Harm OCD Compulsions

Harm OCD sufferers spend a great deal of time trying to (dis)prove their “closeted lunacy.” As a group, they rely on a set of identical tactics that are equally ineffective in treating OCD. These tactics fall under the umbrella term of compulsions. Compulsions consist of repetitive behaviors that are used to ward off anxiety. The OCD sufferer performs them under the naive assumption that they will provide long-term relief. In reality, they provide intermittent relief while sustaining the OCD in the long haul.

The Psychobiological Explanation

The primitive parts of the brain responsible for basic learning interpret compulsions to be favorable behavior. Compulsions act as a form of negative reinforcement, wherein something unpleasant (the anxiety) is removed from the environment as a consequence of the behavior. Therefore, it becomes an automatic response to repeat the behavior in face of similar circumstances. This becomes a problem as the compulsions reinforce the obsessive thoughts. The brain sees that the thoughts trigger a response and concludes that they must be important. Therefore, they become more frequent and the obsessive-compulsive cycle repeats ad infinitum.

How Not To Approach Treatment (Compulsions)

Contamination OCDers repeatedly wash their hands to eliminate germs. Harm OCD sufferers try to “wash” their conscience by means of questioning or debating their thoughts, evoking neutralizing images, seeking reassurance and the like. The behaviors are different but the outcomes identical.

Mental Rituals

Mental sword fighting – Oftentimes, suffers will engage their OCD in mental dialogue, presenting it with reasons why they shouldn’t push a pedestrian into oncoming traffic or trip someone in the street. For every objection made, the OCD counters with reasons to move forward. This mental chatter is highly draining and can leave you feeling detached from what is going on around you. This nasty side effect is known as derealization.

Neutralizing images – Harm OCD can conjure some very disturbing images. It is common for sufferers to counter these depictions with images of happy times with loved ones, religious symbols, so on and so forth.

Reassurance Seeking – Consists of researching, confessing, or evidence-seeking to disprove harm obsessions.

Researching – may consist of reading forum threads about others’ experience with the condition. It may also entail reading about other mental health disorders like schizophrenia to ascertain whether or not the patient’s symptoms coincide with those of the said disorder. Reassurance seeking often helps the OCD fabricate new obsessions. The sufferer may become preoccupied with whether or not they have schizophrenia. They may even get new ideas for their Harm OCD theme.

Confessing – Harm OCDers often confess their harm thoughts to family members. This is an area for concern as the confessions may very well startle those who know very little about the disorder. Confessions are a double edged sword – on one hand, the sufferer may feel guilty for internalizing these thoughts. They believe that by speaking up, they will prevent some disastrous outcome. On the flip side, they may feel guilty for confessing due to the negative reaction expected from family members.

Evidence Seeking – We all have indiscretions that lurk in our past. However, isolated instances of poor decision making don’t dictate the trajectory of your future. A person who is in the reigns of Harm OCD may recall bad choices from the past and use them to justify their belief that what they have is not OCD. A person who fears violently attacking their pet may use memories of having crushed snails in preschool as evidence of their psychopathic nature. Another thing to note is that our memories become distorted with time. Just because you recall doing something doesn’t mean that it played out exactly as you remember. The more you spend analyzing an event from the past the more fictitious some details will become.

Outward Compulsions

Avoidance – In fear that they will act out on their thoughts, Harm OCD sufferers may intentionally isolate themselves from loved ones and avoid certain situations (i.e. driving) that trigger OCD thoughts.

Touching, praying, physically restraining oneself, etc – These compulsions are associated with magical thinking (a cognitive distortion). The underlying belief is that the nonsensical behaviors will ward off harm to loved ones. Avoiding cracks in the sidewalk has no bearing on whether or not a family member will get cancer, for instance.

Reining in the Cycle

Getting a handle on Harm OCD involves eliminating the reinforcing effect of compulsions. This frequently proves challenging as sufferers often display an inflated sense of moral obligation to perform compulsions. This runs counter to the objective of Exposure and Response Prevention, (ERP) which is the core component of cognitive behavioral therapy for OCD. ERP is designed to desensitize the mind to obsessive thoughts through intentional yet gradual exposure to feared obsessions. If no compulsions are performed, the mind learns to disassociate the anxiety with the thoughts and they therefore become less frequent. Beating Harm OCD is about learning to separate your entire person – moral convictions and all – from the obsessive thoughts.

3 thoughts on “Harm OCD Compulsions

  1. Hi, I suffer from harm ocd, mostly suicidal thoughts, with hurting loved ones sprinkled in there. My question comes from the last paragraph, are you saying normal ERP, is not recommended? My confusion comes from two fronts, 1. I do not actively avoid objects or situations, I leave the house, drive, use knives, take my Meds, etc. so how would ERP work for me if I’m not avoiding anything? 2. I always had a little depression along with ocd, but since the harm ocd started it has gotten way worse, even though my mind tells me to die, I dknt think I actually want to, and I think my doctors would agree which is why I haven’t been admitted. My concern is how do I know where depression stops and ocd begins? Uncertainty is something I’m dealing with slowly knowing I cannot be certain of anything really, however I find it extremely difficult to live with the suicidal uncertainty because I believe my OCD from the beginning in first grade to age 28 now is really all spawning from a string fear of dying, (ironic).

    • Matt,

      ERP is most definitely recommended. The point I was trying to make is that people with Harm OCD are so convinced that they are preventing a disastrous outcome by doing compulsions that following an ERP exercise (like intentionally thinking about running someone over and not performing compulsions) seems criminal, therefore there is a significant level of resistance.

      As for your other questions:

      1. Harm OCD compulsions can be mental in nature. Having read parts of your comment, you seem to do a fair amount of mental debating — whether it be about wanting to live or not or whether your symptoms are a result of OCD or depression. ERP in this instance might entail creating scenarios or thoughts in your head without trying to counter their validity.

      2. Sounds like an OCD thought to me. You will never decipher the boundary, you must learn to tolerate the uncertainty.

  2. I suffer Harm OCD towards my child ( she is only two years old) these thoughts started when I was 6 month pregnant. I am so scared everyday. 2 1/2 almost 3 years of this shit is causing me some really hurt inside and i need some real answers. please help.

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