Having a violent thought, does not mean you are violent. Obsessive compulsive disorder is an anxiety disorder that has intrusive thoughts and images that are ego-dystonic. This means that the content and theme of the thoughts are against the persons values, self-image and desires. This is why those with OCD get stuck in thought loops and compulsions in hopes to prevent these fears from happening. Obsessions and compulsions take up a significant amount of the day (at least one hour) and cause significant clinical distress.
Individuals with harm OCD subtype experience intrusive thoughts, images and urges related to fear that they might cause harm to themself or others. Hours of the day are often spent worrying, evaluating and ensuring safety, avoiding moments that harm to someone could happen and feeling shame and distress due to the nature of these thoughts. Someone with harm OCD will do everything they can to prevent harm, the subtype is not an indicator that they are a dangerous person at all.
Common presentations
Fear of harming others:
This can present with intrusive thoughts surrounding driving a car and intentionally swerving into traffic, being around knifes or sharps, fear of snapping and losing control and avoiding holding babies amongst many others.
Fear of harming self (without suicidal intent):
This can present with intrusive urges to jump from a ledge, step into traffic, panic near sharp objects, and may include safety planning with family or friends or avoiding situations that would trigger these thoughts.
Accidental harm fears:
Common obsessions include worries they may have hit someone with their car and not noticed, excessively checking appliances as to not cause a fire, reviewing past events to ensure no harm occurred, fearfulness of offending or hurting the feelings of those around you.
Often those with harm OCD are so fearful they could cause harm to others, they believe even thinking these thoughts could increase the likelihood of these obsessions happening. This is called thought-action-fusion.
There is a great deal of worry related to inflated responsibility and often individuals over-estimate potential triggers in hopes to reduce this uncertainty of harm. Obsessive compulsive disorder at its core is a doubting disorder. This means that someone with harm OCD is filled with feelings of uncertainty, doubt and worry that they could cause harm and they will spend hours engaging in compulsions in hopes to gain certainty that it will never happen.
Common compulsions:
- Avoiding knives
- Avoiding highways
- Avoiding balconies or ledges
- Seeking reassurance
- Checking the news (to get reassurance they didn’t cause harm unintentionally)
- Mental reviewing
- Neutralizing thoughts
- Repeating phrases (“I would never do that”
- Testing yourself around triggers or agreeing with the intrusive thoughts to prove there is discomfort and short term feel reassured
- Googling symptoms of psychopathy
Having violent intrusive thoughts does not make someone violent. In fact, in harm OCD, the opposite is usually true. The thoughts feel unbearable precisely because they clash so strongly with the person’s character.
OCD is a disorder of doubt, not desire. It is fueled by fear, not intent.
Evidence-based treatments like Exposure and Response Prevention help people step out of the cycle of monitoring, neutralizing, and self-policing. Recovery isn’t about proving you would never hurt someone. It’s about no longer needing to.
Reach out to us at Lux Behavioral Health if you are located in Rhode Island or Massachusetts and struggling with OCD. We provide specialized treatment for OCD, anxiety and related disorders and we are here to provide help.
Lux Behavioral Health 