Harm OCD: when you’re terrified of hurting someone you love

You’re chopping vegetables and a flash of an image hits you: what if I stabbed someone? You’re holding your baby and think: what if I dropped them on purpose? The thought is so shocking that you put the knife away, avoid holding the baby, and spend hours wondering what’s wrong with you.

This is a common and well-recognised form of OCD, often called harm OCD. Here’s what it is, and why you’re not the danger you fear.

What is harm OCD?

Harm OCD is a theme of obsessive-compulsive disorder in which obsessions focus on causing harm. The NHS lists fear of deliberately harming yourself or others, for example fear you may attack someone, including your children, among common OCD obsessions. It can also involve fear of causing harm by accident or carelessness.

Common intrusive thoughts include:

• suddenly attacking someone, or pushing them in front of a train
• harming a baby or child
• grabbing the wheel and crashing
• harming yourself, without wanting to
• having caused harm without realising, like hitting someone while driving

Why it doesn’t mean you’re dangerous

• Almost everyone has intrusive thoughts. About 94% of people have had one in the previous three months, according to a study across six continents.
• OCD targets what matters most. It attaches to the people and values you care about, which is why it’s so upsetting.
• The horror is the clue. People with harm OCD are distressed by the thoughts and go to great lengths to prevent harm.
• Thoughts aren’t actions. Having an intrusive thought doesn’t make you more likely to act on it.

Common compulsions

• Avoidance: hiding knives, avoiding being alone with children or loved ones, not driving
• Checking: making sure you haven’t harmed anyone, or checking the news after driving
• Reassurance-seeking: asking others, or searching online, whether you’d ever do it
• Mental reviewing: going over memories to make sure nothing happened
• Testing: deliberately imagining harm to see how you react
• Neutralising: replacing the thought with a “good” one, or praying

Each brings brief relief, then the doubt returns. Our post on why reassurance keeps OCD going explains this loop.

Harm OCD after having a baby

Unwanted thoughts of harm coming to a baby, including by your own hand, are common in pregnancy and after birth, and can be part of perinatal OCD. They’re usually deeply distressing to the parent and don’t mean they want to harm their baby. If this is happening to you, tell your doctor or midwife. It’s treatable, and you deserve support.

Treatment that works

• Exposure and response prevention (ERP): gradually facing the thoughts and situations you’ve been avoiding, like using knives again or spending time with loved ones, while resisting checking and reassurance. The thoughts gradually lose their power.
• Medicine: SSRIs can help, sometimes at higher doses.
• A therapist experienced in OCD, who understands harm thoughts and won’t be alarmed. The International OCD Foundation (iocdf.org) has a directory.

When to get help

Talk to a doctor or OCD therapist if harm thoughts are causing distress, taking up time or making you avoid people or everyday activities.

There’s an important difference between unwanted harm thoughts in OCD and genuine urges or plans to hurt someone. If you have thoughts of harming yourself or someone else that feel like intentions, or you’re thinking about ending your life, get help right away: call or text 988 (US), or call 911 in an emergency.

Frequently asked questions

Does harm OCD mean I’m going to hurt someone?

No. Harm OCD involves unwanted thoughts that horrify you. Having intrusive thoughts doesn’t make you more likely to act on them. A therapist experienced in OCD can help you understand this and treat it.

Why do I get thoughts about hurting people I love?

OCD tends to latch onto what you care about most. The more something matters to you, the more alarming a thought about it feels, and the more your brain treats it as important.

Should I avoid knives or my children?

Avoidance brings relief but keeps the fear going. In treatment, a therapist will help you gradually return to normal activities, which is how the fear fades.

Can harm OCD be treated?

Yes. ERP and medicine help most people a great deal.

How Breatheasy can help

When a harm thought brings a strong urge to check, avoid or seek reassurance, Breatheasy can help you ride it out. Open “Ride out an urge” and Luma helps you watch the urge rise and fall without acting on it. Luma is designed not to give endless reassurance about OCD doubts. Crisis help is always one tap away. Breatheasy can support treatment but doesn’t replace it. Breatheasy is coming soon to iPhone and Android.

Sources

• Obsessive compulsive disorder (OCD): symptoms, NHS
• Obsessive-compulsive disorder, National Institute of Mental Health
• Part 1, You can run but you can’t hide: intrusive thoughts on six continents, Radomsky and others, Journal of Obsessive-Compulsive and Related Disorders, 2014
• International OCD Foundation