Harm OCD: This Type of Obsessive-Compulsive Disorder Leads to Violent Thoughts
Key takeaways:
Harm OCD is a type of obsessive-compulsive disorder that causes people to have obsessions and compulsions revolving around the fear of hurting someone.
Having harm OCD does not make people more likely to be violent. But people with harm OCD worry excessively that they will snap and become violent.
There are evidence-based treatments that help people effectively manage all types of OCD, including harm OCD. With these treatments, you can reduce the negative effect that OCD has on your life.
Table of contents
Obsessive-compulsive disorder (OCD) is a common mental health condition that affects over 2% of people. Researchers have categorized different subtypes of OCD. These are not separate diagnoses but different ways OCD can present itself. One type of OCD is harm OCD.
What is harm OCD?
People who live with harm OCD have obsessions and compulsions about the fear of hurting someone or themselves.
They may have intrusive thoughts and images about losing control and acting violently, even when there is no evidence of them being violent people. They may also engage in repetitive compulsions to try to ease their anxiety, which can rob them of hours of their life.
What are the symptoms of harm OCD?
OCD has two core symptoms: obsessions and compulsions. Obsessions are intrusive and unwanted thoughts, images, or sensations. Compulsions are ritualistic or repetitive behaviors that are performed in an attempt to reduce anxiety.
Harm OCD obsessions
As with most types of OCD obsessions, harm OCD obsessions are often “what if” thoughts. Some examples of harm OCD obsessions include:
“What if I took this kitchen knife and stabbed my spouse with it?”
“What if I swerved off the road and drove over those pedestrians?”
“What is wrong with me? Why would I think about hurting someone? Does this mean I’m evil?”
“Should I tell a doctor or the police about these thoughts? What if I really act on them? I don’t want anyone to get hurt.”
“I love this person, and I don’t want to kill them. But how can I be sure that I won’t?”
Sometimes, obsessions can be intrusive and violent images of harming someone. For example, you might picture what a violent scene might look like if you acted on your thoughts.
Harm OCD compulsions
Obsessions spiral and feel unbearable, which leads people with OCD to engage in compulsions. Compulsions can be either mental or physical behaviors.
Some examples of compulsions that someone with harm OCD might engage in include:
Conducting mental reviews, or repeatedly trying to review memories for “proof” that you aren’t a violent person
Compulsively avoiding or hiding anything that triggers obsessions; for example, you might hide all of the knives in the house to try to prevent yourself from imagining stabbing someone with them
Reassurance-seeking, or asking others repeatedly to confirm that you aren’t a violent person
Checking others and yourself to make sure that you haven’t hurt anybody
Performing mental rituals to try to convince yourself that you will not hurt anybody; for example, you might force yourself to think kind thoughts about someone to try to feel more confident that you won’t hurt them
How is harm OCD different from other types of OCD?
Harm OCD is differentiated by obsessions and compulsions that focus on causing harm to another person. You may have harm obsessions about yourself, but some experts categorize OCD around self-harm as suicidal OCD.
Most people with harm OCD have intrusive thoughts about losing control, acting violently, and hurting someone else. Meanwhile, other subtypes of OCD cause you to have intrusive thoughts about different fears.
For example, someone with contamination OCD could worry about getting sick. Someone with relationship OCD may constantly question their feelings about a partner.
What causes harm OCD?
As with most mental health conditions, there is no singular cause that leads to any type of OCD. There are some factors that can raise your risk for developing OCD, including:
Genetics
Family history
Brain chemistry and structure
Traumatic events
Perfectionistic personality
Low tolerance for uncertainty
There is no evidence that exposure to violence causes anyone to have harm OCD. Harm OCD is not linked, in any way, to violent behavior.
What are the best treatment methods for harm OCD?
Harm OCD can become unbearable if left untreated. But there are treatments that can help. Most experts recommend a combination of medication and therapy to manage OCD.
Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) have been found to be effective for OCD symptoms. These include:
Fluvoxamine (Luvox)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
A tricyclic antidepressant called clomipramine (Anafranil) can also help relieve OCD symptoms.
Medication is most effective for OCD when paired with therapy. The first-choice therapy for OCD is called exposure and response prevention, or ERP. It helps you increase your ability to tolerate intrusive thoughts without giving in to compulsions. With time, obsessions will hold less power over you.
One review found that over two-thirds of people with OCD experienced reduced symptoms with ERP, and around one-third had a full recovery. ERP can be scary, especially at first. If you’re having a hard time with ERP, there are other therapies that can treat OCD, including:
Other treatments that may be helpful for OCD include:
Non-invasive brain stimulation therapies, including transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT)
Other complementary medications, including haloperidol (Haldol) and tramadol
When should you seek help for symptoms of harm OCD?
Most of us have violent, intrusive thoughts from time to time. But if these thoughts are frequent, long-lasting, and cause you to feel overwhelming fear or shame, then it may be a good idea to get evaluated for OCD.
For example, you might have the thought, “It would be so easy to push this person down the stairs.” It’s common for people to have these types of thoughts. If you don’t live with harm OCD, you’d probably brush the thought off. You might tell yourself, “That was a weird thing to think. But obviously, I’m not going to push them.”
People with harm OCD can’t let these thoughts go. If you have harm OCD, they may cause you to feel extreme fear, guilt, and shame. You may spend most of your time thinking these thoughts. You may assign meaning to them, which could make them unbearable.
You may also spend a lot of time trying to get rid of these thoughts. You may feel extremely anxious about what they mean about you. You might repeatedly ask people to reassure you that you aren’t evil. Or you might engage in rituals meant to protect you or others.
If this sounds like you, consider seeking help. Remember that OCD isn’t likely to go away on its own. But with the right treatment, people can recover from these debilitating symptoms and live fulfilling lives.
The bottom line
Harm OCD can be terrifying to live with. If you experience it, you might feel plagued with thoughts and images of losing control of yourself and hurting people. These obsessions do not mean that you’re a violent or evil person. But without treatment, these symptoms aren’t likely to go away.
Research has identified several treatment options, including ERP and medication, that are effective at managing the symptoms of OCD. With the help of these treatments, you can recover and learn how to manage harm OCD thoughts.
Why trust our experts?
References
Cranmer, B., et al. (n.d.). Do I really want to hurt myself?
Hershfield, J. (2019). Overcoming harm OCD. Anxiety & Depression Association of America.
Hezel, D. M., et al. (2019). Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian Journal of Psychiatry.
International OCD Foundation. (n.d.). Subtypes of OCD.
Janardhan Reddy, Y.C., et al. (2017). Clinical practice guidelines for obsessive-compulsive disorder. Indian Journal of Psychiatry.
National Institute of Mental Health. (n.d.). Obsessive-compulsive disorder.
Pittenger, C., et al. (2005). Clinical treatment of obsessive compulsive disorder. Psychiatry.
Society of Clinical Psychology. (n.d.). Psychological treatments.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
