Am I really a dangerous person? How Harm OCD tricks one into questioning their sense of self.
Harm OCD is a subtype of Obsessive Compulsive Disorder (OCD) that includes fear of harm to self or others. It is extremely distressing to the sufferer due to the “taboo” nature of the intrusive thoughts and feelings. Harm OCD often leaves the sufferer in fear of themselves.
What is Harm OCD?
Harm OCD is characterized by persistent and distressing obsessions or doubts. These present as unwanted thoughts, images, or impulses that provoke anxiety related to potential harm. This could be harm to themselves (what if I snap and stab myself?) or harm to others (what if I drove into a pedestrian?). Unlike typical worries, the thoughts experienced with Harm OCD are extremely distressing and elicit an urge to engage in compulsions.
The obsessions are ego-dystonic, meaning they clash with one’s values and self-image. They are not tied to an intention or plan. Therefore, it creates a profound sense of discomfort and confusion.
Common Obsessions in Harm OCD:
What if I ran into a biker?
What if I hit my pet?
What if I threw my baby?*
What if I accidentally overdosed on Tylenol?
What if I threw a glass at my partner at this restaurant?
What if this feeling of anger means I’m a dangerous person?
What if I’m secretly a serial killer and I just haven’t realized it yet?
Intrusive images of causing harm to loved ones, self, or strangers
Intrusive memories of past mistakes where unintentional harm was caused (a time when you yelled at a sibling, for example)
*a subset of Harm OCD can be Postpartum OCD, learn more here
The obsessions or doubts cause high amounts of distress, therefore - one engages in a behavior to try and neutralize or lower that discomfort. This is called a compulsion.
Common Compulsions in Harm OCD:
Avoiding holding or having sharp knives
Avoiding standing near ledges due to fear of jumping off
Avoiding triggering TV shows, etc.
Avoiding driving
Locking away medications
Researching (Googling signs that someone may be dangerous, etc)
Reassurance seeking (Asking others if they think you’re capable of xyz)
Confessing (Sharing memories or events with an intent of relieving anxiety)
Rumination / Mental Review, + many more mental or ‘private’ compulsions!
OCD is a ruthless disorder. It will convince the sufferer that they need to do these compulsions in order to keep themselves and others safe. It can feel too risky to resist compulsions. The tricky part is, cutting out compulsions and building trust back in oneself are essential pieces to OCD recovery.
Recovery and Treatment of Harm OCD
Harm OCD can become incredibly debilitating. It can cause one’s world to shrink, and elicit copious amounts of shame and self-criticism due to the nature of the obsessions. Fortunately, effective and evidence based treatments exist - and recovery and freedom from OCD is possible.
The gold-standard treatment for Obsessive Compulsive Disorder is Exposure with Response Prevention (ERP) plus medication. An additional, evidence-based approach for OCD is Inference based Cognitive Behavioral Therapy (I-CBT). In both treatments, the goal is to reach subclinical levels of OCD - meaning that OCD is not getting in the way of your day to day life.
Treatment for OCD is highly specialized and specific. It requires learning about the disorder and treatment approach, then building skills to respond to triggers differently than you do now.
For Harm OCD, this may look like:
Making a list of compulsions, and learning skills to gradually decrease each compulsion and respond differently when urges arise
Slowly incorporating triggers to practice your new skills
For some this may look like holding a knife for 30 seconds each day, driving somewhere with bike lanes, or listening to a true crime podcast
Learning how OCD tricks one into believing they need to do the compulsion in order to be safe
Building up self-trust again and learning how OCD thrives on compulsive doubt
For both ERP and I-CBT; the goal is to live by your values without OCD calling the shots. If you value keeping yourself and others safe - we can absolutely live those values while still shrinking OCD! It’s our job to separate valued living from compulsive action, and get you back to the life you want to live.
If you or someone you know is struggling with Harm OCD, reaching out for help is a crucial first step. OCD recovery requires specific treatment methods, and the International OCD Foundation is a wonderful resource to learn more . Remember, you are not alone in this journey, and there is hope for recovery.
Madeline Moersch, LCSW is a psychotherapist in private practice in Los Angeles, CA specializing in the treatment of OCD and Anxiety Disorders. She treats clients in New York and California who are seeking relief from Anxiety and OCD.
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