Today’s topic is Harm OCD. Our hosts, Lauren Rosen, LMFT, and Kelley Franke, LMFT, have an open and honest discussion of the ins and outs of this particular subtype.

This subtype typically conjures a great deal of shame in its sufferers, so it’s important to really understand how harm OCD operates so that you can manage your life without limiting yourself because of these obsessions.

Let’s dive into today’s episode!

What is Harm OCD?

(1.55)

Lauren: …we probably want to parse out things like emotional harm, or self-harm, just because those are pretty rich topics. And things that some people struggle with in their own right. But when we’re talking about harm OCD, what are we thinking of?

Kelley: Usually the first thing that comes to mind is violent, intrusive thoughts. Thoughts like, what if I stab my spouse? Or what if I shove that woman into the train tracks? Or what if I poison my family?

Lauren: It could also be, what if I accidentally harm somebody else? Versus, what if I harbor secret urges to cause harm to somebody? When we talk about harm OCD, a lot of the time we’re talking about the fear of causing harm to others. And yet, a lot of people have as their primary obsession fears that somehow harm is going to bestow them or their loved ones, not by their own hand but by someone or something else.

Kelley: Great point. But harm in general could just be violent intrusive thoughts. It doesn’t have to be death, for example, it could be rape. It could be severing someone’s head off. Something very violent and graphic. I’ve seen and heard such a vast variety of intrusive thoughts.

Worry of being fascinated

(4.08)

Lauren: …people avoid knives, for instance, because they’re afraid they’re gonna stab somebody. Or they won’t watch a television show because it involves crime. I was thinking of Law and Order, for example, where you’re likely to see guns or triggering things.

Sometimes people might watch a TV series about a serial killer and find themselves fascinated. And people worry about the fact that they’re fascinated. What does it mean that I am fascinated by this person who has done horrible things?

But it’s human nature.

Kelley: As a human race, we want to figure out the anomalies around us. So it’s only natural to find those documentaries intriguing because when someone behaves in a way that isn’t deemed ‘normal’ we want to understand why.  

…I remember watching the Ted Bundy documentary and wondering why I wasn’t grossed out by what I was watching. I thought I should feel a certain way towards it and the fact that I didn’t feel alarmed. Shouldn’t I be more disgusted? But actually, there’s also empathy. As humans, we are empathetic towards others and I found myself with this hint of empathy toward this sick man.

Of course, everything he did was wrong but it didn’t mean anything about me that I wasn’t repulsed by watching this program.

Fear of losing control

(8.14)

Kelley: Oftentimes, people talk about snapping or reaching a point where they just lose it.

Lauren: We’ve talked a lot about the idea of these concentric circles of different subtypes. And this is where fear is really related to mental health and whether or not you could have a psychotic break from reality and do something that’s completely antithetical to your character. But that’s the fear. I’m going to lose control. And it triggers their harm obsessions as well. 

Kelley: Even avoiding having negative emotions because that might trigger harm thoughts. Fearing that if they become angry, they might take it too far. They feel like they can’t trust themselves to feel that emotion. 

Lauren: The work is around letting yourself I feel those feelings because anger, as it turns out, isn’t just for Ted Bundy. It’s a very normal human experience.

…anger and the expression of that anger, of course, are two separate entities, but certainly allowing yourself to feel it in the very same way that we talk so often about allowing ourselves to feel anxiety. Super important. But it’s going to feel like a threat. And people with harm OCD fear that if they allow those feelings, they might snap. I’m going to lose control and stab my whole family to death, or I’m gonna go on a shooting rampage. You know, there are all sorts of fears that come up in that context. And then there are stories in the news that are really triggering for people around that too because it does happen.

Violent and graphic intrusive images

(12.29)

Lauren: One thing I think is really important that you brought up is this element of intrusive images, because what does tend to come up a lot with this subtype are really graphic and violent images. And that serves as the trigger to the obsession. Sometimes it’s something external, like watching a news story. Recently there was a woman who had severe postpartum depression and killed her three children. That could be a trigger. Or it could trigger an image in your mind, even if it’s unrelated because our brains are creative in that way.

Kelley: The images are rough there. They take the air right out of your chest. All intrusive thoughts do but there’s something about the images that feel so much worse for me.

Do not avoid external triggers

(13.55)

Lauren: The external triggers can inform the internal triggers. But that doesn’t mean that we want to avoid external triggers. So let me break that down a little bit. I think of the movie American History X.

It’s an intense film, with so many gruesome moments and there’s one clip for example, that takes place on a sidewalk. So now those images live in my head, but I don’t want to then not ever watch a movie that I really want to watch or that I’ve heard is impactful or powerful. 

Kelley: You don’t want to avoid sidewalks either.

Lauren: No, that would be incredibly limiting.

Kelley: I wouldn’t put it past OCD to latch onto that for a second. 

Harm OCD ‘urges’

(15.54)

Lauren: Then there’s the element of urges. And I say urges with air quotes, because people worry that they are urges, but it’s more of an awareness of physical sensation. A ‘sense’ of turning the wheel of your car into oncoming traffic or pushing someone that you’re with off of a high precipice. 

It’s the awareness of your physical sensations at that moment that ends up serving as the trigger. Right? The fear of having the urge rather than the urge itself.

Kelley: Exactly. Right. For example, I’m super aware of my hands and the placement of my body near this other person. Could that mean I have this urge to just shove them into traffic?

Lauren: I feel a tingling in my fingers, like a tension building. Does that mean that I’m about to punch this person? I don’t know.

Wrapping it up

(19.23)

Kelley: You’re not your thoughts. You have thoughts and they’re really scary and you’re not alone in it.

Lauren: Yes. Having these thoughts, images, or urges does not necessarily mean anything bad about you as a person. The trouble is that you’re dealing with a doubting disorder. Which means you cannot find 100% certainty about anything. It’s about accepting what is and being okay with trusting yourself, regardless of the uncertainty surrounding these obsessions.

REFERENCE (17:43)  

Kelley, Director of the Center for OCD here in Southern California. 

Instagram @theocdtherapist

Website – centerforocd.com. 

REFERENCE  (18:44)  

Lauren, Director at the Center for the Obsessive Mind. 

Instagram @theobsessivemind 

Website – theobsessivemind.com.