Harm OCD: Symptoms and Treatment – Part 1
by Jon Hershfield, MFT, OCD Center of Los Angeles blog
February 21, 2012
Harm OCD is a manifestation of Obsessive Compulsive Disorder (OCD) in which an individual experiences intrusive, unwanted, distressing thoughts of causing harm. These thoughts are perceived as being ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s values, beliefs and sense of self. Harming obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act.
It is not fair to say that one form of OCD causes more pain than another. In my experience of treating individuals with OCD, those with compulsive hand washing appear to be in no less pain than those who live in fear of being sexual deviants or psychopaths. What sets Harm OCD apart is the way in which it attacks the things we love the most, and does so with such brutality and lack of mercy as to astound even the most creative minds. The moments that we most want to be highlighted by memories of peace and contentment suddenly become contaminated by mental imagery of horrific violence and feelings of relentless guilt.
Common Obsessions in Harm OCD
The mind is a landscape. Being conscious means wandering (mostly aimlessly) around this landscape and encountering the wonderful, the terrible, and the mostly irrelevant. As owners of the mind, we are entitled to go anywhere we wish. In the case of Harm OCD, we find ourselves visiting places in the mind that we would rather do without. However, like any landscape, places we avoid become overrun with weeds, their growth intruding into the well-groomed, peaceful areas of the mental garden, and becoming a relentless burden.
In Harm OCD, as in all forms of OCD, individuals experience obsessions, and in response, perform various compulsive behaviors designed to relieve the discomfort associated with those obsessions. Here is a list of common intrusive thoughts associated with Harm OCD:
Common Compulsions in Harm OCD
Because the compulsions in Harm OCD often go unnoticed by others, it is generally considered to be a type of what is colloquially referred to as “Pure Obsessional OCD”, or “Pure O”. But individuals with Harm OCD almost always exhibit various compulsions that fall into four categories – checking, avoidance, reassurance seeking, and mental rituals. Here are some common compulsions typically seen in Harm OCD:
Checking
Avoidance
Reassurance Seeking
Mental Rituals
Harm OCD might be experienced as an extension of a lifelong battle with the disorder, or it may develop spontaneously later in life. It is not uncommon for children with OCD to struggle with intrusive thoughts of causing harm to their parents, siblings, or peers, either through thoughts of literally attacking them or through the distorted belief that “bad” thoughts may cause bad health or bad luck to someone they care about.
Late onset Harm OCD can be particularly unsettling because without the context of understanding OCD and the various ways it can interfere in one’s life, it may appear that you have simply gone insane. It is not uncommon for someone who previously displayed little or no signs of OCD to suddenly become aware of a harm thought in the middle of some stressful experience, and to then find themselves engaging in compulsions all day trying to suppress thoughts of hurting someone they would never dream of hurting.
OCD sufferers may also discover violent obsessions appearing only after extended battles with other forms of OCD have run their course. Untreated, OCD naturally gravitates toward whatever is most likely to produce compulsive behavior. So when one obsession stops producing, another one often takes its place until treated. In fact, it is the intensity with which we experience love for our children, partners, relatives, etc. that makes them targets for OCD – they are the most likely to stir in us the greatest motivation to protect.
Self-Harm in OCD
Some individuals may also experience intrusive thoughts of self-harm, often brought about by imagining ways to escape anxiety, and then being terrified of what their brain came up with. It is important to note that fear of self-harm is an entirely different phenomenon from actual self-harm behaviors such as cutting. Similarly, the fear of committing suicide is a different issue than genuine suicidal ideation. Some with Harm OCD experience an obsessive fear of self-harm, often related to unwanted intrusive thoughts of losing control, while actual suicidal thinking has to do with the fantasy of ending one’s life. It is important to note that individuals with Harm OCD are at no higher risk of acting violently than the general population, and that having Harm OCD does not indicate that one is a danger to themselves or others. That said, treatment providers should discuss these types of thoughts with their clients to clarify and determine issues of intent.
Treatment of Harm OCD
As with other forms of OCD, it is important that the sufferer seek treatment with a psychotherapist who specializes in Cognitive Behavioral Therapy (CBT) specifically for the treatment of OCD. The primary CBT technique used in treating Harm OCD is the same as that used in treating other types of OCD, and is called Exposure and Response Prevention (ERP). Unfortunately, many individuals with harming obsessions seek out traditional talk therapy or psychodynamic therapy, both of which can swiftly worsen a Harm OCD sufferer’s condition by encouraging them to further examine these meaningless thoughts, which only serves to unnecessarily inflate their importance.
In the next installment of this series, we will discuss in-depth the treatment of Harm OCD using Cognitive Behavioral Therapy. For now, if you are experiencing Harm OCD, remember that you are not alone, that your condition is very treatable, and above all, that you are not crazy.
Jon Hershfield, MFT, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.
by Jon Hershfield, MFT, OCD Center of Los Angeles blog
February 21, 2012
Harm OCD is a manifestation of Obsessive Compulsive Disorder (OCD) in which an individual experiences intrusive, unwanted, distressing thoughts of causing harm. These thoughts are perceived as being ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s values, beliefs and sense of self. Harming obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act.
It is not fair to say that one form of OCD causes more pain than another. In my experience of treating individuals with OCD, those with compulsive hand washing appear to be in no less pain than those who live in fear of being sexual deviants or psychopaths. What sets Harm OCD apart is the way in which it attacks the things we love the most, and does so with such brutality and lack of mercy as to astound even the most creative minds. The moments that we most want to be highlighted by memories of peace and contentment suddenly become contaminated by mental imagery of horrific violence and feelings of relentless guilt.
Common Obsessions in Harm OCD
The mind is a landscape. Being conscious means wandering (mostly aimlessly) around this landscape and encountering the wonderful, the terrible, and the mostly irrelevant. As owners of the mind, we are entitled to go anywhere we wish. In the case of Harm OCD, we find ourselves visiting places in the mind that we would rather do without. However, like any landscape, places we avoid become overrun with weeds, their growth intruding into the well-groomed, peaceful areas of the mental garden, and becoming a relentless burden.
In Harm OCD, as in all forms of OCD, individuals experience obsessions, and in response, perform various compulsive behaviors designed to relieve the discomfort associated with those obsessions. Here is a list of common intrusive thoughts associated with Harm OCD:
- I will suddenly snap and violently attack:
- My significant other or ex
- My child (especially common in Perinatal and Postpartum OCD)
- My parent or other family member
- My nephew/niece/godchild
- A disabled or ill person
- A baby
- A friend
- A stranger
- I will fail to respond to disgusting violent or sexual thoughts appropriately and will reveal myself to be a monster.
- I will suddenly have an uncontrollable urge to push someone into traffic, jump out a window, or experience some other impulse that will result in me being responsible for my death or someone else’s death.
- I will be overwhelmed by harming obsessions and have to act on them to relieve the pressure.
- I will lose consciousness somehow and commit violent acts that I do not remember.
- I will fail to wash or turn off something appropriately and I will be responsible for someone being horrible hurt or killed.
- I will accidentally poison someone.
- I will hit someone with my car and not know it until the police track me down.
- I will lose my sanity and commit suicide.
Common Compulsions in Harm OCD
Because the compulsions in Harm OCD often go unnoticed by others, it is generally considered to be a type of what is colloquially referred to as “Pure Obsessional OCD”, or “Pure O”. But individuals with Harm OCD almost always exhibit various compulsions that fall into four categories – checking, avoidance, reassurance seeking, and mental rituals. Here are some common compulsions typically seen in Harm OCD:
Checking
- Excessively looking in the rear-view mirror to make sure you did not strike someone with your car.
- Looking back at people you walk past or examining them for signs that they have may have been harmed by you.
- Checking your body for signs of a struggle or any indication that you have harmed yourself or someone else.
- Checking to make certain that no items which could be used for harm are visible. For example, locking up tools or placing knives out of reach.
Avoidance
- Avoidance of people that trigger the unwanted thoughts. For example, avoiding being left alone with your young relative for fear that you will hurt them, or avoiding taking a hike alone with your girlfriend.
- Avoidance of places that trigger the unwanted thoughts. For example, avoiding crowded bus stops where you fear you might push someone into traffic.
- Avoidance of items that trigger the unwanted thoughts. For example, staying away from sharp objects such as knives for fear that you might use them to harm someone.
- Avoidance of information that triggers unwanted thoughts. For example, avoiding watching or reading the news where you think you might possibly hear about murder, or avoiding movies or TV programs that you believe might have violent scenes in them.
Reassurance Seeking
- Asking others to confirm to you that they believe you would not do a horrible thing.
- Asking others to confirm that you did not hurt someone and somehow fail to remember it.
- Confessing unwanted thoughts in the hopes that their response will indicate they do not believe you are a dangerous or bad person.
- Repeatedly researching the difference between OCD and sociopathy.
Mental Rituals
- Mental review/mental checking. This is a form of self-reassurance seeking that involves reviewing thoughts and memories of events in an attempt to gain certainty that you have not harmed anyone. This also involves mentally reviewing various reasons why you would or would not commit a violent act.
- Compulsive flooding – Trying to force yourself to imagine violent acts in an attempt to prove that you are disgusted by them and would not do them.
- Thought neutralization – Purposefully forcing yourself to think a positive or otherwise contradictory thought in response to a harm thought.
- Compulsive prayer/magical rituals – Repeating prayers or mantras by rote in response to unwanted thoughts.
- Repeating behaviors – A combination of physical and mental compulsivity, this would typically involve repeatedly starting tasks over or extending them in an attempt to complete the task without having an unwanted “bad” thought.
Harm OCD might be experienced as an extension of a lifelong battle with the disorder, or it may develop spontaneously later in life. It is not uncommon for children with OCD to struggle with intrusive thoughts of causing harm to their parents, siblings, or peers, either through thoughts of literally attacking them or through the distorted belief that “bad” thoughts may cause bad health or bad luck to someone they care about.
Late onset Harm OCD can be particularly unsettling because without the context of understanding OCD and the various ways it can interfere in one’s life, it may appear that you have simply gone insane. It is not uncommon for someone who previously displayed little or no signs of OCD to suddenly become aware of a harm thought in the middle of some stressful experience, and to then find themselves engaging in compulsions all day trying to suppress thoughts of hurting someone they would never dream of hurting.
OCD sufferers may also discover violent obsessions appearing only after extended battles with other forms of OCD have run their course. Untreated, OCD naturally gravitates toward whatever is most likely to produce compulsive behavior. So when one obsession stops producing, another one often takes its place until treated. In fact, it is the intensity with which we experience love for our children, partners, relatives, etc. that makes them targets for OCD – they are the most likely to stir in us the greatest motivation to protect.
Self-Harm in OCD
Some individuals may also experience intrusive thoughts of self-harm, often brought about by imagining ways to escape anxiety, and then being terrified of what their brain came up with. It is important to note that fear of self-harm is an entirely different phenomenon from actual self-harm behaviors such as cutting. Similarly, the fear of committing suicide is a different issue than genuine suicidal ideation. Some with Harm OCD experience an obsessive fear of self-harm, often related to unwanted intrusive thoughts of losing control, while actual suicidal thinking has to do with the fantasy of ending one’s life. It is important to note that individuals with Harm OCD are at no higher risk of acting violently than the general population, and that having Harm OCD does not indicate that one is a danger to themselves or others. That said, treatment providers should discuss these types of thoughts with their clients to clarify and determine issues of intent.
Treatment of Harm OCD
As with other forms of OCD, it is important that the sufferer seek treatment with a psychotherapist who specializes in Cognitive Behavioral Therapy (CBT) specifically for the treatment of OCD. The primary CBT technique used in treating Harm OCD is the same as that used in treating other types of OCD, and is called Exposure and Response Prevention (ERP). Unfortunately, many individuals with harming obsessions seek out traditional talk therapy or psychodynamic therapy, both of which can swiftly worsen a Harm OCD sufferer’s condition by encouraging them to further examine these meaningless thoughts, which only serves to unnecessarily inflate their importance.
In the next installment of this series, we will discuss in-depth the treatment of Harm OCD using Cognitive Behavioral Therapy. For now, if you are experiencing Harm OCD, remember that you are not alone, that your condition is very treatable, and above all, that you are not crazy.
Jon Hershfield, MFT, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.
