Am I a Monster: Hidden Fears and Harm OCD
What if I’m a pedophile? What if I’m secretly gay and want to leave my spouse? What if I forget to lock the doors and something terrible happens? What if that bump in the road I felt when I was driving was actually me running over a body?
Thoughts about OCD usually are accompanied by stereotypical images of someone scrubbing their hands or straightening a crooked picture frame. The truth this, OCD exists in many dimensions. Contamination and symmetry are two of the better-known dimensions where people with OCD may struggle. However, they are not the only two areas that exist. Two other dimensions where OCD can reside include harm and unacceptable thoughts. Although these areas may be lesser known, they are also very common.
This article will focus specifically on harm OCD. But before I get too far ahead of myself, let’s talk about what OCD is and is not.
What Is OCD
OCD or obsessive-compulsive disorder is a mental illness. According to The International OCD Foundation (IOCDF), OCD is a mental health disorder that affects people of all ages and walks of life and occurs when a person gets caught in a cycle of obsessions and compulsions (1).
Obsessions are unwanted thoughts, images or impulses that occur over and over again and feel out of the person’s control. Obsessions are often disturbing, are unwanted and lead to undesired feelings such as fear, disgust, doubt, or the need to make something be ‘just right’. People who have obsessive thoughts often realize they do not make sense and are illogical. However, they feel unable to disengage from them.
Compulsions are thoughts or actions a person takes to try to reduce or eliminate the distress from the obsession. Doing compulsions may create temporary relief from the distress of the obsession. Unfortunately, the relief does not last, and a person winds up feeling like they need to do more compulsions when the anxiety returns. This can create a feeling of being controlled, trapped, or compelled to act despite a person’s wishes to stop doing the ritual they started.
What OCD Is Not
OCD is not the desire to have something neat and tidy. It is not wanting to hang a picture straight or simply having something crooked irritate you. It is not just wanting to wash your hands when they are dirty. Even though people often reference OCD in these contexts, it is not helpful or accurate to say “I’m OCD” when talking about normal activities or desires. For people who have dealt with the immense pain and suffering that OCD can cause, it is often hurtful to hear people use the term flippantly.
Harm OCD
Harm OCD occurs when obsessive doubts take on the form of fear of harming yourself or others either on purpose, through loss of control, by accident, or by negligence. Some examples of obsessive doubts include: What if I’m a pedophile? It’s possible that I could lose control and stab someone. I might be a rapist and not know it. Maybe I’ll forget to turn off the stove and burn the house down. I could lose control of my car and run into someone. While there are many other varieties of doubts experienced by a person struggling with harm OCD, they typically have the same theme of fear of causing harm to self or others.
Shame and Seeking Treatment
People who suffer from harm OCD often never voice their fears to others because they are terrified of what others would think if they knew the types of thoughts that occupied their minds. They tend to carry immense amounts of shame and feel isolated and lonely thinking that they are the only ones who struggle. Unfortunately, studies show OCD typically takes an average of fourteen to seventeen years from the time symptoms begin before it is properly diagnosed (2). Due to barriers like lack of awareness and shame, harm OCD may take even longer. In my experience, it is not uncommon for people who are seeking treatment for other mental health concerns to have their OCD go undetected and untreated even by experienced therapists.
Treatment Options
The good news is that there are many effective treatments available for OCD. Here is a description of some research-backed, reputable treatment options:
ERP (Exposure and Response Prevention) is an evidence-based treatment for OCD that involves exposing a person to the things that create anxiety while helping them refrain from doing compulsions. This treatment starts with small, manageable tasks and works its way up to more and more difficult exposures as the person feels ready. An example of an exposure for someone with harm OCD could be cooking something in the kitchen and after turning off the stove, leaving the room without returning to check to make sure the stove is turned off.
IBT (Inference Based Therapy) is a relatively newly developed but well-researched approach for treating OCD. Rather than using exposure to treat obsessions and compulsions, IBT focuses on helping a person resolve their obsessive doubt. A person who is receiving treatment for OCD would spend time learning about how OCD takes a doubt such as “I might be a pedophile” and uses many methods of logic and reasoning to make the doubt seem valid. They would then learn how to deconstruct this logic and reasoning and replace it with new reasoning that is grounded in reality. Through this process, the person learns to trust themself, their five senses, and their common sense.
ACT (Acceptance and Commitment Therapy) is a process-based therapy focused on using psychological flexibility skills to create a life of purpose and meaning. It can be used in conjunction with other therapies or on its own to treat OCD. It focuses on identifying ways OCD has interfered with living a values-driven life and seeks to restore functioning while learning to tolerate discomfort and redirect thinking. An example of using an ACT approach with harm OCD would be helping a parent be able to hug their child despite having the fear that they may lose control and cause them harm. This would be considered a values-based exposure because it is focusing on helping the person with OCD do things that deeply matter to them despite the difficulty that the obsessive fear causes.
First Steps
If you suspect that you or someone you love is struggling with harm OCD, or any other form of OCD, a good place to start is by getting an evaluation from a mental health professional who is trained to work with OCD. After getting evaluated, you will then discuss what treatment options are available and the next steps to take.
Other Resources
If making an appointment feels like too big of a step, or you do not have access to services, or you are interested in learning more, here are some reputable resources you may find helpful:
International OCD Foundation (IOCDF) https://iocdf.org/ This website is full of information and resources to help you better understand OCD.
The OCD Stories Podcast https://theocdstories.com/ This podcast is dedicated to providing reliable and heart-felt information to professionals, people who suffer from OCD, and people who have a family member who suffers from OCD.
Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts by Jon Hershfield. This is an excellent self-help book about how to deal with harm OCD. It can be read in conjunction with therapy or on your own.
OCD Lived Experience Collective https://ocdlivedexperiencecollective.org/ This is an organization that was founded by a group of therapists who also suffer from OCD. They play many roles including advocating for people to have access to many treatment choices, not solely ERP.
One Last Thought
If you get nothing else out of this article, remember this: you are not crazy, you are not a monster, there is help available and you are going to be okay.
-Sarah Hunter, LCSW
References:
1. Information on what OCD is can be found here: https://iocdf.org/about-ocd/
2. The reference for OCD taking fourteen to seventeen years to be diagnosed can be found here:
https://iocdf.org/wp-content/uploads/2014/10/What-You-Need-To-Know-About-OCD.pdf
To schedule with a therapist at Wasatch Family Therapy, call us at 801-944-4555.
