Harm OCD is like the latest horror flick, except starring you as the lead with your loved ones in supporting roles. It is slated for limited release in your own head. The plot: predictable.
• An upstanding family member suddenly “snaps” and goes on a murderous rampage.
• A crazed lunatic begins mowing pedestrians down in a car.
• A closeted killer is on the prowl in a quiet neighborhood looking for their next victim.
It has the semblance of a modern Hollywood production – special effects and all. False impulses, memories, and backdoor spikes make it seem real. You get the knot in your stomach, the rapid heart rate, the unrelenting sense of doom. It’s the kind of sensations you would expect at the epitome of suspense – that moment some helpless victim is turning a dark corner. Except it doesn’t subside. The climax prolongs indefinitely, as if stuck in a loop. Your mind is racing, trying to figure out what happens next; trying to separate fiction from reality. You question everything but answer nothing. It’s a perpetual state of misery, guilt and detachment.
Abandon hope all ye who enter here
Harm OCD is a subtype of OCD that 99.9% of the population has never heard about. As far as the public is concerned, “OCDers” spend their day barricaded in a bathroom scrubbing away at their hands or compulsively aligning things with geometric precision. Harm OCD is the same beast, but the content of the obsessive thoughts is different. Instead of worrying over germs, Harm OCDers obsess over whether or not they will lash out violently. Some examples would include swerving into an opposing lane, running over a pedestrian, or stabbing someone. To confine the description of Harm OCD to “worry” over violent thoughts would be a gross oversimplication.
Harm OCD is a complete sensory experience. You have the visuals – repetitive images of committing some horrible act (the looping horror movie). The “voice” of the OCD in your head urging you to do all sorts of revolting things (not to be confused with auditory hallucinations). The emotional torment from guilt and anxiety. Periods of flat affect from limbic system overload. Detachment from the present as your mental faculties converge onto the task of “unveiling” your lunacy.
Harm OCD sufferers also report feeling “urges” or “impulses” to commit a violent act. These impulses invite deep introspection that ultimately prolongs the OCD. Analyzing feelings, past behaviors and moral beliefs are all common. This behavior is what differentiates Harm OCD from other disorders, like psychopathy. The thoughts and sensations that the OCD generates are ego-dystonic, or inconsistent with the person’s character. The sufferer may report not knowing whether the thoughts are unwanted or not, but the unrest this self-doubt causes once again points to OCD.
All or only some of these obsessive elements may be present in any given case of OCD. However, the goal of OCD’s gimmicks is always the same: to entice compulsive behavior. Compulsions are used to alleviate anxiety caused by a rift between the person’s character and the content of the obsessions. They can be as nonsensical as touching a car door four times, to something less overt like mentally reciting bible passages. The OCD sufferer performs these behaviors to ward off some anticipated danger. These behaviors complete the OCD cycle by “flagging” the obsessions as significant. You can read more about compulsions here.
The therapeutic approach between various genres of OCD is identical. Learning to identify cognitive distortions to gain a more grounded view of the obsessional thoughts and performing exposure exercises are both crucial to achieving remission. Harm OCD thoughts are often riddled with distortions including magical thinking, magnification (especially with past events), and emotional reasoning. Identifying and re-structuring these thoughts can reduce anxiety and thus the temptation to perform compulsions. Suppose the OCD tells us that if we don’t touch the car door four times we will accidentally run someone over. We can retort with a logical argument drawing from past experience (ie. I drove my car several times in the past without touching the door and never ran someone over). These thought restructuring exercises must be practiced diligently. Cognitive re-structing will help you build up towards accepting your harm thoughts, which must happen in order to achieve remission. Acceptance means you tolerate their presence without trying to analyze their meaning or perform other compulsions.
Exposure exercises are very challenging with any form of OCD, but must be seen through to conquer the OCD. If you suffer from harm thoughts about family members, try to spend increasing amounts of time with them each day (especially during anxiety-provoking situations like dinner). Refrain from doing compulsions by restructuring any disturbing thoughts and trying to stay engaged. In time (think in terms of months), the anxiety will slowly diminish and you will function much better in these situations. The thoughts will become less frequent and the anxiety short-lived.
Once you learn to deal with one genre of OCD, you skill set can be extrapolated to others. The new theme may startle you in the beginning, but you will be able to see it for what it is.
CBT Therapy for Harm OCD
Working with a therapist brings the following benefits:
• Structured treatment plan
• Increased accountability
• Opportunity for interaction with other OCD sufferers
• Expert advice to address questions/concerns as treatment progresses
A competent therapist can help Harm OCD sufferers really push the boundaries (in due time) during exposure exercises. In the same vein, regular homework exercises of incremental difficulty keep the sufferer from becoming overwhelmed with treatment.
Medications like selective serotonin reuptake inhibitors (SSRIs) are effective for treating Harm OCD and other thematic variations of the disorder. They also combat underlying problems, like depression. SSRIs will not lower your inhibitions increasing the likelihood that you will act out your obsessions.
Every person has a different degree of tolerance for exposure exercises and the actual OCD itself. If Harm OCD has significantly infringed on your life, medications can tame the OCD and allow you to start exposure therapy. Consult a psychiatrist (not a general doctor) about this.
When Therapy Is Not an Option
Cognitive behavioral therapy for OCD is not accessible to everyone. Many sufferers take their struggle to the internet, browsing message boards and “googling” various mental health disorders. This is not recommended. Some accounts of others’ struggles will unnecessarily scare you and give the OCD new ideas to latch onto. Online research (also known as reassurance seeking) is an easy compulsion to get caught up in. Sharing treatment struggles with others in similar circumstances is always valuable, but you have to weigh the risk against developing a new compulsion.
Three Pillars to OCD Freedom (Self-Treatment)
Self-treatment for Harm OCD is entirely possible with discipline, patience and motivation. Structured therapy might require these qualities to a lesser extent, but you are still largely responsible for the treatment outcomes by choosing to do your exposure assignments. By following the steps below, you can expect to see positive results in several weeks to months. Setbacks happen and progress isn’t always linear. When you get this process down to a science, however, you will be amazed what little role OCD can play in your life.
• Identify situations that trigger your OCD
• Expose yourself to these situations on an increasingly frequent basis
• Delay, reduce, and eventually eliminate compulsions with the help of cognitive re-structuring and finally acceptance.
For Further Reading:
Dr. Frank Penzel describes violent OCD obsessions.
Jon Hershfield, MFT of the OCD Center of Los Angeles describes his experience treating patients suffering from Harm OCD.
A patient of Dr. Steven Phillipson describes her ordeal and eventual recovery from Harm OCD: