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A Lesser-Known Subtype of OCD: Harm OCD

In this photo, we see a close-up shot of a womans hands. She is wearing a forest green long sleeve sweater, and is playing with the ends of her sleeves. Her hands on resting on her knees, as she nervously fidgets with her hands.

A Lesser-Known Subtype of OCD: Harm OCD

In this photo, we see a close-up shot of a womans hands. She is wearing a forest green long sleeve sweater, and is playing with the ends of her sleeves. Her hands on resting on her knees, as she nervously fidgets with her hands.

OCD, which is the abbreviation for Obsessive-Compulsive Disorder, is more than just hand-washing or checking if the door is locked. With developing research, fortunately, there has been a growing understanding of OCD more and more in recent years. This research and analysis have uncovered the variety of symptoms and manifestations of OCD that actually break down into subtypes. Many lesser-known subtypes of OCD are seen as taboo or shame-inducing. One of these subtypes is Harm OCD, where you have unwanted, intrusive, and repeated thoughts, images, and impulses around harming yourself or others.

It can already be a challenge living with OCD, as it is widely referenced yet also widely misunderstood. People use the term casually when describing their need to have things organized or clean; this can be incredibly painful and insulting to those who actually live with Obsessive-Compulsive Disorder. Add to that when you are struggling with a lesser-known subtype of OCD and you have a troubling and triggering situation on your hands. If you struggle with these intrusive thoughts, you probably feel ashamed about them. The key to living with Harm OCD is understanding what it is and isn’t and how to get help when you are struggling.

What is Harm OCD?

This vicious cycle begins with the individual experiencing disturbing, scary, and intrusive thoughts. These thoughts may be regarding the person harming others or harming themself.

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Often, thoughts of harming others include scenes like car accidents or stabbings. No matter the context, they are distressing and identified as intrusive, as opposed to a true desire. When these thoughts involve self-harm, they are followed by the individual attempting to figure out if they are truly suicidal or not. People with Harm OCD often seek out their loved ones to get reassurance above their experiences. They often will engage in mental reviewing in an effort to convince themselves that they are not in danger of harming themselves. People who have Suicidal OCD are known to avoid places that may trigger suicidal thoughts for them.

How is Harm OCD Different from Suicidal Thinking?

There are many ways to differentiate Harm OCD from suicidal thinking. One of the key features is that a person with an Obsession will report their obsessions as unwanted. They quickly report being anxious or uncomfortable by the presence of this intrusive thought. They are aware, however persistent the thought is (or thoughts are), that they don’t truly reflect how they feel and what they want. However, a person with suicidal thinking may express a sense of relief because they may, in the midst of their depression, come to believe that this is the only answer to their problems. They may acquire the means to take their own lives, such as by purchasing guns. Mood swings are common amongst suicidal individuals, as they may be emotionally high one day and extremely low the next day.

3 Ways to Get Help When you are Struggling with Harm OCD

1) Work with an OCD specialist to learn ERP:

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People with Harm OCD are often misdiagnosed as experiencing suicidal ideation. It is important that you are working with an OCD specialist who understands this particular subtype and can provide you with the right support. Understanding your specific subtype of OCD, such as Harm OCD, can be helpful because labels can help us know that we are not alone. Labels provide us with a clear category and description summarizing our experience. Not only does this help to ground us in the reality of our situation, but it provides us with specific references and resources to go back to when we are concerned and need reassurance about our situation.

Understanding your subtype of OCD is very beneficial. However, it is important to understand that, no matter the subtype, the treatment for OCD will always be ERP. ERP stands for Exposure and Response Prevention and is a form of Cognitive Behavior Therapy (CBT). The Exposure aspect refers to confronting the issue, whatever it may be. In this case, it means acknowledging and sitting with the Harm thoughts that are occurring. Response Prevention occurs when you make a choice not to participate in your compulsion.

The process of going through ERP as part of your therapy for OCD will bring with it times of discomfort, anxiety, and fear. Over time, however, you will be able to teach yourself that your intrusive thoughts do not have power over you. The more exposed you are to these thoughts without resisting them, the more used to them you become. This is a process called habituation, and it is what allows you to live more easily with your intrusive thoughts and go about your daily life.

As you continue to do this work, you will begin to see your intrusive Harm OCD thoughts as signals that you need to check in on yourself. Touching base with yourself about your emotional regulation, basic self-care needs, what stressors and triggers might currently be at the forefront of your mind, and so on is beneficial. These alarm bells are part of your nervous system’s way of calling for help; you may think that your thoughts are unmitigated and serve no purpose, but if you can utilize them as a call to resume your ERP work, then they will have a meaning. It doesn’t have to have a positive meaning; it might be neutral at best. But it will have a purpose, which can be of some comfort in tough times.

2) Always live based on your values, not fears:

Let’s review what we mean by living based on your values and not your fears. When you are living with OCD, you are living with a mental health challenge that is driven by the anxiety and uncertainty of whether a feared outcome will come true. Therefore, you engage in rituals (also known as compulsions) to avoid or prevent a feared outcome. This is what we call being driven by your fears. Your fear says, “What if I hit someone while driving?” If you respond to your fear, you say to yourself, “I won’t drive today,” or, “I will have my partner drive.” Letting your fears decide your actions ultimately shrinks your life.
In contrast, living your life based on your values means making decisions based on your values. 

Let’s say again; you have the thought of, “What if I hit someone while I am driving?” You ask yourself: where do you need to go? Is it work, is it school, is it a date night? These are the things that you value,

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and you don’t want to miss out on them. It won’t make your intrusive thought(s) vanish, but it is a method that enables you to keep moving forward.

This is not a process that is undertaken all at once, nor should you expect to do it alone. Therapy for OCD, such as what we offer here at our therapy practice in Woodland Hills, not only helps you to identify your values but can assist you in moving forward from events in which you let fear overtake your values. When you work with an OCD therapist, you have guidance to discover your highest values. This may seem like a straightforward process; you may know that you love your family, you understand the necessity of your job, etc. But in actuality, when we begin to unpack your value system and rank it, then weigh it against your fears, you may require more in-depth work to call upon. This is because our human instinct to avoid discomfort is so strong. It takes repeated and consistent work to be able to set aside any primal reactions you may have and focus on your values instead.

Attempting always to live based on your values as opposed to your fears means leaving space for yourself to struggle with that concept. If you aim for “always” and fall short, you will still be making more progress and achieving more inner peace than if you didn’t try at all. This sort of work requires a lot of patience with yourself, grace for yourself, willingness to try again, and self-compassion.

3) Practice self-compassion:

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Living with OCD is never easy, and it may feel like you wish you had “other subtypes” than Harm OCD. Practicing self-compassion is giving yourself the empathy and support you deserve while you learn to navigate this subtype of OCD. Remember that there is nothing you have done to acquire this subtype; you are not being punished for anything. You are not a bad person, and you have the right to live in a peaceful mindset. That may not always be easy or even possible, but with work, you can spend more time feeling regulated and in command of your triggers.

How often do you make time for self-care? Having a self-care routine is incredibly beneficial when it comes to managing OCD. Caring for yourself is also a great way to show compassion to yourself; you are deserving of care even if you are struggling more than you would like on any given day.

Determine how to speak to yourself with compassion. You may choose to say affirmations out loud, such as, “I am distressed by this thought, but it does not control me,” or, “I am not a bad person just because I am experiencing a bad thought.” Create ways to be kind to yourself; adding extra guilt or negativity to your struggle isn’t going to make it any more tolerable.
Create a support network, reach out to your friends and family, and let them know what you are experiencing so you can feel supported and connected. Not only does this enable you to receive care and support, but it reaffirms that you deserve those things. Too often, when in a negative headspace, we distance ourselves from others. In leaning toward people instead of isolating ourselves, we subvert our instinct that we don’t deserve love and care unless we are “at our best.” To allow yourself to be supported is to renew your commitment to self-compassion, self-care, and self-love.

The people you recruit to be part of your support network will be able to see the whole picture when you feel overwhelmed with singular thoughts or one intrusive theme or idea. They may be able to remind you of your progress, ground you in the present, and/or just be with you to ride out your discomfort. A group of friends and family do not take the place of OCD treatment, but they can definitely be part of an overall self-care routine that helps you navigate the ins and outs of your days.

When you find yourself on your own, whether you are unable to reach anyone or whether you are struggling to pick up the phone, it is good to have a routine in place and go to that routine as soon as you are able. You may have created a self-care toolkit of sorts; maybe you have a box of your favorite comfort items, such as candles, a bubble bath, a book you love, photos you enjoy looking at, a journal to write in, and more. You may have a voice recording saved on your phone of affirmations to help you through tricky times or a podcast you listen to that lets you know you’re not alone. You might want to practice a meditation you find helpful or move your body in some way. Practicing as much of this routine as you can on a regular basis will allow you to visit it even when you are under duress. We seek what is familiar when we don’t feel grounded or in-control. The more familiar self-care and self-compassion are, the more easily you will access them.

Obsessive Compulsive Disorder creates a persistent state of feeling unsafe. Add to that this subtype, in which your intrusive and compulsive thoughts directly correlate with harm, and you may feel

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afraid most of the time. You may constantly be reviewing your actions to determine if you did, in fact, harm someone. You may feel unsafe around objects that could cause harm. You may feel the need to take a consistent inventory of whether or not you truly think you will harm yourself. This can make the desire to participate in compensatory behaviors feel overwhelming. These behaviors are your attempt to make yourself feel safe from your thoughts, and suppressing them will require diligence in your ERP work and self-care routine. You may feel like the only person in the world who feels this way, as most people do not speak about being plagued by violent thoughts. Don’t let your shame isolate you. Do not hesitate to connect with others who experience Harm OCD to remind yourself that you are not alone. Continue your ERP therapy as your journey progresses so that you can learn to control and subdue your responses to these thought exposures and feel safer in your daily life. Maintain self-care and self-compassion and adjust what that means for you as you continue to do the work to regulate your responses to your thoughts and triggers.

OCD Treatment at Embracing You Therapy

Our OCD specialists are here to help you better understand the obsessions, compulsions, cycles, causes, and treatments Of Obsessive-Compulsive Disorder. In our individual therapy session for OCD, we utilize ERP, CBT, and ACT principles to help you live a life based on your values, not OCD fears. Contact us today for your complimentary 20-minute phone consultation with our Client Care Coordinator.

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