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What is Harm OCD?

Obsessive compulsive disorder, otherwise known as OCD, is an illness not as common as you might think. While people may describe themselves as “being OCD” about how they organize their kitchen cabinets or how often they ask houseguests to take off their shoes, OCD, in reality, only affects approximately 2% of the adult US population. In children, it’s less common, affecting 1 in 100.

OCD is not an illness marked by minor annoyance or a preference for having things ordered a certain way. Rather, it’s an illness that involves intense anxiety and extreme worries that, without treatment, dramatically interfere with the lives of sufferers.


The Basics of OCD

By definition, OCD is a mental illness that involves intrusive thoughts (obsessions) that terrify the suffer and force them to engage in rituals (compulsions) as a way to manage their felt dysregulation. These thoughts are egodystonic, which means they go against the sufferer’s values and true desires.

OCD is a cyclic disorder where checking causes more checking and leaves the sufferer feeling stuck in a pattern of obsessions and compulsions. The obsession appears right before the compulsion, which is performed to relieve the sufferer’s anxiety. Yet this relief is only temporarily; as a rule, OCD is never satisfied. Once the intrusive thought appears again, it requires the sufferer to engage in another compulsion. And each time the compulsion is performed, it validates the intrusive thought and gives OCD more power. Thus, the cycle is born.

One of the most common symptoms of OCD is a fear of germs, which generally manifests in handwashing. In this example, the cycle goes as follows: The OCD sufferer has an intrusive thought that their hands are dirty, the suffer washes their hands, the sufferer experiences temporary relief, the sufferer has another intrusive thought that their hands are dirty, the sufferer engages in their compulsion again, the sufferer experiences temporary relief until another thought comes along and the compulsions start anew. Each time the sufferer washes their hands, they validate their OCD and solidify the idea that their hands were contaminated in the first place. And this makes OCD worse: Intrusive thoughts ignite OCD but compulsions are the elements that keep it around.

What Exactly Are Intrusive Thoughts?

It’s impossible to have OCD without having intrusive thoughts, but you can have intrusive thoughts without having OCD. In fact, most people experience intrusive thoughts at one time or another; 85% of the population reports violent or graphic intrusive thoughts from time to time. The main difference between the OCD brain and the non-OCD brain is that those without OCD are able to dismiss their intrusive thoughts as nonsense. The OCD sufferer, conversely, takes their intrusive thoughts seriously.

Of course, giving the intrusive thoughts credence causes all sorts of anxiety in the OCD sufferer, which is where the compulsions come in. The sufferer engages in rituals as a way to “prevent” their intrusive thought from really happening or to “check” that it didn’t.

Even so, the OCD sufferer doesn’t totally buy into their intrusive thoughts; this is to say that they don’t really believe them to be true. But their OCD asks them “What if they are?” and this doubt, this uncertainty, is enough to cause terror and the subsequent anxiety. That’s why OCD is referred to as “the doubting disease” – a disease marked by a need to be 100% sure.

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The Specifics of Harm OCD

We used an example of handwashing above because a fear of germs is representative of the best well known type of OCD. But one of the most dangerous misconceptions of OCD is that there is only one type, or two types, or three types. In truth, there are several different types; theoretically, someone can suffer from OCD about anything. Some people may even suffer from a type of OCD that makes them wonder if they’re really alive.

Harm OCD is a subset of OCD that is largely unknown to the public and, more dangerously, it is also unknown to some mental health clinicians too. Harm OCD involves intrusive fears and worries about causing harm to others (there is another type of OCD, Suicidal OCD, that involves fear of harm to oneself).

Importantly, as previously mentioned, Harm OCD (like all types of OCD) involves egodystonic thoughts – there is no part of the sufferer that enjoys the thoughts or wants to act on their harm worries. The thoughts are not fantasies; they terrify, shame, and confuse the sufferer. This is among the biggest differences between those with Harm OCD and those who genuinely desire to hurt others. The latter derives pleasure from the idea of violence; Harm OCD sufferers find violence repugnant.

Intrusive thoughts of harm are common in everyone, regardless of mental illness status. But in those who suffer from Harm OCD, the thoughts are more frequent, more debilitating, more stressful, and more upsetting. The sufferer takes the thoughts seriously, which makes them profoundly horrifying.

The True Danger of Harm OCD

People with Harm OCD are not dangerous; typically, they’re even less likely to cause harm than those in the general population. The true danger exists in the ignorance that surrounds the disorder.

It’s believed that 1 in 3 therapists misdiagnose Harm OCD, labeling the suffer violent or dangerous, and threatening to report them to the police (and in some instances, doing so) or refusing to see them again. Sadly, there are cases where people with Harm OCD have had their children taken away from them.

Labeling someone with Harm OCD as a threat is a gross misunderstanding of the disorder and reporting them to the authorities is akin to reporting someone with Contamination OCD to the Center for Disease Control because they believe that they contracted HIV from touching a doorknob.

When this misdiagnosis takes place, the Harm OCD sufferer can go seek help elsewhere (albeit with a baggage of trauma), making sure they go to a therapist who actually understands OCD. But the sufferer must know that they have OCD in the first place.

And that’s one of the major problems with this kind of misunderstanding…..

Harm OCD flies under the radar, with most of the general population unaware it exists. Those who suffer from it are just as unaware and all they know is that one day they wake up and it feels like their life turned on a dime. They’re suddenly inundated with unwanted and intrusive thoughts of harm and they immediately begin to fear that they’re some sort of psychopath or a serial killer in the making.

If they go to a therapist who validates this fear by threatening to report them or painting them as a danger, this will only cause more terror and shame on the part of the sufferer and worsen their underlying disorder. It’ll also lead the sufferer to conclude that they’re evil, when in reality they’re suffering from a mental illness.

It’s not an exaggeration to say that therapists who misdiagnose sufferers of Harm OCD as being genuinely violent set those sufferers up for suicide and this has most certainly happened in the past. This is why therapists should not ever treat OCD unless they have specific training in all aspects of it, including the lesser known types.

Harm OCD Incidence

There aren’t a lot of solid statistics regarding the incidence of Harm OCD. Because it’s one of the most shameful types of OCD, many of those who have it don’t admit to it for fear of embarrassment or the fear of their obsessions being misconstrued as fantasy or desire.

Nonetheless, Harm OCD is believed to be a common flavor of OCD, which is why awareness surrounding it is even more important.

Common Harm OCD Obsessions

Harm OCD can look differently depending on the individual suffering from it. It may include thoughts involving the accidental or intentional acts of:

  • Running someone over with a car or truck
  • Poisoning someone
  • Pushing someone in front of a subway, train, amusement park ride, or into traffic
  • Throwing someone out of a plane
  • Throwing a child off a bridge or building
  • Stabbing someone
  • Strangling or hanging someone
  • Breaking someone’s neck
  • Pushing someone down the stairs or down an escalator
  • Contributing to the harm of another unintentionally (for example, someone with Harm OCD may drop a battery or pill outside and fear that a child will find it, swallow it, and choke or poison themselves)
  • Setting fire to a home or business
  • Shooting someone (those with Harm OCD may be averse to guns because of this reason and never own them. However, they may fear things like grabbing a policeman’s gun in a crowded stadium and going on a shooting rampage)
  • Smothering or suffocating someone
  • Going crazy and acting out in a rage (for this reason, many people with Harm OCD are very uncomfortable with their own anger, even under circumstances where it is necessary and valid)

Harm OCD, in general, tends to focus on people closest to the sufferer. Parents with Harm OCD, for instance, are often afraid of harming their own children. Others may find that their OCD focuses on marginalized or frail people, such as babies or the elderly. It may focus on strangers as well. Some with Harm OCD may have fears that focus on animals, rather than or in addition to humans.

Harm OCD, like all types of OCD, isn’t silenced by logic. A woman who suffers from OCD may still fear harming a man with her bare hands, even if he outweighs her by 150 pounds.

Common Harm OCD Compulsions

As previously addressed, the compulsions that OCD sufferers engage in are attempts to control their anxiety. In Harm OCD, some of the most common compulsions include:

  • Hiding knives, scissors, hammers, jump ropes, sharp objects, or anything that could be used as a weapon
  • Never owning or voluntarily being around firearms
  • Avoiding any cleaners with caustic ingredients, antifreeze, or yard solutions that are poisonous (many people with Harm OCD will keep all of these things out of their home)
  • Checking drinks for poison (the Harm OCD sufferer may sample the drink first, believing they’ll consume the poison if there is any)
  • Avoiding vulnerable people
  • Turning the car around to check for “dead bodies” whenever they hit a pothole or road debris (many with Harm OCD avoid driving altogether)
  • Avoiding matches, lighters, or lighter fluids
  • Keeping their hands in their pockets whenever they’re on escalators or around subways (the compulsion here helps the sufferer reassure themselves that they won’t push anyone down the stairs or in front of moving trains)
  • Asking others for reassurance
  • Checking others for signs of harm (checking for blood stains, neck bruises, or other wounds)
  • Checking the news for reports of hit and runs or unsolved murders
  • Researching serial killers to reassure themselves that they don’t have the same characteristics as people who are truly evil
  • Checking for signs of life (someone with Harm OCD may pass a person on the street and fear that they somehow killed them. So, they will look back to reassure that the person is still standing)
  • Checking for signs of death (someone afraid of stabbing a houseguest in the middle of the kitchen may search that kitchen for evidence of the imagined murder)
  • Testing themselves to make sure they won’t act on their obsessions
  • Avoiding true crime stories or violent movies for fear that the violence will put ideas in their head
  • Avoiding going out in public for fear that they’ll act on their obsessions
  • Making lists of their positive traits to reassure themselves that they’re not amoral
  • Performing mental compulsions that “cancel” out the violent thoughts
  • Praying, counting, or offering mental reassurance
  • Calling up old memories to check that they haven’t acted on any of their obsessions in their past

As previously noted, people who experience Harm OCD often have trouble expressing anger as they erroneously believe their anger will cause them to lash out or act violently. It’s not quite a compulsion but a subconscious OCD habit. As a result, they internalize their anger until it evolves into more anxiety.

What Causes Harm OCD?

OCD isn’t caused by one thing but occurs as the result of several complicating factors. Scientists have an idea of what’s behind it while also understanding what’s not behind it.

It starts in the brain, where people with OCD have minds that don’t function as normally as people without OCD. Communication between certain parts of the brain is compromised, which results in the sufferer receiving erroneous messages regarding the importance of their intrusive thoughts. Neurotransmitters, chemicals involved in neurotransmission, play a role in OCD, too. Sufferers often have low levels of serotonin (and may have genetic mutations that affect how well it’s transported). They may additionally have low levels of dopamine while having higher levels of glutamate.

Genetics weigh in as well: OCD tends to run in families, with 25% of those who have OCD having an immediate family member who has it. But genetics aren’t an end all be all – why one person genetically predisposed to OCD gets it while another person genetically predisposed does not remains a mystery.

Compulsions, a type of behavioral conditioning, don’t cause OCD, as sufferers engage in them as a result of already having OCD. But they definitely solidify the disorder.

How Dysfunctional Beliefs Affect OCD

While intrusive thoughts are a hallmark of OCD, the thoughts themselves aren’t really the root of the problem. As noted above, intrusive thoughts happen to everyone (though people with OCD experience them much more frequently). But OCD sufferers pay attention to these intrusive thoughts, giving them power and control. In other words, OCD possesses a peculiar and particular talent for making its sufferers buy into dysfunctional beliefs.

Per the Obsessive-Compulsive Cognitions Working Group, there are six different types of dysfunctional beliefs common in those with OCD. They include:

  • An overinflated sense of responsibility: OCD sufferers often believe that it’s up to them to stop negative outcomes or any potential danger that may affect them or others. This isn’t because the OCD sufferer sees themselves as omnipotent or possesses an inflated sense of self-importance; it fully comes from a place of stress, anxiety, and fear.

    In Harm OCD, this may manifest as the sufferer making it their responsibility to assure that nothing bad happens to their family. They may compulsively check their car tires to assure that they’re not over or underinflated (and therefore prone to popping or causing an accident). They may also feel the urge to clip the cords of their window blinds, fearing that they present a strangulation hazard to kids or animals.

  • Making meaningless thoughts meaningful: Sometimes called “thought-action fusion”, OCD sufferers believe that thinking about something is the same as doing it (or that thinking of something makes it more likely to happen).

    Someone with Harm OCD may imagine hitting a pedestrian while driving through a crosswalk and then believe that it really happened. This “thought-action fusion” may also manifest as believing that not doing something a certain way, such as praying a certain way or counting to a certain number, will result in a tragedy (such as an airplane crash or an earthquake).

  • Attempting to control thoughts: No one, whether they have OCD or not, is in control of their thoughts. Yet people with OCD try to be. This leaves the OCD sufferer engaging in activity like thought-stopping, where they attempt to stop their minds from thinking about their intrusive thoughts. Unfortunately, this makes the OCD worse as trying not to think of something is the surest way to make sure you do.

    In Harm OCD, the sufferer may look at a knife and imagine themselves stabbing their roommate. They’ll then go to great lengths to stop themselves from thinking this thought, perhaps hiding the knives (or anything else triggering).

  • Overemphasizing theoretical threats: Another commonality of OCD sufferers is their tendency to overemphasize any theoretical threat. This is potently problematic, since the OCD mind is highly creative and will see threats in everything; if you look for danger, you can really find it anywhere.

    In Harm OCD, a sufferer who leaves their child alone in the house for thirty seconds to run out to the mailbox will overestimate how much danger their child is really in. While it’s possible that a child could hurt themselves when left alone no matter how briefly, it’s highly unlikely. In the OCD sufferer’s mind, however, this unlikeliness morphs into a possibility, then a probability, and then a certainty.

  • Self-imposed perfectionism: Perfectionism is a bit confusing when it comes to OCD because you can be a perfectionist without having OCD. According to the stats, around 30% of the population are perfectionists (while only 2.5% have OCD). Still, perfectionism is a common trait in people who suffer from OCD and they’re often self-critical while placing high expectations on themselves.

    In Harm OCD, this belief may manifest as the need for utmost perfection in the areas that might compromise health or wellness. A seatbelt that’s too loose, for instance, may be enough to stop the OCD sufferer from driving their car or letting others ride in it.

  • No tolerance for uncertainty: OCD is a disorder that requires 100% certainty (99.9% certainty is not enough). Any slightest bit of doubt is enough for it to latch on, telling the OCD sufferer that something bad has happened or will happen.

    In Harm OCD, this belief may manifest as needing to be 100% sure in regard to safety. A sufferer who is having kids over to their house may child-proof their home to a degree that is overkill. For example, they may insert covers into all the outlets even when the children are nine or ten-years-old and well beyond the age that requires these kinds of precautions.

What Influences OCD’s onset?

It’s possible for OCD to appear in children, but it’s more than twice as common in adults. Yet adults with OCD can often look back and see that, while they might not have had a diagnosable disorder in childhood, they possessed the blueprint.

Under most circumstances, OCD pops up during two periods of life, late childhood/early adolescence (between 8 and 12) and early adulthood (around 19 or 20). Late onset, after the age of 50, is rare but not unheard of.

The onset doesn’t appear to be brought about by a specific trigger as a rule. Some people can trace it back to a traumatic event or a time of transition (it may be triggered by strep throat too), but many sufferers describe it as appearing out of the blue, turning on like a light switch.

What Doesn’t Cause Harm OCD?

Our understanding of the causes of all OCD, harm and otherwise, have evolved as we’ve gained more insight into the disorder. Once upon a time, it was believed that parenting played a huge role, especially in regard to potty training. Children with OCD were believed to be the result of moms or dads who dominated or shamed the child during toilet training.

Nowadays, parents aren’t believed to be a cause, outside of the genetics they pass down to their children. Families aren’t either, but they can make it worse in two ways. First, families who enable the OCD sufferer – offering them reassurance or helping them engage in their compulsions – can unwittingly make the disorder worse. Families who do the opposite – shame, humiliate, or criticize the sufferer – can make it worse as well.

Stress doesn’t play a role in creating it, though it can compound OCD in those who already have it.

In regard to Harm OCD specifically, being exposed to violence doesn’t cause it nor does any genuine underlying desire to harm. Harm OCD thoughts are egodystonic thoughts, which means they go against the sufferer’s desires, values, morals, and sense of self. This is why they’re so terrifying, anxiety-provoking, and unwanted.

In people with a genuine desire to harm, the thoughts are egosyntonic, aligning with their morals (or lack thereof). People with a genuine desire to harm are not bothered or tortured by their violent thoughts; they’re excited and enthused by them.

Misconceptions About Harm OCD

OCD, as a whole, comes with bags and bags of misconceptions, an entire luggage carousel, really. It’s largely marginalized by society and made to be a joke or painted as no big deal. Many people are unaware that OCD is a mental illness and instead they chalk it up to a personality quirk, personal preference, or anal-retentiveness.

Some of the most common misconceptions about OCD include:

  • There are only a few types of OCD (there are numerous types of OCD, some that haven’t been identified yet)
  • OCD is a minor illness that doesn’t interfere with the sufferer’s life
  • People with OCD are always concerned with contamination and engage in compulsions like handwashing (Harm OCD sufferers may suffer from Contamination OCD as well, but they may also have no contamination concerns at all)
  • OCD is driven by a desire to stay organized (OCD is driven by fear and anxiety)
  • People with OCD are rigid, particular, and hard to get along with
  • OCD is not debilitating (according to the World Health Organization, OCD is the tenth leading cause of disability worldwide. In young women (between the ages of 15-44), it ranks fifth)
  • Everyone is a little bit OCD (while people may have anxieties, worries, and OCD-like tendencies, for OCD to be OCD, it must present as a disorder that, without treatment, significantly disrupts the sufferer’s life. Thus, there’s really no way to have a “minor” version of it. However, many OCD sufferers find that their OCD gets better overtime with therapy and/or medication, going from a life-affecting disorder to one they can manage more easily)
  • OCD is a phase that will pass (without treatment, OCD almost always gets worse. Even with treatment, OCD can flare up again during times of transition, stress, or for no identifiable reason at all)

Not surprisingly, Harm OCD is one of the types of OCD that involves a rabid misunderstanding because of its subject matter. Sometimes, with therapists who don’t understand this type of OCD, their misconceptions are compounded by the duty of clinicians to report harm. But this duty requires therapists to report actual threats and legitimate dangers; Harm OCD is neither. The only person Harm OCD is dangerous to is the sufferer themselves as it invokes shame, disgust, and tends to have a high suicide rate.

People with Harm OCD don’t have their obsessions because they are bad; they have them because they are good. If they weren’t moral or ethical, the intrusive thoughts would not torment them like they do.

Other misconceptions about Harm OCD include:

  • Harm OCD reflects repressed anger
  • People with Harm OCD are at risk of acting on their obsessions (OCD sufferers never act on their fears)
  • Harm OCD is caused by exposure to violent movies or video games
  • Harm OCD always involves obvious compulsions (Harm OCD often involves some aspects of Pure O where the compulsions are mental and invisible)
  • Harm OCD is about “wanting” to hurt others (nothing could be further from the truth)

One of the greatest misconceptions about Harm OCD is that it’s rare. As discussed above, it’s difficult (and impossible) to say exactly how many people have Harm OCD as the shameful nature of the obsessions lures people into silence. But, because OCD attacks a sufferer’s values, it’s fair to assume that Harm OCD would be among the most common subtypes.

The health, wellness, and safety of loved ones and others is on the “high priority” list for many people, which makes it an easy target for OCD.

Some sufferers find that OCD morphs and evolves as their circumstances change. They may suffer from Responsibility OCD initially only to find that it eventually transforms into Harm OCD.

OCD is very much a disease that is always searching for the worst thing – the worst way to torture its mark. And, as a result, it’s always open to suggestion. Some people develop Harm OCD after becoming parents; their child becomes the most important thing to them and that’s why OCD latches onto it.

Treatment for Harm OCD

There is no magic pill that cures OCD, though there are medications that help. Typically, these are not prescribed alone but in a therapy/medication one-two punch combo. It’s believed that therapy and medication work better together than either element on its own.

Harm OCD, specifically, is treated the same way of all types of OCD, with some variations thrown in. Frontline treatment includes:

CBT with ERP: Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is thought of as the “gold standard” of OCD treatment and it’s where many therapists, psychologists, and psychiatrists start. During ERP, patients are encouraged to avoid compulsions around their intrusive thoughts.

ERPs can either be planned or organic. In the former, the patient purposely exposes themselves to a thought and refrains from engaging in their neutralizing action. Someone with Harm OCD who fears running people over may purposely drive down a neighborhood street filled with potholes and then stop themselves from going back to make sure the bump felt when running over a pothole wasn’t really representative of them running over a person.

Organic ERPs happen when sufferers let the thoughts come naturally (for most people with OCD, intrusive thoughts are so frequent that they never need to wait long for them to appear). Someone with Harm OCD who fears stabbing others may find that they have an intrusive thought while walking into a restaurant and spotting a steak knife laying on the table. They’re asked to let the thought come and go without engaging in their compulsion – they’re instructed to refrain from checking fellow diners for signs of stab wounds, to refrain from checking the knife for signs of blood, and to refrain from asking for reassurance from anyone around them.

In both instances, the sufferer is asked to refrain entirely, and not just in the moment. The driver who ran over the pothole is asked not to go home and check the police blotter or news reports for hit-and-runs and the restaurant-goer is asked not to check the police blotter or news for reports of stabbings at the local Applebee’s.

On paper, it seems easy and simple enough but – in reality – ERPs are extraordinarily hard to do and people with OCD rarely bat .1000 when doing them. Sometimes, they’re able to and, sometimes, they give into their anxiety and perform their compulsion because the stress is just that overwhelming. As long as they stick with it – and follow through with ERPs more than they cede to OCD – they should make progress.

ERPs are a way to change the brain’s perspective on intrusive thoughts. By not engaging in the compulsion, the sufferer begins to see the thought as merely a thought and not something real or valid. The more they see this, the easier ERPs become.

Medication: Medication doesn’t work for everyone, but it does work for most: 70% of people with OCD respond. Pharmaceuticals rarely make OCD go away entirely, but they do make the thoughts less terrifying and help the sufferer perform ERPs. In this sense, medication is not a cure but it is a tool in the patient’s arsenal.

Having said that, it’s not unusual for people to try multiple medications before they find one that works. Part of this has to do with the number of brands that help OCD; there are many. The other part has to do with an individual’s genetic makeup. Some people metabolize drugs faster or slower than what is normal and this can impact a drug’s efficiency while potentiating side effects.

People can either be poor metabolizers, intermediate metabolizers, extensive metabolizers, or ultra-extensive metabolizers (also called “ultra-rapid metabolizers”). Most people are extensive metabolizers and drugs are designed for them. But those who are poor/intermediate or ultra-extensive may experience issues when taking specific types of medications (including antidepressants).

Poor/intermediate metabolizers metabolize drugs at a slower rate than normal. This increases levels in the body and increases the risk of side effects and overdose. Most often, poor/intermediate metabolizers require lower doses than what is usual.

Ultra-extensive metabolizers have genetics that do the opposite: They metabolize drugs quickly, lowering the levels in the blood and making the drug less effective. It may be recommended that ultra-extensive metabolizers take higher doses of the drug to remedy this challenge, but that’s not always feasible (as higher levels aren’t always safe).

When able, it’s recommended that people know their genetic status before they begin any OCD medication; knowing the type of metabolizer lowers the need for trial and error while decreasing the risks of consuming a drug with adverse effects. A simple saliva test can provide consumers with their genetic road map; in many cases, this is covered by insurance.

OCD sufferers who have preexisting conditions or who take drugs for other problems face additional challenges. Some OCD drugs can’t be prescribed with other pills and some people with serious medical conditions, such as heart defects, heart disease, or diabetes, may be encouraged not to take any drugs that cause hypertension or arrhythmias. Children, teens, and young adults may be advised against some antidepressants as they can increase the risk of suicide in young people.

Even with all the above, the most common medications prescribed for OCD are Serotonin Specific Reuptake Inhibitors (SSRIs); these are antidepressants that increase serotonin in the brain. They tend to work in OCD sufferers since low levels of serotonin or a problem with its transport in the body are commonly linked to OCD.

SSRI drugs include:

Serotonin-Norepinephrine Reuptake Inhibitors (which are essentially cousins of SSRIs) may be used as well; these work by enhancing serotonin and norepinephrine. Anafranil (or Clomipramine), a tricyclic antidepressant, is regularly prescribed too. It’s believed to be one of the most effective medications for OCD, but it does have a propensity for unwanted side effects (such as weight gain).

Off-label medications are occasionally used to manage OCD, increasingly so. They’re not explicitly approved for OCD, but they are believed to be effective from first-hand accounts and anecdotal reports. Some of the ones prescribed include:

ACT Therapy: ERP is the most called upon type of therapy but Acceptance and Commitment Therapy (ACT) is hot on its tail. ACT treatment focuses on the acceptance of the intrusive thoughts and the emotions they elicit. With ACT, the OCD sufferer is encouraged to view their thoughts as nothing more than thoughts. They may do this more effectively by making use of visual images (such as picturing the thought on a movie screen or TV set).

At its heart, ACT relies on a combination of acceptance, mindfulness, psychological flexibility, and self-compassion. Suffers are told to view their thoughts as dispassionately as possible, letting them come and go as they please without reacting to or analyzing their content.

In Harm OCD, the sufferer may have an intrusive thought where they imagine grabbing a jump rope from a child and strangling them with it. Rather than reacting in fear, checking the child for signs of life, or throwing the jump rope away to avoid the thought in the future, the sufferer is taught to remind themselves that they are having a thought. They change the intrusion from “I grabbed a jump rope and strangled that child” to “I’m having the OCD thought that I grabbed a jump rope and strangled that child.” The difference is subtle, but it speaks volumes.

Lifestyle: OCD is rarely controlled without professional help and/or medical treatment but lifestyle does help manage it to some degree.

Because OCD is exacerbated by stress, limiting stress (or, even better, eliminating it) can help keep symptoms in check.

For this reason, it’s recommended that OCD sufferers:

  • Eat a diet rich with fruits, vegetables, protein, and whole grain
  • Exercise routinely
  • Practice mindfulness, meditation, or yoga
  • Limit coffee and other caffeinated drinks
  • See a therapist weekly
  • Seek out support groups (for Harm OCD, support groups are most helpful when other members also have Harm OCD)
  • Maintain social relationships and speak to their friends and family about their thoughts and feelings
  • Limit alcohol (it’s believed that 25% of people with OCD eventually develop a substance abuse disorder, perhaps as a way to self-manage their illness)

TMS: A new form of treatment is Transcranial Magnetic Stimulation (TMS). TMS is a procedure that is more commonly used to treat major depressive disorder but some providers are now using it to treat OCD. While the research shows that it’s effective, most insurance companies still consider TMS for OCD experimental and, as such, won’t cover it. This should change as more studies come in.

TMS is not invasive as some people fear. Rather, it makes use of magnets to access deep areas of the brain that are associated with OCD. It requires five-days-a-week treatment for a period of 4-6 weeks as well as a maintenance program for optimal results.

Finding a Harm OCD Therapist

There are many therapists who treat OCD when they shouldn’t; they’re not specially trained in it and don’t understand enough about it. While it’s damaging and traumatic for anyone with OCD to see an unqualified clinician, it has the potential to be worse for those with Harm OCD and other taboo types.

If the therapist erroneously assumes that the sufferer is truly violent, the results can be tragic. And they can also leave the sufferer so rattled that they won’t seek help again.

Our self-help OCD therapy course has helped 1000s of OCD sufferers since 2018.

"My OCD is finally manageable"

Jennifer S


JJ Keeler

JJ Keeler is a writer and illustrator living in Colorado. She is a mom, coffee-lover, and dog servant. She has battled with harm OCD since college, which made her become one of the most knowledgeable minds on OCD, and inspired the writing of the memoir I Hardly Ever Wash My Hands: The Other Side of OCD.

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