What is Harm OCD? A Definitive Guide 

Harm OCD is a subtype of OCD that focuses on obsessions surrounding harm to self and/or harm to others.

For people with OCD, harm thoughts evoke excessive feelings of shame due to the violent nature of the intrusive thoughts and the misunderstanding of OCD.  It is important that you understand that there is nothing to be ashamed of. 

Harm obsessions can be all-consuming fears about our own safety or the safety of the people that the sufferer loves most.

OCD targets what we value most. OCD obsessions are egodystonic in nature, meaning they thrive by challenging our values and testing our ability to navigate the doubt.

It is important to recognize that you are not your thoughts.

People with harm OCD thoughts are terrified by their thoughts do not want to act on them. This is a key distinguishing factor that separates those who desire to harm themselves or others intentionally. 

These intrusive harmful thoughts are disturbing, can be violent and aggressive in nature, and feel torturous to the person with harm OCD.

Many are afraid to share their obsessions with their therapist for fear that they will be misunderstood and reported for their intrusive thoughts.

This article acts as an in-depth guide to Harm OCD so that if you recognize these symptoms within yourself, you have the knowledge to support yourself and the confidence to speak with a medical professional who will help you without judgment.

What is Harm OCD?

For people with OCD, thoughts of harm involve excessive fear over the possibility of harming oneself or others. 

Sufferers find themselves constantly seeking certainty that they would never harm themselves or their loved ones.

These obsessions may include people imagining themselves stabbing, strangling, or hitting children, family members, pets, or themselves. They may also be plagued with images or urges to sexually assault others. 

They might imagine themselves using sharp objects such as knives, scissors, power tools, pens, or even their bare hands to cause harm.

People with harm OCD also experience physical sensations and urges that may make them feel like they are at risk of throwing themselves into the path of oncoming cars, throwing themselves down the stairs, steering their car into pedestrians, or even driving their car off a bridge, for example.

It makes sense that people who have these thoughts of harm would take them very seriously.

This is what makes symptoms of harm OCD so frightening. The person takes those intrusive thoughts, images, or urges as an indication or desire to act.

With any OCD, we’re in a constant dance of being plagued with fears which spike our uncertainty and anxiety, which we then try to eliminate by engaging in physical or mental compulsions.

Those compulsions are repetitive and ritualistic behaviors that are performed in a bid to gain a sense of certainty and control. For someone with harm OCD, it is often the fear of what might happen if they don’t engage in these compulsions that keeps them stuck in the cycle.

They perceive the potential consequences as being too high risk and are afraid they will snap, and take action on those intrusive thoughts.

OCD tends to fixate on the things that matter most and so the obsessions that oppose our core values. This is what makes these doubting thoughts so terrifying and incredibly painful to live with.

When you’re battling with thoughts such as, how can I be absolutely sure that (X person) will be safe? You exert tremendous energy trying to find the answer to an unanswerable question that, in your mind, has severe consequences if not acted upon.

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Harm OCD Vs Suicidal OCD

Suicidal OCD is incredibly similar to harm OCD and is sometimes referred to as Harm OCD with Suicidal Obsessions.

Those living with harm OCD suffer from obsessions about potential harm coming to themselves or others. This may be fears of accidental harm, or intentional harm. 

The main differentiator between these two subtypes lies in the obsessions.

Those with suicidal OCD struggle with fears that focus on intentional harm to oneself.

NOTE: Suicidal OCD is not the same as suicidal ideation. Suicidal OCD is characterized by unwanted thoughts about suicide. The sufferer does not want that outcome, they are fearful of it. Those with active suicidal ideation want to die by suicide. If you recognize symptoms of either, please seek medical assistance.

Harm OCD Symptoms

Obsessions and compulsions can arise in many forms but for those with harm OCD, obsessions present as fears about harming themselves or others and the compulsions are done to alleviate those fears.

Common Harm OCD obsessions

• Someone may be chopping food in preparation and suddenly fear that they my take the knife and stab a loved one. They may wonder, “Why did I think that? Could I stab my loved one? Is there something wrong with me?”

• Someone could be driving their car and suddenly have a vivid intrusive thought about driving their car into oncoming traffic. They may feel an adrenaline rush and take that as an urge or desire to do so. They may wonder, “Do I want to kill myself? Why would I want to do that? What if I can’t stop myself?”

• A parent may hold their child and suddenly feel the impulse to drop them. They may wonder, “Do I want to drop my baby? What would happen if I did? Maybe I should put them down? Are they safe with me?”

• Someone might argue with a friend and have the sudden urge to slap them. They might think, “I wouldn’t actually do that, would I? Am I going crazy? Could I really do something like that?”

Common Harm OCD compulsions

Harm OCD thoughts, feelings, sensations, images and urges commonly create a great deal of discomfort for people with OCD. 

A common question our clients have is, “Do people with harm OCD act on their thoughts? Am I going to do something bad?”

Because there is such fear about what could happen, sufferers seek to guarantee that these thoughts will not become a reality with compulsive behaviors:

• Seeking reassurance that you will not commit harm. Examples:
  • Googling “fear of harming,” “what if I think about harming my baby?” etc.
  • Asking your loved ones if you’re a bad or violent person
  • Reassuring yourself by saying things like, “I would never hurt anyone”

• Checking to see if you have harmed yourself or another person.  This may involve checking them physically or mentally. 

• Mentally ruminating on whether you are capable of harming someone or yourself. 

• Being hyper-aware of every move you make, and mentally checking for the intentions behind your behaviors. 

• Avoiding objects, places, or activities that could encourage you to commit harm, such as:
  • Tall buildings
  • Knives 
  • Giving your baby a bath

Causes of Harm OCD

Researchers are still unable to identify what actually causes OCD.

There are factors that are always considered:

Biological – including DNA, family history, and genetics. OCD has been found to be a hereditary disorder so those with OCD within the family are likely more vulnerable to developing OCD than those with no familial connection to this condition.

Psychological – Personality type and other mental health conditions are taken into consideration as both could lend themselves to an increased likelihood in developing this disorder.

Environmental – Upbringing and stressful life events are taken into consideration. While biological factors do not appear to trigger the onset of OCD in isolation, a predisposition to the disorder combined with a traumatic life event could contribute to the development of OCD.

The common misconception is that harm OCD develops because the individual has the desire to commit violent acts toward another or themselves.

As with all intrusive thoughts that present themselves in this way – similar to pedophilia OCD – sufferers assume these thoughts must be valid in some way and mean something about them.

This is simply not the case.

If you struggle with harm obsessions, it does not mean that you have a hidden intention or want to commit these acts.

What does it feel like to live with Harm OCD?

Living with harm OCD is painful to say the least. Those with this subtype can live in perpetual terror of their thoughts and the fear of what might happen if they don’t try to regain control and certainty over them.

Those who do not understand this subtype could never truly know the agony of these relentless obsessions and the negative impact it has on quality of life, including:

• Isolation

This is a lonely subtype. Avoidance is a common compulsion, and often, avoidance of those you love most.

Harm OCD sufferers find themselves gradually separating themselves from the people in their life and limiting their social interactions for fear of what might happen.

They might be afraid of harm they may cause to others or fear that harm may come to them. And so they actively avoid putting themselves in situations that may trigger their obsessions and where they don’t feel in control of the situation.

• Immense shame and guilt

When a subtype like this latches on to the people who matter most in our lives, throwing violent, disturbing, aggressive, and often repulsive harmful thoughts our way, sufferers can feel like they are drowning in shame.

Harm OCD is very effective in its goal of making them believe that they are a bad person.

Those thoughts and fears are given more weight and validity than they deserve and are taken as a sign that there must be something wrong with who we are as a person.

• Identity crisis

Constantly second-guessing their identity, clients who come to us often question:

What kind of person must I be to think such a thing?

Why would I think this if I didn’t want to do it?

I must be a terrible person.

Those OCD obsessions challenge their sense of self-concept and leave them trapped in a spiral of questioning – WHO REALLY AM I? IS THIS ME?

Top tips & advice to remember…

1. You are not your thoughts
2. Thoughts are not facts
3. You have not ever acted on those thoughts
4. You are more than your OCD
5. You can live by your values and not your fears
6. Although terrifying, this is a highly treatable disorder that you can fully recover from

Treatment

When a patient or client comes to therapy, the first question they often ask is, “How do I stop harm obsessions?” or “Please, tell me how to stop self-harm OCD thoughts?” or “Tell me how to make these urges go away?”  

While these requests are 100% understandable (given how scary they are), our clinicians work quickly to educate our clients that this is not an effective goal of OCD recovery.  

Instead, using the below treatment tools, people with harm OCD can learn how to change their reactions to their obsessions (which is within our control), instead of making them stop (something that is not in our control).

Overcoming harm OCD can feel impossible, but rest assured, it’s not. The gold-standard approach to OCD treatment and OCD recovery is Exposure Response Prevention (ERP) which is a form of Cognitive Behavioral Therapy (CBT). 

1. CBT with ERP

The cognitive portion of CBT refers to the identification of distorted thoughts and learning to restructure them into more reasonable, rational thoughts.  The behavioral portion is where ERP comes in. OCD treatment requires that we focus mostly on the behavioral component, as this has the best clinical outcomes. 

The goal of this is to be able to spend time doing the things you love, with the people you love, without letting harm OCD dictate how you live your life.

The practice of ERP involves the creation of a hierarchy. 

This hierarchy is developed together by the therapist and client.  Once the client has been educated on how to manage their thoughts, feelings, sensations and urges, they will then begin slowly exposing themselves to their feared stimuli. 

You are never forced to do an exposure you feel unable to tackle. You will be met where you’re at and we work at your pace.

The purpose is to practice tolerating thoughts and NOT engaging in harm OCD compulsions. 

With harm OCD, common examples of ERP might look like include:

• Going to feared places, doing feared activities, using feared objects without ruminating on whether you’re going to use them to commit harm

• Practicing spending one-on-one time with your baby or spouse while resisting the urge to ruminate on whether they are safe with you.

• For Self-harm thoughts, practice being alone (and then being alone with sharp objects) while resisting the urge to ruminate over whether or not you feel in control or may snap.

During treatment, our clinicians will also train you to use skills such as mindfulness, Acceptance and Commitment Therapy (ACT) and Self-Compassion.  

Recent studies have shown that incorporating mindfulness into CBT and ERP improves recovery outcomes. Mindfulness involves experiencing your thoughts, emotions and physical sensations, from a non-judgmental, “right now” perspective. 

Mindfulness is a tool that can be used anywhere in any situation. An informal or formal meditation practice can also help you to gain discipline with your thoughts, feelings and sensations and can be included in everyone’s mindfulness practice. 

It’s important to remember that ERP, like most treatment modalities, is hard work. 

It can feel exhausting at times to constantly face your fears, but it gets easier with time as you grow more comfortable with discomfort. By continuing to practice response prevention, you can get to a place where harm OCD does not limit your day-to-day life, you can engage in intimate and loving relationships, and find the freedom to live in accordance with your values.

2. 1:1 private therapy

Clients often feel a sense of trepidation when they first contact our team for support.

And this is understandable. There is a big fear of being misunderstood that stops many sufferers from getting the support they need. However, when you approach a team of highly qualified mental health professionals and OCD specialists like ours, you are welcomed without judgment.

No matter how hard it feels to begin treatment, our clients never regret starting.

Ours is a team of licensed professionals who understand the complexities of OCD and know that you are not your thoughts. We know that you do not want to have these thoughts, and we know that you do not want to act on them.

We know that they do not bring you pleasure.

You can rest assured in the knowledge that our team is here to help you recover using proven modalities that get our client’s incredible results.

There is an incredible life available to you that isn’t governed by OCD. If you’re based in California or Arizona we invite you to get in touch and submit an initial intake form here.

3. Online program

For an affordable and accessible alternative to private therapy, you can join ERP SCHOOL. 

A self-paced online program created by top OCD specialist, Kimberley Quinlan, gives you all of the tools and techniques to take your life back from OCD.

You will learn the exact ERP and CBT techniques used with private clients, and how to apply those to your specific harm obsessions and compulsions.

This program has everything you need to stop letting intrusive thoughts ruin your life and resist the urge to do compulsions so you can regain control and experience joy again.

Join ERP SCHOOL here.

Harm OCD FAQ’s

• Why does harm OCD feel so real?

Intrusive thoughts across all subtypes feel very real and that is what makes them so debilitating.

Images can be incredibly vivid, and our bodily response to those thoughts are taken as a sign that something must be wrong.

The anxiety that arises following those obsessions is wrongly taken to me that those thoughts are a source of threat and danger that shouldn’t be ignored.

This is why harm OCD feels so real.

Because the job of our anxiety response is to warn us of signs of perceived danger we take any anxious sensation in our body as a cue to respond. In the case of OCD, those thoughts are perceived as dangerous even though they are not – they are just thoughts.

• Is harm OCD dangerous?

People with harm OCD are not more likely to harm themselves or others than those without OCD.

Remember, the intention is key here.

Someone who has the desire to hurt themselves or others may be thinking about how to do it or what it would look like very intentionally. The goal is to carry out the act.

The misconception with harm OCD is believing that having those intrusive thoughts means that we want to commit the act. This is untrue. Those with harm OCD engage in relentless and repetitive compulsive behaviors to actively ‘ensure’ that they do not act on their thoughts.

This is why harm OCD is not dangerous.

The sufferer does not want to harm themselves or others. Fundamentally, it is driven by the desire to protect oneself or others, not harm them.