What Is Harm OCD?

Key Takeaways

• Harm OCD is a subtype of Obsessive-Compulsive Disorder characterized by intrusive thoughts of harming oneself or others.
• Having violent or disturbing thoughts does not mean you are dangerous. In fact, people with Harm OCD are often among the least likely to commit violence.
• The problem lies not in the thoughts themselves, but in the compulsions and attempts to neutralize or control them.
• Effective treatments include Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT), both of which focus on changing your relationship with thoughts rather than eliminating them.
• Recovery involves accepting uncertainty, reducing compulsions, and reconnecting with what truly matters: your values, relationships, and daily habits.

Disclaimer: This article is for educational purposes, not medical advice.

Harm OCD: The Fear of Causing Harm to Others

Picture this: you are walking along a tall cliff overlooking the ocean as the sun sets on the horizon. It is a beautiful evening, and you are lucky to share it with a loved one: a sibling, parent, or partner. They step close to the cliff and a thought flashes in your mind: “What if I push them down the cliff?”

Most people quickly discard such thoughts as nothing more than mental noise. A few of us, however, are not able to let go of them so easily. “Do I actually want to push them down? What if I’m not able to control myself next time and end up killing them? Am I secretly a cold-blooded psychopath capable of hurting my loved ones?” 

Sometimes accompanied by unpleasant physical sensations, like an increase in heart rate or changes in body temperature, these thoughts exemplify what a person with Harm OCD might experience when triggered.

The most important thing to remember is that having these thoughts does not mean the person is any more likely than anyone else to commit horrible acts like pushing their loved ones down a cliff. 

What Is Harm OCD?

Harm OCD is a condition that leads to excessive worry about harming others or oneself. It is a common OCD subtype, with 31.8% of NOCD members having Harm OCD in 2023.

People with Harm OCD worry that, given the right circumstances, they might be capable of committing heinous acts. Their fear is often triggered by intrusive thoughts, such as the mental image of stabbing someone. 

Thoughts of this kind are very common. Most people have similar thoughts several times throughout their day, but a filtering mechanism in the brain quickly labels these thoughts as “noise,” allowing them to go on with their lives unaffected. 

In people with Harm OCD (and OCD in general), the mind has a harder time letting go of intrusive thoughts. Instead of filtering them out as meaningless mental noise, the brain locks onto them, giving them more attention and urgency than they deserve. This heightened focus often leads to compulsions that lower the person’s quality of life.

But here’s the important part: the intrusive thoughts and the brain’s sensitivity to them are not the real problem. What truly drives the cycle of OCD is the response to the thoughts. When someone begins to fear, avoid, or fight against these thoughts, they develop a strained relationship with their own mind and turn to compulsions for relief. And it is these compulsions, rather than the thoughts themselves, that create lasting harm.

What Harm OCD Is Not

Harm OCD is not driven by intent; it is driven by anxiety. What fuels the condition is the person’s worry that they might be capable of doing something horrible, NOT an actual desire or intent to do it. 

In fact, the person worries so much about harming others (or oneself) because they have a deep aversion toward violence or causing harm. In other words, they worry because not harming others is a deeply held value.

People with Harm OCD are among the least likely to act on violent thoughts because the thoughts horrify them

People with Harm OCD and other subtypes of OCD are the least likely people to commit the heinous act they worry about so much. Professor David Veale, a leading expert in OCD, said in a BBC interview that there are no recorded cases of people with OCD acting on their intrusive thoughts.

What Causes Harm OCD?

There is no single factor that determines whether a person will develop Harm OCD or not. Rather, the condition is likely caused by a combination of factors, with the most common ones being genetic predisposition, brain chemistry, and having experienced traumatic life events. 

Common Harm OCD Obsessions

The most common obsessions in Harm OCD involve hurting someone loved by acting violently or impulsively. The person fears losing control and harming someone who is precious to them. They may get mental images of attacking someone.

Another common harm obsession is believing that you have already done something horrible even if there is no evidence to that effect. This is known as false memory OCD.

The Compulsive Mind: What Is a Compulsion and What Types Are There?

Compulsions are how people with OCD respond to their anxiety and worrisome thoughts. They are “solutions” that never actually work. 

Unconsciously, we engage in compulsions to eliminate that nagging feeling of anxiety. And it works, but only briefly. In the long term, the obsession remains because the underlying issue has not been resolved: we are still engaged in a tug-of-war with ourselves, desperately trying to convince ourselves that whatever we fear won’t come to pass. 

Compulsions can take on many forms, but here are the most common ones.

• Rumination: Rumination is the act of thinking about the same thing over and over to find a solution to an obsession. A person with OCD can ponder over the same questions for hours in a desperate bid to find release from their anxiety. 
• Reassurance seeking: This involves asking a family member, a friend, or even a therapist about an obsession or worry in an attempt to get them to say that everything is OK. Like rumination, the person finds temporary peace but it is never long-lasting as the underlying issue has not been addressed.
• Self-assurance: Sharing the same DNA as rumination, self-assurance involves a relentless effort to convince yourself that you are safe to be around. People silently tell themselves that they would never hurt anyone. 
• Avoidance behaviour: People with Harm OCD may avoid knives or other sharp objects for fear that they may lose control. They may avoid activities where they could potentially harm people, such as driving. Staying away from certain people is also common. 
• Checking your thoughts: People with Harm OCD may be hypervigilant about their thoughts in an attempt to convince themselves they are safe to others and to themselves. They may constantly check that they are not thinking about harming others. In some cases, the checking can happen outside their mind. A person may visit the place where they fear they might have done something horrible. 
• Ritualistic behavior: Praying, reciting mantras, or engaging in rituals are telltale signs of OCD and also common among people with the harm subtype.
• Thought neutralization: This ritualistic behavior consists of replacing a bad thought with a good one or canceling out a “negative” thought by saying or visualizing something else.

Why Compulsions Don’t Work

Compulsions don’t work because they perpetuate the same mentality that created the problem in the first place. We experienced an intrusive harm thought. Our fear and reluctance to accept the possibility of such thought coming to pass leads us to engage in compulsions, driving us ever more deeply into the fear-based mindset. 

There’s a quote often attributed to Einstein (whether or not he actually said it is debated) that captures the idea beautifully: “We can’t solve problems by using the same kind of thinking we used when we created them.”

A compulsion is exactly the kind of solution Einstein warns us about: a fix based on fear, the very feeling that gave rise to the problem in the first place.

Why Harm OCD Feels So Real: Thought-Action Fusion

What makes it possible for intelligent individuals to get “tricked” by their own minds into believing they are capable of unspeakable acts? The answer lies partly in a concept called thought-action fusion. 

Thought-action fusion (TAF) is a cognitive distortion where the person believes thought and action are one and the same. In other words, they believe because they had the thought, they are already guilty of committing the act, at least in a moral sense, or that they are much more likely to do it in the future.

You are not your thoughts. The fact that they distress you is proof of your empathy and conscience

It is worth noting here that Harm OCD fears and obsessions are often ego-dystonic, targeting the person’s most cherished beliefs and values. As such, a mother who firmly believes parenthood is sacred may have thoughts of harming her own children.

The Role of Uncertainty

Harm OCD and other types of OCD point to difficulty coping with uncertainty. Although the horrible thought is very unlikely to come to pass, the mind fixates on the small chance that it might. The goal is to learn to live with uncertainty while choosing to move on.

Overcoming Harm OCD

Breaking free from Harm OCD involves coming to one conclusion: the usual “solutions” have never worked, and only contribute to the problem. Compulsions provide only temporary relief, like scratching an itch. However, in the long run, the itch just grows.

Progress can only be achieved when the person faces their obsessions and fears head-on while avoiding compulsions, a principle that is to some extent incorporated in all effective OCD therapies and that has been developed into Exposure and Response Prevention (ERP) therapy, the most effective treatment against OCD.

Here is a quick guide to ERP and other effective therapies. It’s worth noting that medication can also be used to treat OCD, most often in combination with one of the therapies discussed below. The most commonly prescribed medications are SSRIs, which stands for selective serotonin reuptake inhibitors.

ERP

To this day, ERP remains the gold standard for treatment of OCD and its subtypes. A study from the University of Pennsylvania found that around 80% of people respond well to ERP. ERP is a specific form of Cognitive Behavioral Therapy, which we will discuss below. It is based on a simple concept: exposure to obsessions or fears without engaging in compulsions. 

Repeatedly facing our troublesome thoughts or triggers while avoiding compulsions helps us build tolerance and acceptance. While ERP can be done on your own if you are willing to invest the necessary time, it is recommended that you work with a therapist who specializes in ERP. Together, you will come up with a list of triggering situations and face them one by one, usually starting with the more manageable ones and taking on more difficult ones as you progress.

CBT

Once upon a time, Cognitive Behavioral Therapy (CBT) was considered the primary treatment for OCD. Today, many therapists still use CBT, but they often pair it with more specialized approaches like ERP or ACT.

CBT focuses on examining and challenging problematic thoughts. The difficulty is that, in OCD, many intrusive thoughts are irrational by nature, and trying to “figure them out” can unintentionally feed the cycle of rumination. The real issue is not the thought itself but the compulsive way we respond to it.

That said, CBT can still be very helpful, especially for understanding your thinking patterns and the origins of your fears. 

ACT

Acceptance and Commitment Therapy (ACT) is based on two principles. First, your thoughts and emotions are not the problem; the problem is how you relate to them. Second, the secret to a healthy and fulfilling life lies in values. 

ACT first teaches you to accept your thoughts and emotions so that you can move past them and then helps you define your values so that you can apply them to lead a life that’s truly meaningful to you.

Beyond Therapy

As the success of therapies like ERP points to, the key to recovery lies in normalizing intrusive harm thoughts. Your goal should not be to eliminate these thoughts completely, but to change your relationship with them. 

Instead of treating an intrusive harm thought as a threatening intruder who just broke into your home, you start regarding it as a slightly annoying visitor. You let them into your home, observe them with curiosity, and allow them to leave of their own accord.

This shift in mentality can be extremely liberating. To many, it feels like a huge weight has been lifted off their shoulders, and they can finally start living. 

To attain this relationship with your obsessive thoughts, therapy is key. ERP and ACT are invaluable tools in the recovery of anyone living with OCD. However, other practices and daily habits can also contribute immensely to your recovery.

Join a community

A great way to break the illusion created by intrusive harm thoughts is to realize that you are not alone. Becoming part of a group that discusses OCD and difficult thoughts openly gives you an opportunity to share your experiences as a form of exposure and to learn from others’ experiences.

ACT for the Public is a free email list where you’ll gain insight into what others out there struggle with. You will undoubtedly identify with many of the people posting and will quickly realize that you share some of the same unhelpful thinking patterns. This is a great exercise for unraveling the complex mechanisms that lead to OCD.

Educate Yourself

Learning about OCD will undoubtedly diminish the power of your intrusive thoughts. As you learn more about how the brain functions and the patterns and habits that people living with OCD share, you’ll be less vulnerable to intrusive thoughts and obsessions. Here are a few great resources to help you understand OCD.

• The OCD Stories podcast: Tune in to this podcast to hear first-person accounts of people living with OCD and their recovery journeys. The podcaster, a counselor from the UK, often invites other therapists and researchers to discuss their experiences treating OCD.
• Overcoming OCD by David Veale and Rob Willson: This is a seminal work in the treatment of OCD authored by leading practitioners. Read it once to understand the condition, and then reread it carefully to work through all the exercises at your own pace, including ERP.
• A Liberated Mind by Stephen Hayes: A superb introduction to ACT, this book is meant to be a companion in your recovery journey. It guides you in defining your values, applying them in your life, and letting go of old thinking patterns to enhance your mental flexibility and well-being.

Work on Mindfulness

It is a shame that mindfulness has been co-opted by mass media and turned into just another buzzword. But there is truly something of importance in the concept of mindfulness; something that can benefit anyone, but particularly people who exhibit OCD-like thinking patterns.

With enough meditation and self-reflection, you can begin to spot intrusive and repetitive thoughts earlier and earlier, limiting their impact just that bit more every time. Here are some practices that anyone with OCD can benefit from:

• Daily meditation: As simple as sitting down every day for 15 minutes. Slightly blur your vision and set your gaze on a point around 6 feet in front of you. Focus on your natural breathing. Start watching your thoughts come and go. Crucially, don’t try to stop them. As soon as you notice a thought, acknowledge it and return to your breathing.
• End-of-day reflection: This is an ancient practice popularized by the Stoics. At the end of your day, once you’ve dispensed with your daily duties and have some downtime, sit in a quiet corner and go over your day. Mentally rework your steps since you woke up in the morning up until this very moment. While the Stoics focused on their relationships and how they managed their interactions with others (“How could I have been kinder to such and such?”), you can also choose to focus on the different thoughts and mental states that you experienced throughout. This will help you be more in touch with what’s actually happening in your head.
• Daily tasks: Picking a few tasks where you commit to being as present as possible is an excellent way to strengthen your mindfulness muscles. Just pick three activities to start with. A few good examples include brushing your teeth, cooking dinner, or folding your clothes.

Strengthen Your Connections

Humans are social creatures. A lack of deep, meaningful connections with other people contributes to many pathologies (and sometimes causes them), OCD among them. Nurturing your current relationships and forging new ones that are meaningful to you strengthen your support network. 

Our support network can mean the difference between a healthy and an unhealthy psyche. This is backed by science: a 2018 Nature Neuroscience study by Marco Venniro and colleagues found that rats were much less likely to abuse methamphetamine and heroin if they had access to social interaction. 

Get the Basics Right

It is amazing how much impact the basic, everyday things we often take for granted can have. Getting a good night’s sleep, eating a balanced diet, and maintaining a healthy work–life balance may not solve all your problems. However, if you live with OCD, these habits have a good chance of easing some of your symptoms. If you are not doing them already, this is the place to start.

What Harm OCD Teaches Us About Life

Having Harm OCD, or any other type of OCD, is debilitating to the extreme. The upside is that those who have this condition can become very resilient and capable of navigating other challenges successfully. 

There is also a lot to be learned by reflecting on the thinking patterns that people with OCD have in common and why they affect them negatively. Here is what I consider the biggest lessons OCD has to teach us:

• Embrace uncertainty and give up the illusion of control
• Focus on what you can actually control: yourself and your actions
• Don’t run away from your problems or fears: face them!
• Expect the worst and learn to be comfortable with it
• Life is too short to overthink so get busy!

Harm OCD: FAQ