Harm OCD, a brief introduction
A journey down one of the darker paths of the mind
This is an essay explaining Harm OCD. A common, but little-known, form of OCD that makes sufferers afraid that they are a danger to themselves, or to others.
This article contains discussions of very disturbing topics including mental illness, sexual assault, racism, pedophilia, sexism, extreme violence, etc. I speak about this stuff in brutal detail, because I think it’s important we be clear on the nature of this illness and the kinds of distress it can create.
1.
In general, OCD is a mental illness affecting 1-2% of the population. There are signs that OCD can be among the most serious of anxiety disorders. For example, it typically must be treated with much higher doses of SSRIs than other forms of anxiety and depression. OCD is not the “fun” or “cute” disorder it is often portrayed as on TV and in memes.
Wikipedia defines OCD quite adequately: “Obsessive-compulsive disorder (OCD) is a mental disorder in which a person has certain thoughts repeatedly (called "obsessions") or feels the need to perform certain routines repeatedly (called "compulsions") to an extent that generates distress or impairs general functioning. The person is unable to control either the thoughts or activities for more than a short period of time.”
Harm OCD is a form of OCD. In harm OCD the patient falsely fears that they will do something destructive, unethical, and opposed to their own values, or that they have done something like this in the past.
Harm OCD is well understood by the medical community. Psychiatrists and psychologists have documented many cases of what we are calling harm OCD. Examples of harm OCD form an important part of diagnostic implements like the Y-BOCS. However, the impetus for thinking of it as its own unique category of OCD, with special complications and features, has largely been driven by the community of its sufferers.
To be clear, harm OCD is not a separate illness from other forms of OCD, it’s only a different kind of manifestation of OCD. It’s not uncommon for people suffering harm OCD to have experienced other types of obsessions and compulsions in the past, or even to experience them at the same time.
Some examples of harm OCD include:
Susie is concerned that when she is cooking for her children she will include bleach in the dish and kill them.
William is worried that he will sleepwalk in the night and stab his partner to death.
Jiang is worried that she will grope and sexually assault a child while walking down the street. She fears she may have already done this and not remembered.
Morgan fears that he will, absentmindedly “on autopilot”, write out a confession to a horrific crime he hasn’t committed. He never throws out any paper in case he has accidentally written confessions on them.
David is worried that he will just “flip out”, “lose control” and start beating up people as he walks down the street.
Kiara is worried that she will mutter the N-word when she is on the phone with a black client under her breath.
Lisa is concerned she will accidentally perform a hit and run. Every time she hits a bump in the road she reverses, to make sure it wasn’t her running over someone and not realizing it.
Trevon repeatedly has images pop into his head of him raping and murdering people. He worries this means he is a psychopath who wants to rape and murder people.
Ayaan had sex with a woman several years ago. When he looks back on it he worries what if the woman wasn’t really consenting? What if he pressured her into it, not meaning to? He replays tiny details of the event in his mind.
An attentive reader might be thinking “I see the obsessions, but where are the compulsions”. Compulsions in this form of OCD can be subtle and less obvious than, say, cleaning compulsions. A sufferer might keep their hands in their pocket so that they don’t accidentally grope someone, or mentally replay the events of the day, looking for evidence that they hurt someone unattentively. They could try to think good thoughts, to cancel out the bad thoughts. They may mentally rehearse arguments about whether some occasion on which they had sex was coercive or not. Forms of OCD where the compulsions are very well hidden are sometimes called Pure O OCD. Some people even believe it is possible to have OCD with no compulsions at all, even hidden ones- just obsessions- however this is controversial.
Sidenote: I mentioned that harm OCD sometimes involves a fear of having done the wrong thing in the past. To be strictly accurate, there are some cases called “real-event OCD” where the patient really did do something wrong in the past. In these cases though, the patient will greatly exaggerate in their own mind how wrong these acts were.
In addition to harm OCD, there are two forms of OCD that are closely related and worth mentioning because they also integrally involve the values and identity of the subject.
One is sexuality OCD, where the patient is afraid that they have a different sexuality than the one they usually regard themselves as having. Some examples, A) a straight man worries that he is secretly a homosexual because he keeps having unwanted thoughts about having sex with men pop into his head. B) A man or woman who keeps having unwanted images of having sex with children come into their head and worries this means they are a pedophile.
The other is scrupulosity OCD, where the sufferer worries about blaspheming against religion, or not being sincere in their faith, etc., etc. They may have, say, involuntary sexual thoughts about the virgin Mary and be deeply distressed by this. Martin Luther may have triggered the reformation, partly because he was driven to distress by scrupulosity.
People with any form of harm OCD are not dangerous. Professor Ross Menzies, a prominent psychologist specializing in OCD, once told me words to the following effect:
If hypothetically he wanted to be absolutely sure that he was not associating with someone who would perpetuate a hit and run, he would be well advised to spend time with an OCD sufferer afraid of doing just that. If he wanted to be absolutely sure his children would not be abused, he would leave them in the care of a person with pedophile OCD. If he wanted to associate with someone who was controlled and unlikely to lash out, he would associate with someone whose OCD made them terrified of exploding in anger, and so on.
He even suggested that harm OCD could be thought of as the opposite end of the spectrum to sociopathy, and disorders where there is an absence or mutedness of conscience.
The tragedy of harm OCD that, through a process akin to natural selection, the mind picks the worst possible fear- the one most opposed to the sufferer’s deepest values- to inflict on them. This is what sticks the best- what is hardest to shake. The sufferer is effectively being punished for the depth of their opposition to running people over, or raping children, or being racist, or stabbing their partner.
2.
Twice now I have seen rubbish on Twitter of the following form:
Someone says they have intrusive thoughts about performing a deviant act [the two examples I’ve seen: sexually assaulting a child, saying the N-word].
People pile on and say that it’s disgusting that a person would admit to being tempted to such acts.
This is a horrific thing to do, and contemptible among those of them that should know better. It is one of the most hurtful things you could possibly do to a person with harm OCD, and their special vulnerabilities and fears mean that it really is no better than physical violence against them. If you only take one thing from this article, let it be this having an intrusive thought about doing x does not mean you are tempted to do x. Quite the opposite, it means that you find x especially abhorrent or terrifying. Many people with harm OCD may believe that they are tempted to do horrific things but they are not.
How can a person falsely believe that they are tempted to do something horrific? Well, there are many ways, but here is one example. Try not to think of a pink elephant. You can’t do it, right? Well, imagine if instead the thought you were trying to block out was serially raping and murdering women. You can’t force yourself not to think about something. In the end, the thought pops into your head so many times that you begin to fear that it must be because you desire it. In truth, it’s the exact opposite. Because you want nothing more in the world than not to imagine these horrific thoughts you can’t stop thinking about them.
It should be obvious why telling a person with harm OCD that their condition proves they are dangerous or evil is one of the cruelest and awful things you can do to a person with words.
3.
Harm OCD is a self-concealing illness.
Because it specifically involves things you are horrified of it makes you not want to talk about it. You fear that if others find out about these thoughts, you may be ostracised. Tragically, as the events on Twitter, I mentioned show, this can sometimes be true.
I believe that the real incidence of people with harm OCD is probably much higher than we know, for this reason.
I’m skeptical of the idea that what mental illness needs is awareness-raising. I think mentally ill people, more than awareness, need resources and support. Too often, awareness is pushed as a substitute solution for proper funding, sick leave arrangements etc. However, the self-concealing nature of this particular disorder though means that in this special case, there is a strong need for people to know more about this disorder. Then, I hope, more sufferers will recognize their own suffering, realize that it doesn’t mean they’re a bad person, and get help. We need to get knowledge about this disease into the culture.
Finally, people who talk about their harmful OCD in detail, despite it representing everything they abhor, are heroes. They are risking their reputations and their mental stability to tell you something very painful about their experience. May God have mercy on your soul if you use that as an opportunity to turn on them.
Harm OCD nearly ruined my life. Finding out about it saved my life. I’m convinced many people have it and don’t know it, which is why I’ve paid for Google ads advertising this article. I’d appreciate it if you helped out by sharing this article if you found it useful.
An acquaintance got this one, along with more conventional OCD and a bunch of other stuff that comes with the territory. Got misdiagnosed with schizophrenia at first. Almost ruined her life would be an understatement in her case. Remains one of my trickiest social interactions, as i never quite know if there is some OCD spiral going on or just normal relationship weirdness. Anyway, thanks for sharing that.
thank you so much for writing this :)