Harm OCD is a category of obsessive compulsive disorder where a person has intrusive, unwanted thoughts about harming themselves or another person. They may also have obsessive worry about what it means about them that they had these intrusive thoughts in the first place.
Harm OCD is a common manifestation of OCD although it is highly stigmatized. Much like HOCD or POCD, people with Harm OCD often avoid treatment and suffer in silence because they fear what others might think if they were open about their thoughts. People with Harm OCD are no more likely than the average person to engage in violent acts but this fact does not bring comfort to the person with OCD. They often fear that a therapist will “lock them up” if they disclose the content of their thoughts.
Obsessive thoughts common to those with Harm OCD:
- Fear that they will impulsively harm a loved one
- Fear that they will impulsively harm themselves
- Worry that they will accidentally harm someone due to carelessness
- Fear that they will run someone over with their car on purpose or by accident
- Fear that there is something wrong with them because they have intrusive harm-based thoughts
- Fear that they might blurt out a racial obscenity
- Worry that they might have some sort of deep-seated personality defect. Some worry that they have antisocial personality disorder.
Avoidance rituals common to Harm OCD:
- Avoiding sharp objects
- Avoiding cooking
- Avoiding giving kids a bath for fear they will drown them
- Avoiding driving a car for fear they will cause harm
- Checking to see if they have caused harm by checking the rear-view mirror
- Seeking reassurance from others that they did not cause harm or say a harmful thing
- Re-reading emails and text messages to be sure that they did not say anything offensive
Exposure and Response Prevention (ERP) therapy is the most effective treatment for Harm OCD. Like with all other types of OCD, the avoidance of the content area only makes OCD stronger. When a person avoids knives, for example, they teach themselves that avoiding knives is the only way they can be sure that they don’t act violently. That is the wrong lesson. Through ERP, we create an exposure hierarchy that helps the person face their fear directly. We teach the person that they can cook, drive a car, give the kids a bath, and do other activities that they have been avoiding all while accepting the risk that they might act on their fear. This is scary and hard at first but they come to learn that “the bad thing” is unlikely to occur and also that they can endure the discomfort.