What is Harm OCD?


– Carolyn Moriarty, LCPC


What is OCD?


Obsessive-compulsive disorder (OCD) is an anxiety disorder that is characterized by the presence of obsessions and compulsions. 

  • Obsessions are thoughts, ideas or images that are unwelcome, upsetting and recurrent.
  • Compulsions are repetitive mental or behavioral rituals done to alleviate the distress caused by obsessions

Individuals will engage in repetitive mental or behavioral rituals (compulsions) that help them to feel that they are safeguarding themselves from these possibilities. These compulsions are effective in the short-term because they can immediately extinguish intense guilt, shame and anxiety. However, the relationship between obsessions and compulsions is cyclical, with one only serving to reinforce and perpetuate the other.


Characteristics of Harm OCD


People with Harm OCD experience intrusive thoughts or mental images related to causing harm to themselves or others. The nature of these obsessions are distressing and experiencing them on a daily can cause individuals to feel that they are inherently immoral or are likely to end up committing an immoral act.


Common Harm OCD obsessions include intrusive thoughts such as:

  • “I could drive my car into oncoming traffic/off a bridge with just a turn of the wheel.”
  • “Did I run somebody over with my car without realizing it?”
  • “What if I just dropped my baby on purpose?”
  • “What if I just lost control completely and harmed my family member/partner/pet?”
  • “Why am I thinking these horrible thoughts? Does it mean I want to act upon them?”


Common Harm OCD compulsions:

  • Locking kitchen knives in drawers
  • Avoiding certain family members
  • Checking news reports for stories of hit-and-runs
  • Retracing your steps to look for evidence of a car accident


Are These Thoughts Actually Dangerous?


No. In fact, intrusive thoughts are in direct opposition with one’s values and beliefs. The significant amount of distress they cause signals that the individual does not want to be having the thoughts and does not want them to come true. They completely contradict what a person would want to happen.

Thought Action Fusion

Thought-action fusion (TAF) is cognitive distortion that is commonly associated with OCD. This concept describes the mistaken belief that thinking about a negative event is morally equivalent to actually carrying out that event.

There are two main types of thought-action fusion:

  • Likelihood TAF: This involves the belief that thinking about a negative event increases the likelihood that the event will occur. For example, someone with might believe that having a thought about harming someone makes it more likely that they will actually harm that person.


  • Moral TAF: This involves the belief that having a specific thought is morally equivalent to carrying out the action. In other words, individuals with Harm OCD might feel intense guilt or responsibility for simply having a violent thought, even if they have no intention of acting on it.


Thought-action fusion is often the root cause of the distress many individuals with OCD experience because it causes them to question if they really are “dangerous” or “depraved”.  It is important to understand that thoughts are just that—thoughts. There is no deeper meaning or significance behind them, regardless of how much one searches to find it. If a thought causes worry, distress or anxiety, that is a good indication that it conflicts with your morals. Serial killers voluntarily think about injuring others and take pleasure in the thoughts. This is not the same as somebody who experiences significant distress and panic because they had the realization that they are physically capable of harming somebody.


Treatment for Harm OCD


Acceptance and Commitment Therapy (ACT)

The intolerance of uncertainty is very common for people struggling with OCD, and acceptance can be an integral part of treatment by learning how to tolerate feelings and thoughts that may have once seemed unmanageable.

ACT also targets thought-action fusion though the process of defusion, or creating distance or separation from one’s thoughts. Defusion involves recognizing that thoughts are just thoughts, not necessarily reflective of reality or something that requires immediate action.


Exposure and Response Prevention (ERP)

ERP is an evidence-based method of treatment within CBT. ERP exposes a person to a stimulus (i.e. person, person, thought or memory) that produces anxiety or discomfort. Throughout the exposure process, the individual is encouraged to actively resist engaging in their typical response to that trigger. This allows people to learn that their feelings of discomfort and doubts naturally subside on their own without them doing anything about it.





Seeking Mental Health Support

If you feel that you or a loved one may be experiencing some of the signs and symptoms associated with Harm OCD, consider scheduling an appointment with Chicago Counseling Center. Our therapists specialize in OCD and can develop an appropriate treatment plan tailored to your specific needs. Meet our team to learn more!


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