Mental Health

Harm OCD: Part 1


If you have Harm OCD, you’re always on the run and you may fear that your exhaustion could lead to that one thought slipping by that you “should” have seen as a warning. Thankfully, treatment for this form of OCD with cognitive behavioral therapy really works. 

Harm. Many of us frame our self-worth on the issue of whether or not we are causing harm. I don’t have to be productive, attractive, talented, so long as I am confident that I am not doing harm. Harm is taking something away from others, often through violence, and often with the infliction of pain. To cause harm, and to do so willingly is to be inhuman, to be in a class of creature on Earth unworthy of love. Then, our greatest fear, that of being truly alone, becomes real the moment we start to see ourselves as capable of doing harm.

Harm OCD, a form of obsessive-compulsive disorder, takes this discomfort we have with the “harm” concept and creates an impossible black-and-white world where the expectation is that in order to be good, you must be devoid of thoughts about harm. This obsession with harm leads to a variety of compulsive behaviors aimed at reducing discomfort that ultimately fuel and invigorate the intensity of the thoughts, trapping the sufferer in an endless cycle of pain and self-doubt.

Though Harm OCD as a term is typically referring to obsessions of a violent nature, many forms of OCD can be associated with a fear of harm. Here are some types of OCD and ways in which they are fueled by a fear of harm:

Harm Obsessions in Various Forms of OCD

  • Violent obsessions – fear of harming others through an act of violence
  • Self-harm obsessions – fear of harming oneself through an act of violence
  • Sexual obsessions (i.e. pedophile obsessions) – fear of harming others through an act of sexual aggression
  • Sexual orientation obsessions – fear of harming others by perpetuating a lie about one’s “true” orientation
  • Relationship obsessions – fear of harming others emotionally through acts of betrayal or fear that the presence of harm thoughts means the absence of love
  • Contamination obsessions – fear of harming others through the spread of contaminants
  • Checking obsessions – fear of causing accidental harm as a result of failing to check something effectively (i.e. failing to ensure that a stove has been turned off) or fear of having hit someone with a car and not noticing
  • Just Right/Symmetry obsessions – fear that leaving things somewhat “off” may result in unknown negative consequences for others (i.e. leaving a picture crooked somehow causing a loved one to fall ill)
  • Religious obsessions – fear of harm thoughts directed at religious icons or fear of harm thoughts being blasphemous
  • Morality obsessions – fear that harm thoughts are condemnations of one’s moral character or concern that harm thoughts represent ambivalence about causing harm

At the core of all OCD trickery is the argument that resisting compulsions isn’t worth the risk of your fears coming true. The OCD survives on compulsions, and it will kick and scream its way through your sense of decency to get what it needs to survive. But what are these compulsions?

Most people who tell me they have Harm OCD also tell me they have “Pure O” or “Pure Obsessional” OCD. You are likely to find a lot of books and websites referring to these terms. To determine if what you’re reading has any legitimacy, read their definition carefully. If they are suggesting that there is something “pure” about the experience because there are no compulsions, then they probably don’t know much about OCD. The term “pure” is a relic from the days when we did not understand how people could be engaging in compulsions without it being visible. So, it’s common for people suffering from sexual or violent obsessions whose compulsions may not be obvious washing or checking rituals to call themselves “Pure O.” Now we understand that OCD sufferers of all persuasions are engaging in covert and mental behaviors that serve the same function as physical compulsions.

A mental ritual is a voluntary shift in your attention aimed at reducing the discomfort associated with an unwanted thought. In other words, it is a behavior that you are engaging in with your mind in an effort to feel clean. The Harm thought is perceived as a foreign object. It is an idea that, were it to be made real, would be the ultimate contamination of your identity. Efforts to remove this contaminant from your mind are silent forms of washing, and no less compulsive than scrubbing at the sink.

Common Compulsions Associate with Harm OCD

  • Avoiding things that trigger Harm thoughts (i.e. knives, the news, violent media). This may also include hiding items or locking them away for fear that being around them will be dangerous.
  • Physically checking that no harm has been done (i.e. driving back to check you haven’t hit someone or checking your body for signs of having been in a struggle) or checking for evidence of a feared event (i.e. scanning the internet for reports about a feared event)
  • Mentally reviewing events to determine if harm was done or if there was an intention to do harm
  • Physically or mentally checking your body to determine if any physical sensations might be indicators of past or imminent harm
  • Neutralizing obsessions by trying to replace them with non-triggering thoughts (this may include compulsive prayer)
  • Confessing thoughts to feel certain that the person hearing the confession knows what happened in your mind and can make a “better informed” decision about whether to be around you (particularly common in Relationship OCD)
  • Reassurance seeking (i.e. manipulating others into telling you that you would never hurt someone or researching people who have caused harm and highlighting how different you are from them)
  • Magical/superstitious compulsions (i.e. counting to “good” numbers to ward of harm, tapping, chanting, or other physical or mental behaviors aimed at protecting oneself from harm thoughts becoming true)

Believe it or not, this is a pretty short list of compulsions in Harm OCD. The OCD often presents you with the worst you can imagine against the people you care the most about, precisely because it is the worst you can imagine and because you do care about them the most. Treating the disorder means knowing more about your OCD than it knows about you. It means being able to imagine more and sit with more than the OCD thinks you can handle.

Common thoughts I hear Harm OCD sufferers stuck on:

  • I am going to “snap” and commit an impulsive act of violence against someone (often a loved one or someone seen as vulnerable, such as a child)
  • I am going to “snap” and experience a personality shift that will turn me into a sociopath who will go on a killing spree
  • These thoughts are warnings that I am going to commit violence and if I don’t attend to them the right way, they will come true
  • I am in denial of the fact that I enjoy acts of violence and am a violent person deep down
  • I may have committed acts of violence and have not gotten caught (yet!)
  • Because I think about suicide sometimes, it means I am going to kill myself
  • I could lose control of my faculties and act violently (i.e. push someone in front of a train, stab myself with a pencil, jerk the wheel of my car into oncoming traffic)
  • I am meant to be a sociopath and must be vigilant to avoid my true self acting out
  • Exposure to violent imagery will make me go insane
  • I must be certain that no part of me could cause harm and that no people who cause harm have anything in common with me
  • I’m not certain if I hate the thoughts completely 100% of the time and if I might like them at all, it means I am a monster

You are NOT a Monster.

When my youngest was just a baby, I remember holding her in one arm while I carried a bag of trash in the other and headed toward the chute in my apartment building. I opened it up, creaky, smelly, metal scraping against metal, and peered into this dark portal where whatever gets dropped in is forgotten forever. I lifted the trash bag, balancing my child with my other arm, and then the movies that are constantly playing in my mind took a wrong turn. Throw the baby down there.  Watch her fall into darkness. Throw your whole life away with it. Be the guy who murdered his kid on a whim. 

Ugh, ok. Guess this will be the baby chute from now on. 

So far, a thousand bags of trash have left my grip for the unknown, but no babies. Still, an imaginary baby eats it pretty much every time it’s trash day. I can see the humor in it, but then I have the luxury of not being persecuted by the thoughts. If you have Harm OCD, you’re always on the run and you may fear that your exhaustion could lead to that one thought slipping by that you “should” have seen as a warning. Thankfully, treatment for this form of OCD with cognitive behavioral therapy really works.

In the next segment of this blog, I’ll discuss both how to treat Harm OCD with cognitive behavioral therapy and how to stop minding the horror movies in your head without letting them define you.

Click here for Harm OCD: Part Two

Click here for Harm OCD: Part Three

Click here for Harm OCD: Part Four

  • Jon Hershfield, MFT

    Director, The Center for OCD and Anxiety
    Anxiety Disorders, Cognitive Behavioral Therapy, Obsessive-Compulsive Disorder (OCD)