerate not knowing what will happen as well as the discomfort associated with the thoughts—often, the people I’ve worked with eventually feel just as confident while driving, or doing any other activities they once feared, as anyone else.

Where to go for help with Harm OCD

OCD is highly misunderstood, even by mental healthcare professionals, but a qualified therapist who specializes in OCD—like myself and my colleagues here at NOCD—will be able to make an accurate diagnosis. Every NOCD therapist goes through intensive training in ERP and receives ongoing guidance from our clinical leadership team. And we truly understand OCD like few others do—many therapists at NOCD have dealt with OCD themselves, have learned to manage their symptoms, and understand just how crucial ERP therapy is for recovery. 

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