Why Harm OCD is More Complicated Than You Might Think
Harm OCD shows up as a thought like "What if I stabbed someone?" or "What if I jumped?" and then your brain treats that thought like a warning. It's one of the most upsetting kinds of OCD, and one of the most misunderstood.
By Nathan Peterson, LCSW, OCD therapistPeople with harm OCD obsess over the possibility of harming others
Harm OCD brings unwanted thoughts, images, or urges about hurting someone, often the people you love most. Some common ones:
- "What if I grab the knife and hurt my partner?"
- "What if I push someone in front of the train?"
- "What if I hurt my baby?"
- "What if I swerve into another car?"
- "What if I snap and lose control?"
The thoughts feel awful because they're the opposite of what you want. If you have harm OCD, you're usually the one working hardest to keep everyone safe.
They may also obsess over the possibility of harming themselves
Harm OCD can also point inward: "What if I jump off this balcony?" or "What if I lose control and hurt myself?" The thought scares you, and you pull back from the edge. That fear is what separates it from wanting to hurt yourself.
If you're having thoughts of wanting to die or hurt yourself, that's different from harm OCD. Please call or text 988 in the US, or your local emergency number, right now.
What harm OCD compulsions look like
- Hiding knives, scissors, or medications
- Avoiding being alone with kids, pets, or a partner
- Checking that everyone is OK
- Replaying the day to make sure you didn't hurt anyone
- Asking people if they think you're dangerous
- Searching online for "signs of a psychopath"
- Pushing the thought away or saying a "safe" phrase
Each one feels protective, but each one tells your brain the thought was real danger, so the next thought hits harder. For the full list, see harm OCD symptoms.
Where does harm OCD come from?
No one knows exactly what causes OCD. Genes, brain differences, and stress all seem to play a part. Harm OCD isn't caused by anything you did, and having the thoughts doesn't say anything about your character. It picks harm because being safe and kind matters to you.
How harm OCD is treated
Exposure and response prevention, or ERP therapy, is the main treatment for harm OCD. You don't argue with the thought or try to prove you're safe. Instead, you slowly get closer to what OCD tells you to avoid, and skip the checking and reassurance.
- Cook dinner with a knife on the counter.
- Hold the baby, even while the thought is there.
- Read a news story about a crime without checking your feelings.
- Let the thought stay without saying it's "not true."
I know, putting the knife back on the counter feels like the most irresponsible thing you could do. It isn't. Hiding it is what tells your brain you're dangerous.
The goal isn't to feel sure you'd never do it. The goal is to let the thought come along while you live your life.
Common questions about harm OCD
Does harm OCD mean I secretly want to hurt someone?
No. Harm OCD sticks to the things you care about most. The thoughts upset you because they go against who you are. That upset is a big part of what makes it OCD.
Will I act on my harm OCD thoughts?
Harm OCD is about the fear of acting, not a wish to act. The checking and avoiding come from trying to make sure it never happens. If you ever have thoughts you want to act on, that is different, and you should talk to a professional right away.
Should I hide the knives?
Hiding knives, avoiding the baby, or staying away from edges are all ways of avoiding, and avoiding teaches your brain the thought was dangerous. In ERP, you slowly go back to these things, at a pace you can handle.
How is harm OCD different from suicidal thoughts?
With harm OCD, the thought of hurting yourself scares you, and you work to keep it from happening. Suicidal thoughts usually come with wanting to die or feeling hopeless. If that sounds like you, call or text 988 in the US right now.
