Have you ever struggled with distressing thoughts about hurting your loved ones or yourself despite having no intention to do so? For people with harm OCD, these thoughts are common and are not easy to just “ignore” or “brush off”.
Harm OCD is a form of Obsessive-Compulsive Disorder characterized by obsessions or intrusive thoughts related to causing harm to themselves or someone else, and compulsions such as mental reviewing, avoidance, or reassurance seeking to relieve distress caused by these obsessions.
People with harm OCD are not dangerous, and with specialized therapy can learn to reduce harmful intrusive thoughts and respond more effectively without relying on ritual behaviors.
What Is Harm OCD?
Obsessive-Compulsive Disorder (OCD) affects about 2 million adults in the US, with harm OCD affecting nearly 20% to 30% of those individuals. Harm OCD is characterized by unwanted, intrusive thoughts of causing violence to oneself or others, despite no desire to act on them [1].
People with harm OCD are no more likely to harm others than the general population, as these are ego-dystonic fears that conflict with the self-image, and are not conscious intentions.
Someone with harm OCD does not intentionally think about inflicting harm, but rather these thoughts pop into their heads without cause and can be highly distressing as they are often contradictory to the person’s values and morals. This can trigger intense feelings of anxiety, self-doubt, guilt, and shame, and lead to isolation or even substance abuse, as an attempt to cope with the intrusive thoughts [2][3].
What Causes Harm OCD?
Like other forms of OCD, harm OCD is caused by several biological, psychological, and environmental factors, including a family history of OCD, experiencing childhood trauma such as neglect or abuse, and structural brain differences.
In some cases, harm OCD may be brought on if someone has witnessed a traumatic or violent event, but the exact link is still not well known.
Harm OCD does not mean someone is an inherently violent or bad person. Remember, these thoughts are in response to being afraid of becoming a bad or harmful person.
There are certain events or situations that individuals with harm OCD report trigger their symptoms or make them worse. Some of the triggers of harm OCD include:
- Stressful Life Events: Job loss, relationship strain, or major changes increase anxiety and obsessive fears of losing control.
- Media Exposure: News about violence, crime, or graphic content can spark intrusive images or worries of acting on them.
- Situations of Responsibility: Handling sharp objects, driving, or caring for others (e.g., kids) trigger doubts about accidental harm.
- Fatigue or Sleep Deprivation: Exhaustion reduces mental filters, making harmful thoughts more vivid and harder to dismiss.
- Past Trauma: Witnessing violence or a personal history of aggression can resurface as fears.
Symptoms of Harm OCD
Like all forms of OCD, harm OCD is characterized by obsessions and compulsions.
Common Obsessions of Harm OCD:
Those with harm OCD are rarely violent or actually cause harm. But they struggle daily with intrusive thoughts about inflicting harm on themselves or others, which leads to self-doubt and anxiety:
- While driving down a busy street, you suddenly become worried that you will drive over pedestrians or hit someone in an accident and kill them. This comes from fear of causing accidental harm.
- If you fear you will become violent with a partner or child, you may have intrusive images of being aggressive or getting violent with someone. This often comes from the fear of hurting others, especially loved ones.
- You may see violence or hear about a harmful situation and wonder if you played any part in what happened, or feel guilt even if you have no connection to the situation.
Common Compulsions of Harm OCD:
To overcome these obsessions and negative feelings, people with harm OCD often engage in compulsions to reduce the anxiety and eliminate the chance of causing harm:
- Mental Compulsions: Constantly reviewing past actions to confirm you didn’t hurt someone.
- Physical Compulsions: Repeatedly checking that objects that could cause harm are locked away, such as keeping kitchen knives in a locked drawer.
- Avoidance: People with harm OCD tend to isolate themselves and avoid any situation that could trigger intrusive OCD thoughts.
- Reassurance: Some people with harm code may excessively seek reassurance from others that they didn’t harm anyone, which can strain relationships over time.
Treatment Options for Harm OCD
Exposure and Response Prevention (ERP) is the gold-standard, research-backed treatment for harm OCD, encouraging individuals to face feared thoughts of causing harm while resisting compulsive rituals like avoidance or reassurance-seeking.
This is a specialized form of Cognitive Behavioral Therapy where therapists guide clients in building a fear hierarchy, from mild triggers to intense ones, proving that intrusive thoughts don’t lead to action, fostering confidence and reducing compulsions over time.
Some standard techniques used in ERP for harm OCD include [4]:
- Verbal Exposure: Repeatedly name or describe triggers (e.g., “knife”) without rituals, completing rituals.
- Image Exposure: View photos of feared objects, tolerating anxiety until it naturally fades.
- Live Exposure: Progress to real-life contact, such as holding a knife and learning that it won’t cause harm.
Evidence-Based OCD Treatment at Maple Mountain
At Maple Mountain Mental Health and Wellness, our compassionate team of clinical psychiatrists and experienced therapists provides evidence-based treatments for OCD, including specialized CBT and advanced FDA-approved TMS Therapy. Our licensed mental health team prioritizes your well-being and safety throughout the therapeutic process.
Through a holistic, blended approach, we address each aspect of your health and recovery needs to support long-term healing. Reach out today for an evaluation.
Sources
[1] Brock, H. et al. 2024. Obsessive-Compulsive Disorder. StatsPearl.
[2] Surles, T. 2025. Harm OCD: Symptoms, Causes, and Treatment. NOCD.
[3] Laving, M. et al. 2022. The association between OCD and Shame: A systematic review and meta-analysis. British Psychological Society.
[4] Clark, D. 2020. Cognitive Behavioral Therapy for OCD and its Subtypes. Cipra.