Understanding Harm OCD vs. Actual Violent Thoughts

People who have experienced violent thoughts might worry that it means there is something wrong with them or that they’re bad people. But the truth is that most people report having had violent thoughts. While most people move on from these thoughts, those with harm OCD become “stuck” on them. They worry that they won’t be able to stop themselves from acting on these thoughts. 

Having these intrusive, violent thoughts can feel scary and overwhelming. Many people feel shame and worry that there’s something wrong with them. But these thoughts are just that. They’re thoughts, not actions, and they don’t define who you are. In fact, people with harm OCD are actually less likely to be violent.

There’s a big difference between OCD and violent ideation. Harm OCD thoughts are unwelcome and can cause feelings of anxiety and guilt. You might worry that the thoughts are true or that you’re secretly a violent person. However, with actual violent thoughts, there’s no guilt or worry. 

In this article, we’ll go over what harm OCD and actual violent thoughts look like. We’ll also discuss harm OCD vs. violent thoughts and how harm OCD can be treated.

What is Harm OCD?

Harm OCD is a subtype of obsessive-compulsive disorder.

Understanding Obsessive-Compulsive Disorder

OCD is a mental health disorder that is characterized by obsessions (uncontrollable and recurring thoughts) and compulsions (repetitive and excessive behaviors).

Obsessions refer to unwanted, recurring thoughts and fears. For example, a person with OCD might worry about things being dirty or contaminated. While it’s normal for everyone to have intrusive thoughts from time to time, with OCD, these thoughts cause significant anxiety and distress.

People with OCD often perform compulsions to temporarily relieve the anxiety they feel. Usually, people with OCD understand that their compulsions won’t have a realistic effect on the outcomes. But they have an intense feeling that they need to perform these compulsions to prevent something bad from happening. Compulsions can include counting, checking, ordering, or seeking reassurance.

Specific Features of Harm OCD

With harm OCD, obsessive thoughts and images are centered around acts of violence towards others or oneself. Common themes can include harming loved ones, strangers, or children. While these thoughts can seem scary, they’re not uncommon. Some research has shown that harm obsessions are one of the most common themes in OCD.

OCD violent thoughts can cause overwhelming feelings of anxiety, guilt, and shame. These thoughts can pop up suddenly or be triggered by certain situations. For example, they might occur when holding a knife, being in a room with a pet or baby, or watching the news. These thoughts may feel real, but they're ego-dystonic.

This means they clash with a person's values, beliefs, and sense of self. Despite this, people with harm OCD might spend a significant amount of time analyzing themselves to try to determine if they’re capable of the violent acts they’re thinking about. 

Typical Thought Patterns

Some typical thought patterns with harm OCD include:

• “What if I snap and hurt someone?”
• “What if I throw my baby out of the window?”
• “What if I’ve hurt someone and forgotten?”
• “What if I can’t prevent something bad from happening?”
• “What if I’m secretly a violent person?”
• “What if I stab myself with this knife?”

Common Compulsions and Safety Behaviors

The intrusive thoughts from harm OCD can lead to compulsions, which are behaviors that help relieve anxiety for a short time. Common compulsions include:

• Avoiding situations perceived to be dangerous, such as being alone with others or near an open window.
• Compulsively checking things, such as driving the same route again to make sure that they didn’t hit a pedestrian.
• Mental checking, such as replaying events in their heads to check for any violent actions or urges.
• Seeking reassurance, such as asking people to confirm they’re not a violent person or engaging in research binges about violence or mental illness.
• Avoiding triggers, such as holding babies or pets, driving, handling knives, or being in crowded places.
• Confessing thoughts to others due to feelings that if they don’t, they’re “hiding something”.
• Trying to neutralize the thoughts with certain words or phrases, such as “I’m a kind person; I wouldn’t do that.”
• Checking their emotions, such as picturing themselves hurting someone, to ensure they still feel scared or uncomfortable about the thought.  

Actual Violent Thoughts

Actual violent thoughts are often ego-syntonic in nature, involve intent and planning, and elicit a different emotional response.

Ego-Syntonic Nature

Actual violent thoughts are of an ego-syntonic nature, meaning that they align with the person’s desires or values. This means that they don’t cause distressing feelings, and people don’t try to suppress them. In fact, because they align with a person’s worldview, they might actively bring these thoughts up. They might feel justified or like they need to seek revenge, meaning that the thoughts have a purpose and are wanted.  

These thoughts also don’t come and go; instead, they can increase over time. For example, individuals might start preparing and planning. They might think about when and how they are going to perform the violent acts. 

Intent and Planning

Actual violent thoughts are more goal-oriented. This means that they’re not intrusive, and the individual feels justified in causing harm. They might have specific targets and methods in mind, and a timeline associated with the plan. Practicing and rehearsing are also common. 

Emotional Response Differences

Violent thoughts cause different emotional responses. Rather than feeling guilt or horror about the thoughts, the person might feel satisfaction or excitement about violent scenarios. However, in some situations, there might also be a feeling of numbness. Anger or resentment is often the driving emotion, and there is a lack of empathy.

Another key marker is that there is a lack of compulsions to try to prevent these thoughts from becoming reality. People with true violent thoughts also don’t avoid situations where they might have these violent thoughts. In fact, they might even look for these situations.

Differences Between Harm OCD and Violent Ideation

Harm OCD and actual violent thoughts have different emotional responses and behavioral patterns.

Emotional Response to Thoughts

Harm OCD thoughts bring up difficult emotions, such as horror, disgust, anxiety, and panic. People with harm OCD worry about hurting others. They often feel guilty or ashamed of these intrusive thoughts.

This differs from violent thoughts. Those thoughts can bring comfort, satisfaction, excitement, or even indifference. When thinking about potential acts of violence, the individual feels justified or empowered rather than upset.

Relationship to Personal Values

With harm OCD, thoughts directly contradict deeply held moral values. For example, the person might value kindness and equality. This means that the violent thoughts feel very wrong to them.

The disconnect between personal values and intrusive thoughts causes the troubling emotions associated with harm OCD. People may also experience self-doubt because they can’t understand why they’re thinking something that goes against their personal values and beliefs.

With actual violent thoughts, they often align with a person’s current emotional state or desires. Because there’s no moral conflict, there’s no worry or desire to suppress the thoughts.

Response Patterns

With harm OCD, the goal of a person’s response is to reduce anxiety and prevent anything bad from happening. They might do this by trying to neutralize or suppress the thoughts. They might also try to avoid situations where they are fearful they might act on these violent thoughts or seek reassurance that they’re not a violent person.

This is different from actual violent thoughts, where the goal is to prepare. Individuals might respond to violent thoughts by planning, preparing, or elaborating on the fantasy. They might also consciously revisit these violent thoughts.

Level of Distress

Harm OCD thoughts can be very distressing. Thoughts are intrusive and can lead to intense feelings of fear. This distress is a result of the thoughts themselves. Harm OCD thoughts might also come and go in intensity, based on the level of stress a person is experiencing or how well their OCD is being controlled. 

But with actual violent ideation, there’s no distress about the thoughts themselves. Instead, people may worry about getting caught or facing the consequences of violent actions. Thoughts can also ramp up over time, meaning that they grow in intensity rather than come and go. 

Behavioral Patterns

A major marker of harm OCD is that people engage in compulsions to prevent any perceived risk. This might look like avoidance and safety behaviors, such as avoiding potentially dangerous situations. They might also withdraw socially. 

With actual violent thoughts, people will engage in behaviors related to justifying or carrying out the violent thought. This might include research, acquiring weapons, and planning or rehearsing the violent act. They may also conceal or hide what they’re doing to avoid getting caught. 

Recognizing Harm OCD Symptoms

Harm OCD comes with a range of symptoms, including both physical and mental symptoms that can impact someone’s daily life.

Intrusive Thought Patterns

The intrusive, violent thoughts that people with harm OCD experience can feel very real. Because of how real and uncontrollable they feel, people can confuse them with intent. These intrusive thoughts can include both thoughts and images about harming others or oneself. A pattern of “What if?” thoughts is also common with harm OCD, such as, “What if I swerve my car into that person on the sidewalk?” or “What if I stab myself with this kitchen knife?”

Harm OCD can also cause intrusive thoughts about the past. People might experience doubts about something that happened in the past or worry that they have done something to hurt another person and forgotten about it. 

Physical and Emotional Symptoms

The distressing thoughts associated with harm OCD can lead to a number of physical and emotional symptoms. Anxiety and fear from these thoughts can lead to panic attacks. People may feel tense, both physically and mentally, and often feel the need to stay hypervigilant. They might also experience feelings of shame and guilt about the thoughts that they are having. 

The ongoing stress and anxiety can also make it difficult to concentrate and create a feeling of restlessness, like someone just can’t relax. This can also cause fatigue, headaches, and stomachaches, and make it difficult to sleep at night.

Compulsive Behaviors

Compulsions with harm OCD center around trying to relieve anxiety and preventing something bad from happening. This can include avoiding potential triggers, such as kitchen knives, being alone with another person, or watching violent movies. They might also engage in excessive checking.

For example, they might regularly check the news for violent crimes to make sure that they haven’t performed a violent crime and forgotten about it. Or they might mentally check that they still feel horrified thinking about violence to reassure themselves that they’re not a violent person. 

People with harm OCD might also seek reassurance from others that they’re not ‌a violent person. They might also feel compelled to confess—even when they haven’t done anything wrong. 

Impact on Daily Life

Managing harm obsessions can be stressful and tiring. People might have difficulty keeping up with work and their daily activities. The shame and fear caused by intrusive violent thoughts might also cause them to isolate themselves socially.

Compulsions associated with harm OCD can be time-consuming, often occupying more than an hour each day. This can also make it difficult to manage work and other responsibilities. People with harm OCD might also feel compelled to seek reassurance from their friends and family members. Over time, this can cause tensions in relationships.

There’s a lot that you can’t always see with harm OCD. People might feel as though they can’t trust themselves and their emotions. For example, they might worry about “snapping” or losing control and doing something violent. They might also want to seek help but feel worried that they’ll be labeled as “dangerous” if they do.

Supporting Someone with Harm OCD

In this section, we’ll go over how to best support someone with harm OCD.

Creating a Safe, Non-Judgemental Environment

Because harm OCD thoughts can cause so much anxiety and shame, it can be difficult for people with harm OCD to share how they are feeling with a loved one. Respecting their vulnerability and how they’re feeling can go a long way. Avoid any shock or alarm when your loved one shares the thoughts that they’re having with you. Instead, remind them that thoughts don’t equal actions or character. 

It’s also important to validate the distress rather than validating the fear. While providing reassurance might reduce anxiety in the moment, it ends up feeding the compulsions, which can make OCD worse over time. Instead, focus on showing understanding of the person’s emotions. For example, “That sounds really hard.”

Helpful Communication Strategies

When communicating, it’s important to listen actively and validate how the person is feeling.

Repeating what they said back to them in different words can help check that you understand what they’re saying and are hearing them. Keep in mind that many people with harm OCD experience deep feelings of shame or guilt over their thoughts, and it can take a lot to share them with another person. Respect their boundaries and avoid pressing them for further details, as this can lead to more shame.

Some examples of positive things to say to a loved one experiencing harm OCD include:

• “Thank you for trusting me with this.”
• “Having these thoughts doesn’t make you dangerous.”
• “This sounds really frustrating and exhausting.”
• “Many people with OCD experience thoughts like this too. You’re not alone in how you’re feeling.”

What Not to Say

Although we often have good intentions, saying the wrong thing can trigger strong feelings in someone with harm OCD. This can make it harder for them to express their emotions. Phrases to avoid include:

• “You would never hurt another person.” - This provides reassurance, which can fuel compulsive thoughts. 
• “Everyone has violent thoughts.” - While this can be true, OCD violent thoughts are much more distressing and persistent. This phrase can invalidate what your loved one is experiencing.
• “Maybe you’re thinking this because you’re stressed. What do you think might be causing that?” - Problem-solving or trying to analyze the thoughts can also feed compulsions. As a loved one, your role is to offer understanding rather than trying to solve the problem. 
• “Just stop thinking about it.” - This implies that people with OCD have control over their thoughts. But the reality is that these thoughts are intrusive and unwanted. It isn’t as simple as just avoiding thinking about it.

Encouraging Professional Help

For some people, it can be difficult to seek professional help. They might have some internalized stigma where they consider it weak to seek help, or they may worry about being a burden to others.

You can counteract these beliefs by normalizing seeking help for intrusive thoughts. For example, remind them that OCD is a common mental health condition and requires treatment like any other health issue.

When someone is experiencing mental health issues like OCD, they might be feeling too tired or overwhelmed to seek help. As a friend or family member, you can offer to help them with researching OCD specialists to ease some of their mental load. You can also help by offering practical support for their appointments. For example, you could drive them there or watch their kids while they go.

Supporting Treatment Compliance

Although it's very effective, treatment for OCD can be challenging. One thing that helps people in their treatment is support from their friends and family.

A simple acknowledgment that you can see how hard they’re working can be a nice encouragement. If your loved one comes to you to seek reassurance, it’s best to avoid providing this, as one of the goals of treatment is to avoid compulsions. Instead, identify that they are having an OCD thought and gently remind them to use the strategies learned in therapy.

Your loved one might be undergoing exposure and response prevention (ERP), which is the most common treatment for OCD. As this involves gradually facing feared situations, their therapist might recommend that they have a friend or family member with them as added support. If this is the case, ensure that you follow the therapist’s guidelines to avoid pushing them through exposures too quickly.

Treatment for OCD, like any other mental health condition, is a journey. Your loved one might have ups and downs as they go through treatment. A good way to provide your continued support for them is to help them celebrate their small wins, such as going to their appointments or completing an exposure task. 

When to Seek Immediate Professional Help

Although rare, there are some crisis situations in which immediate professional help is needed.

Warning Signs Requiring Urgent Attention

Warning signs that you need to seek immediate help include:

• Sudden change from distress to comfort with violent thoughts.
• Specific plans or preparations for violence.
• Acquisition of weapons or the means to cause harm.
• Loss of reality or psychotic symptoms, such as hallucinations or delusions.

Crisis Resources and Emergency Services

If the person is experiencing a mental health crisis but isn’t in immediate physical danger, call the Suicide and Crisis Lifeline at 988. For life-threatening emergencies, call 911. A mobile crisis team may also be available in certain areas. This team of trained professionals can help de-escalate situations when in-person intervention is needed. You can request a mobile crisis team by calling 988.

Professional Assessment Needs

If someone is a threat to themselves or others, it’s important to seek the support of trained mental health professionals. These professionals are able to perform a risk assessment to understand if the person is currently at risk of violent actions. If a person is at risk of harming themselves or others, these trained mental health professionals can create a treatment plan to ensure safety.

Trained mental health professionals can also test for OCD. While there’s no single test for OCD, a variety of specialized OCD assessment tools can be used to gain a deeper understanding of the OCD symptoms being experienced. This might involve questions about the presence of obsessions, any physical or mental compulsions, and the impact these obsessions and compulsions have on the person’s daily life. 

Treatment Options for Harm OCD

A number of evidence-based therapies and medications can be used to help treat harm OCD.

Evidence-Based Therapies

If someone has OCD, it’s important they get proper treatment. Traditional talk therapy, which is used for a variety of mental health conditions, can actually make OCD worse because it encourages people to examine their intrusive thoughts, which gives them more meaning. Instead, recommended treatment for OCD includes:

• Exposure and Response Prevention (ERP): Focuses on gradual exposure to anxiety-provoking situations or obsessions while avoiding engaging in compulsions. Over time, this leads to learning that what the person fears doesn’t happen, helping to reduce anxiety. ERP is considered the gold standard for OCD treatment and is effective for about 80% of people with OCD. 
• Acceptance and Commitment Therapy (ACT): Focuses on accepting distressing thoughts and changing one’s relationship with them.
• Cognitive-Behavioral Therapy (CBT): Focuses on the relationship between thoughts, feelings, and behaviors. CBT may also introduce mindfulness practices to help people learn to view their thoughts as neutral rather than threats.

Medication Options

When considering medication, it’s important to work with psychiatrists who are familiar with OCD to ensure that the right medication is prescribed. Selective serotonin reuptake inhibitors (SSRIs) are often used to treat OCD. These medications work by increasing the amount of serotonin in the brain, which can help reduce the frequency and intensity of obsessions and compulsions.

It’s important to note that medication can take time to work. While medication effects are often seen within 42-64 weeks for depression, they can take up to 6-10 weeks for OCD. For this reason, it’s often recommended to combine medication with evidence-based therapy.

Specialized OCD Treatment Centers

Specialized OCD treatment centers have staff that are specifically trained in OCD diagnosis and treatment, including specific subtypes like harm OCD. For this reason, they can have a better understanding of the obsessions and compulsions associated with harm OCD and provide more comprehensive treatment, which can be more effective.

Many specialized OCD treatment centers offer intensive outpatient and residential programs. These programs provide safe, distraction-free spaces to practice OCD management skills regularly. They may also offer support groups for additional support. The International OCD Foundation’s Resource Directory can be used to help find specialists in OCD. 

Self-Care and Coping Strategies

In this section, we’ll go over coping strategies for individuals with OCD and their loved ones.

For Individuals with Harm OCD

Managing intrusive thoughts can be difficult. Although it's natural to want to suppress these unwanted thoughts, trying to do so can actually make them stronger. Instead, it’s better to use mindfulness and acceptance techniques. This helps you recognize the thought without reacting emotionally. This might include deep breathing or meditation.

Harm OCD can also bring up difficult emotions. Using distress tolerance skills when you feel overwhelmed can help to better manage these troubling emotions.

Examples include self-soothing actions, such as taking a warm bath or shower. They also include distracting techniques, such as engaging in creative activities. Prioritizing taking care of your complete wellbeing, including eating regular, balanced meals, getting enough sleep, and moving your body, can also help with managing OCD symptoms.

For Loved Ones and Supporters

It’s natural to want to help your loved one when they’re going through something like harm OCD. But it’s important to set boundaries and practice self-care when doing so.

This keeps you healthy, so you can care for yourself. It also helps prevent relationship problems from OCD behaviors, like seeking reassurance. If you’ve been providing your loved one with reassurance, it can be difficult to stop. Setting a boundary, like you’ll only reassure them once per day, can help you slowly reduce the frequency of reassurance.

If you start experiencing symptoms of burnout yourself, such as feeling excessively tired or having a lack of emotion, it can be helpful to seek your own therapeutic support. Some people also find it helpful to join a support group for family members. In these support groups, you’ll learn more about OCD and share experiences.

Building a Support Network

It can be overwhelming to manage OCD on your own. But you don’t have to. There are several ways to connect with others who understand OCD, either in person or through online support groups.

Families and OCD - International OCD Foundation

NAMI Family Support Group 

Relief from OCD - Anxiety and Depression Association of America

Support Groups and Treatment Groups - International OCD Foundation

Takeaway

Harm OCD thoughts can be overwhelming, but they don’t reflect your intentions or character. While getting support and treatment can be scary, it’s a brave decision. Proper support and guidance can help you understand OCD, ease symptoms, and learn how to respond to intrusive thoughts in a healthier way. You don’t have to try to manage these thoughts and feelings on your own.

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