Harm OCD, Part II
In this week’s episode of Purely OCD, our hosts, Lauren Rosen, LMFT, and Kelley Franke, LMFT, continue the conversation around Harm OCD.
As the second episode in a Harm OCD series, today, the focus is on physical harm obsessions.
Let’s talk about physical harm
Lauren: …we’re going to be talking specifically about physical harm. Whether or not you want to perpetrate that to somebody else, or that somebody might harm you or a loved one.
Mental Rumination in Harm OCD
Kelley: Let’s go into the really covert ones, like mental rumination. So this could be mentally reviewing past times that ‘prove’ that you are capable of harming somebody. For example, if you were a child and you bullied somebody, you might take that to mean that you are capable of causing harm. Or it could just be having the feeling of being mad.
Lauren: Yes, I’m mad right now and that might mean something. It’s funny. I’ve never thought about this. But as I think most children do this, but my friend bit me in the stomach when I was a child.
…it just goes to show you that really anybody could go back in time and think of an instance that would indicate they might be prone to harming other people.
Kelley: But even just that feeling of anger is very triggering for a lot with harm OCD. They think that because they are angry they are more likely to act violently. So they may then overcorrect by being incredibly nice, and it may not be obvious to the person, but this is a compulsive behavior.
Lauren: … adding to that, sometimes the trigger is not just the feeling of anger, but the fact that you’re experiencing an intrusive image or a thought at the same time as feeling angry. Imagine your child is throwing a temper tantrum and you’re p*ssed off about it, and suddenly you have an image pop into your head – what if I ring their neck?
It startles you and then rumination and checking comes into play – did I really want to hurt her in that moment? Does that mean I will hurt her?
The covert rituals, the mental rituals, and all of the subtypes are the most insidious. And they can really look like anything in terms of the process of trying to analyze and figure it out in your own mind so that you don’t feel quite so anxious about what you’re capable of.
Magical Thinking in Harm OCD
Lauren: There are lots of ways in which we might try to get certainty that harmful thoughts are not somehow indicative of some internal desire again.
Switching gears a little bit, I tend to see a lot of magical thinking-style compulsions come into play, where someone might do something that objectively, is totally unrelated to the outcome. For example, I’m going to tap the wall three times because I had a thought that my mother might be shot and, somehow, that’s going to prevent her from being shot and dying.
Avoidance in Harm OCD
Kelley: This could be like avoiding sharp objects or anything that could be a potential weapon, which everything could be a potential weapon…
Lauren: If you’re creative enough, yeah.
That’s such a good reframe. If you’re coming up with a lot of really wild and crazy ideas, not like judgmental, but sort of off-the-wall ideas about how you could harm someone like, maybe I could squeeze them with my armpit and suffocate them there. Right? That’s just an indicator that you are very creative. And you’ve got a creative mind.Lauren Rosen, LMFT, (7.55)
Kelley: …it could be avoiding situations where you’re in close proximity.
Lauren: Especially in the context of being, for example, in a high space. You’re on a high platform, close to another person, and you might think about pushing them off. Well, I shouldn’t get close to them. And my hands better stay in my pockets. And those are all compulsions, those are always of trying to reduce your discomfort around this idea that it’s a possibility that you could push somebody off that ledge.
Harm by proxy
Kelley: It can also be harmed by proxies. I’ve seen it with people worrying about their children – what if they get molested? Or what if they get into a car accident and it was my fault because I let them out of my sight and go with this irresponsible person? These are all the concentric circles you talked about, hyper-responsibility and harm, and moral scrupulosity can even get involved here.
Lauren: …just another reason why the categories themselves are arbitrary and not particularly important except for the fact that they help people to feel seen and less alone.
But yeah, accidental harm has a moral scrupulosity flavor to it. So for instance, if you see a piece of trash in the street, and then you think, “Well if I don’t pick up that piece of trash, what if somebody drives by and they try to avoid the piece of trash? And in doing so they hit a small child, and it’s my fault? I gotta pick that up. Otherwise, the small child is gonna die.”
When reassurance-seeking backfires
Lauren: …I think it’s important as we talk about the different compulsions that come up in this subtype as well as all the rest, that we talk about why it’s a problem.
One of the reasons that compulsions can be a problem, and it may not be the most important of them, is that sometimes when you seek reassurance, it backfires. The person does not give you the answer that you’re looking for. That person in that instance that I just gave could say, “No, I’ve never had a thought like that. That’s horrible.” Which of course is going to backfire and exacerbate somebody’s anxiety.
Confessing in Harm OCD
Kelley: ..this will happen in a session where clients will say, “I was walking down the street, and I was with my best friend, and we were walking side by side and I bumped them, and they tripped. And that just was really bad.” And then you’re like, okay. I can see what you’re trying to do.
Lauren: Yes! That’s interesting. Why are you sharing that information with me? Is there something that you’re looking for? Yeah, there are so many tricky ways to go about getting reassurance or doing a compulsion.
Contamination Harm OCD
Kelley: Contamination harm could be, what if I didn’t wash the counter well enough and there is raw chicken? And now I’ve served that where I chopped a salad…
Lauren: …now everyone has Ecoli?
Kelley: Or, I packaged something that may have had some type of contaminant on it. And I mailed it off to my grandma and grandpa…
Lauren: …now I killed my grandma. One other thing to maybe bring into that specific example, let’s say you fixate on whether you washed the counter enough. And you’ve packaged this thing up to your grandma that touched the counter. Just to be safe, you unwrap it, Lysol everything, and wrap it back up so that when it gets to Grandma, she’s safe… The problem is that it does actually alleviate your anxiety a little bit. And when it does, it reinforces this whole cycle and makes you more dependent on those behaviors so that the next time you’re now in a position to send a parcel, you do the entire ritual over again.
Everything, Everywhere, All at Once
Lauren: There’s just the example I keep going back to in my mind, I saw that Everything, Everywhere, All At Once. It won the Academy Award. I loved it.
One of the things that trip me up about it, or that makes me laugh about it, is that there are all of these alternate realities. The whole idea is that you’re going through different parallel universes in the multiverse.
And in one of the realities, they have hotdogs for fingers.
And so I have a really overactive mind. And I never, not once in my whole life before seeing that movie, thought about a universe where people had hotdogs instead of fingers, right? That just never occurred to me. And so, the idea that somehow you’re going to be able to think of all of the potential iterations of how things could go wrong and resolve them is ludicrous, right? We have to accept uncertainty because we’re not even aware of all of the ways in which things could go awry. And that’s okay.
The next step in this process, part three, will be on Exposure and Response Prevention and learning how to navigate the presence of the obsessions without engaging in these compulsive behaviors.