Most people, if they’re being completely honest, might admit to having fleeting and far-fetched thoughts of harming people who make their blood boil. The driver whose eyes are glued on his phone and not the road and the person who sneezes without attempting to cover their nose and mouth may have been subjected to some of the thoughts we’re least proud of.
The majority of people aren’t particularly bothered by these thoughts, understanding that the chances they’ll actually cause harm are incredibly slim. Some, however, might truly obsess over whether they’re capable of hurting people when they get angry, simply on the basis of having fleeting thoughts, images, or urges about committing violence—especially if they suffer from Obsessive-Compulsive Disorder (OCD).
This article will examine how people are affected by a subtype of OCD called Harm OCD. We’ll also look at whether these thoughts say anything about the probability of you harming others, and how a therapeutic approach specifically designed to treat OCD can help manage your fears and worries. But before we examine the fear of causing someone else harm when we get mad, let’s first gain an understanding of what this condition is.
What is OCD?
OCD is a mental health condition characterized by a relentless cycle of distressing, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that the sufferer performs to alleviate the distress. It’s a surprisingly prevalent disorder, with one recent study demonstrating that OCD affects around 2.5% of the global population.
OCD is an equal-opportunity disorder affecting people of every age, gender, and socioeconomic background. While it often emerges during adolescence or early adulthood, OCD can also develop in young children or even well into adulthood. The exact cause of OCD remains uncertain, and experts believe it to result from a complex interplay of genetic, neurobiological, and environmental factors.
The cycle of OCD symptoms begins with an intrusive and distressing thought, image, feeling, or urge—including intrusive triggers about harming others. These are known as obsessions, the O in OCD. To alleviate the distress that comes from their obsessions, people with OCD then engage in repetitive behaviors or mental rituals called compulsions. For example, someone with contamination fears might compulsively wash their hands, while someone with a fear of having sexual contact with a minor (pedophilia PCD) might avoid any situation where children will be present. While these compulsions can provide some relief in the short term, they only perpetuate the OCD cycle and make it stronger over time.
Understanding Harm OCD
People’s obsessions often focus on one or more specific themes, or subtypes. Some of the better-known subtypes of OCD include Contamination OCD and Perfectionism OCD, but OCD’s themes vary widely—most OCD themes are far from the stereotypes you might see in movies or hear about in conversation and directly relate to what each individual person most values & fears..
Harm OCD is one of these lesser-known subtypes, but it’s actually very common. This theme features obsessions about causing harm to others—people or animals—or oneself, often leading to safety-related compulsions. People with Harm OCD experience unwanted and distressing thoughts about causing harm, even though they have no intention or desire to harm anyone—and they’re not likely to. These thoughts can be highly violent, graphic, or taboo in nature, leading to intense anxiety, guilt, or shame.
People with Harm OCD often worry that they might act on these thoughts, even though they have no history of violent behavior or intent to harm others. To reduce their anxiety and neutralize the perceived threat, people with Harm OCD may engage in compulsive behaviors, including mental rituals, such as repeating specific phrases, or physical rituals—like avoiding particular objects or situations, seeking reassurance from others, or performing actions to prevent harm.
Harm OCD can significantly interfere with a person’s daily functioning and quality of life. It can lead to avoidance of specific situations or people, and greatly disrupt one’s relationships and work or school performance.
Learning to trust that you won’t harm others
Some people with Harm OCD fully recognize that their thoughts are irrational and inconsistent with their true character and values, while others may have difficulty distinguishing between their obsessions and actual intentions. It’s important to realize the nature or intrusive thoughts as unwanted and misaligned with one’s actual values or desires. If an unintentional, unexpected thought causes you distress or anxiety because of how strongly it goes against your morals or intentions, that’s a good sign that you’re unlikely to act on it.
“People with Harm OCD are certainly no more likely to act on their harm-focused thoughts than people who don’t have the condition and don’t obsess over the same things,” says Dr. Patrick McGrath, Chief Medical Officer at OCD. “Obsessions are ego-dystonic, which means that they go against a person’s values and beliefs, so you could argue that people with OCD are actually less likely to go punch someone when they get mad, for example—that’s exactly the thing they’re so afraid of.”
Research has actually shown that people with OCD don’t struggle with impulse control—so if you find yourself intensely worried that you could do harm based on the intrusive thoughts or urges you have, it’s likely that something else is going on. Interestingly, studies have also shown that people with OCD feel as if their impulse control is weaker than others’, even though it isn’t. “Someone with Harm OCD may see a TV show or hear a news report where some mild-mannered so-and-so sees red and commits a violent act, and they’ll think: ‘Oh my God! What if that’s me?’ Then that worry influences the way they think about their own thoughts and emotions going forward.“
Of course, if you’re struggling with fears about hurting others—especially those you care about—it’s not enough to be told “Don’t worry, you probably won’t!” Luckily, there’s a type of therapy that helps people with Harm OCD free themselves from the torment these types of obsessions trigger. It’s called exposure and response prevention therapy, or ERP, and most people who commit to it see a reduction in the symptoms within a few months or less.
Exposure and response prevention therapy (ERP)
ERP’s beginnings can be traced back to the 1960s. This evidence-based approach is specifically designed to break the OCD cycle. ERP involves confronting your fears by gradually exposing yourself to your OCD’s triggers and then refraining from performing your usual compulsions for short-term relief.
“It’s important to note that other types of therapy—while often effective in treating other conditions—may make your OCD symptoms worse,” says Dr. McGrath. “They most often do this by inadvertently reinforcing rumination or trying to suppress ego-dystonic thoughts without addressing the underlying compulsions.” This can increase the likelihood of you relying on maladaptive coping strategies and avoidant behaviors, intensifying the cycle of anxiety and distress.
ERP, on the other hand, involves working closely with a therapist who understands how OCD works. The first core component of ERP involves exposure to situations, thoughts, or objects that trigger your OCD-related anxiety. This can be challenging at first, but it is a crucial step for your brain to learn that these triggers are not as threatening as they seem. When engaging in exposure exercises, either in therapy sessions or on your own, the goal is response prevention: resisting the urge to engage in compulsions. Over time, you learn to let your distress dissipate over time, rather than reinforcing your fears through compulsions that only make them worse.
For people with Harm OCD, exposures are designed to help them confront their fears related to causing harm, learning over time that they don’t need their compulsions to feel safe and trust themselves. These exercises may take various forms:
- Verbal exposures involve saying or writing down disturbing thoughts related to harm. This might include writing a script describing a situation where you harm someone or discuss your fears verbally with a therapist or trusted person.
- Imaginal exposures might involve vividly imagining scenarios related to your harm obsessions. You might be asked to close your eyes and create mental images of situations that trigger your fears.
- Reading or viewing exposures can be based on reading or watching content related to harm, violence, or distressing situations. For example, you might be asked to read news articles or watch documentaries about accidents or violent incidents.
- Physical exposures involve facing situations with a potential for harm, even if the harm is highly unlikely. For instance, handling sharp objects (e.g., knives), being near traffic, or being around pets or children can be part of physical exposures.
ERP is usually conducted in a graded manner. You’ll start with exposures that evoke mild anxiety and gradually work your way up to more challenging situations. This step-by-step approach helps build confidence and resilience over time. Your therapist will provide support, guidance, and feedback throughout this process. They’ll help you navigate difficult emotions and challenges that often arise during treatment.
ERP is a long-term strategy that treats your symptoms’ root cause. Once you’ve made significant progress, the focus shifts to maintaining gains and preventing relapses. Your therapist will equip you with coping strategies you can employ after the formal treatment period—usually between 12 and 20 weeks—has ended.
Begin your recovery journey now
Schedule a free call with the NOCD Care Team today and learn more about how a licensed therapist can help you overcome harm OCD. Once we match you with a therapist, you can start sessions quickly and from the comfort of your home. Over time, typically just a few months, you’ll learn how to resist your compulsions and return to living on your terms.