What is Harm OCD?
Harm OCD, also known as Pure Obsessional OCD, or Pure-O, is a form of OCD in which individuals report that they experience obsessions associated with OCD without any observable compulsions. This is such that the individual experiences obsessive and intrusive thoughts or mental images in which the individual commits immoral acts against others, seemingly, without any compulsive reaction to these obsessive thoughts. Sufferers of Harm OCD find their intrusive thoughts to be abhorrent and experience extreme difficulty talking about their experience as it involves confronting their worst fears and intense feelings of guilt and responsibility. Harm OCD is the most common presentation seen at the OCD Clinic.
What are the symptoms?
The symptoms of Harm OCD vary greatly across individuals, however, some of the common symptoms include:
- Recurrent, intrusive thoughts of physically assaulting or killing one’s family members, friends or others or acting sinfully.
- Repeated worry about hitting another with a vehicle.
- Fear of accidentally causing harm to someone.
- Worry about having said or written something inappropriate.
Why does it occur?
There are many factors that may contribute to the development of Harm OCD such that its development cannot be attributed to any one factor. Factors that may contribute to the manifestation of Harm OCD may include past experiences or environmental triggers as well as genetic predispositions. Typically, developing such an intense fear about bringing harm upon people such as your family members is a sign of a deep level of love, care and concern rather than a manifestation resulting from a desire to truly bring harm to your family.
What treatments are available?
Exposure and Response Prevention
In recent years a type of Cognitive-Behaviour Therapy (CBT), known as Exposure and Response Prevention (ERP), has proven successful in the treatment of Harm OCD. This therapy teaches clients how to face their fearful obsessions and identify the presence of compulsive and avoidant behaviours maintaining the obsessions and to challenge this behaviour. Often Harm OCD sufferers have difficulty identifying associated compulsive actions due to the absence of any outward sign of a compulsion. These difficult to identify compulsions are covert in nature and may include a compulsive need for reassurance that the individual is in control or an avoidance of anything that may threaten this control (such as the person the thoughts are about or sharp tools). Once a Harm OCD sufferer has identified that they do, in fact, experience compulsions, they can work towards replacing unhelpful compulsions with functional, long-term coping mechanisms.
A further variant of CBT, Mindfulness-Based CBT, has also now been found to be one of the most effective developments in CBT treatment of harm OCD as it teaches an individual to accept their uncomfortable thoughts in a non-judgmental manner. This, in turn, reduces the need for compulsive responses to cope with the uncomfortable feeling experienced as an individual more willingly accepts uncomfortable experiences.
Cognitive Restructuring and Imaginal Exposure
Other treatments found to be affective include Cognitive Restructuring, requiring a client to question the validity of their intrusive thoughts and Imaginal Exposure, exposing individuals to their own obsessive and distressing thoughts with the aim of decreasing an individual’s sensitivity to the thoughts.
Ultimately, the treatment of Harm OCD involves breaking the cycle of obsessive thoughts and compulsive actions. This requires the identification of the separation between obsessions and compulsions, and accepting that the obsessions are there but are simply thoughts with no basis that do not require a compulsive reaction to dispel them.
Dr Emily O’Leary
- Clinical Director of Anxiety House and OCD Clinic since 2010
- Ten years’ experience with clients with OCD and anxiety
- Clinical supervisor and STAP trained
- Worked in public and private sectors for many years
- Worked in acute inpatient and outpatients units
- Regular speaker on radio and social media
- Researcher and presenter at international conferences