Written by Clinical Psychology Registrar James Clancy
Some people living with obsessive compulsive disorder (OCD) are haunted by a question, “What if I hurt someone?”, even though they have no desire or intention to do so. Harm OCD can occur when the mind latches onto thoughts of causing harm, intentionally or by accident, and then treats these thoughts as if they are real, urgent, and dangerous warnings.
What is Harm OCD?
Harm OCD involves unwanted, intrusive thoughts, images, or urges about harming yourself and/or others. These thoughts are ego-dystonic, meaning they clash with your values and who you know yourself to be, which is why they may feel so distressing.
Common obsessions include fears of:
- Losing control and physically harming or attacking someone
- Running someone over while driving
- Hurting a baby or child you care about
People experiencing harm OCD can feel intense guilt, shame, and anxiety about these intrusive thoughts, not pleasure. These emotional reactions are a key difference between harm OCD and legitimate intentions or desires to harm.
Why It Feels So Real
Research examining intrusive thoughts has found that disturbing thoughts are common in the general population, but they can become OCD obsessions when they are interpreted as meaningful or dangerous. In harm OCD, several thinking styles may make the thoughts feel “real”:
- Inflated responsibility: Feeling it is your job to prevent even the slightest possibility of harm.
- Thought–action fusion: Believing that thinking about harm is almost as bad as doing it, or makes it more likely to happen.
- Intolerance of uncertainty: Feeling you must be 100% sure you’d never act on the thought.
These beliefs understandably drive people toward compulsions like avoiding knives, avoiding certain roads or returning to that location to check that they had not collided with a person, monitoring their thoughts and feelings, or constantly seeking reassurance from others about these thoughts. These seem like logical actions at first glance; however, these safety behaviours may keep the brain stuck in threat mode, so the thoughts stay vivid and frightening, and require investigation again in future.
You Are Not Your Harm Thoughts
It is important to highlight that if you are experiencing harm OCD, this does not mean you are secretly dangerous or more likely to act on violent thoughts. In fact, the intense fear and distress people feel with harm OCD may indicate that the thoughts clash with their core values, such as kindness, safety, and empathy.
How Harm OCD is Treated
The gold-standard treatment for harm OCD is cognitive-behavioural therapy (CBT), with a focus on exposure and response prevention (ERP).
- Exposure: Gradually facing feared situations or thoughts (for example, holding a kitchen knife while cooking, driving past pedestrians, writing an “I might hurt someone” script).
- Response prevention: Reducing rituals like checking, avoidance, mental reviewing, or reassurance seeking.
Over time, this helps you to detach from intrusive thoughts to learn that:
- Thoughts are not actions.
- Anxiety and doubt can rise and fall without engagement, and associated behaviours/rituals.
- Being a caring person is shown by how you live your values, not by never having a disturbing thought.
When to Seek Help
If “What if I hurt someone?” intrusive thoughts are influencing your daily functioning, causing you distress and leading you to doubt your basic character, it may be time to seek help. Harm OCD is more common than you may expect, but with a strong therapeutic alliance with your clinician and the approaches described, you may see reductions in symptoms.
Speaking with a clinician who understands OCD can help you sort out the difference between Harm OCD and actual risk and give you a clear plan to respond differently to these thoughts.
References
Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2019). Exposure therapy for anxiety: Principles and practice (2nd ed.). Guilford Press.
Australian Psychological Society. (2023). Evidence-based psychological approaches for obsessive–compulsive disorder. Australian Psychological Society.
Overview page: https://psychology.org.au/for-the-public/psychology-topics/obsessive-compulsive-disorder
Clark, D. A. (2005), Intrusive thoughts in clinical disorders: Theory, research, and treatment. Guilford Press.
Janardhan Reddy, Y. C., Sundar, A. S., Narayanaswamy, J. C., & Math, S. B. (2017). Clinical practice guidelines for Obsessive-Compulsive Disorder. Indian Journal of Psychiatry, 59(Suppl 1), S74–S90. https://doi.org/10.4103/0019-5545.196976
Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis. Clinical Psychology Review, 40, 156–169.
https://doi.org/10.1016/j.cpr.2015.06.003
Rosa-Alcázar, A. I., Sánchez-Meca, J., Gómez-Conesa, A., & Marín-Martínez, F. (2008). Psychological treatment of obsessive–compulsive disorder: A meta-analysis. Clinical Psychology Review, 28(8), 1310–1325.
https://doi.org/10.1016/j.cpr.2008.07.001
