What is Harm OCD?
That's what I'm going to be talking about in this video.
I'm Tracey Marks, a psychiatrist
and I make mental health education videos.
Today's video is based on several viewer questions
asking me to talk about Harm OCD.
Harm OCD is a subtype of obsessive compulsive disorder.
OCD used to be classified as an anxiety disorder
but now it has its own designation
as a compulsive disorder grouped
with other compulsive disorders,
but it still causes a lot of anxiety.
The core symptoms are obsessions,
which are thoughts that intrude into your mind
and gets stuck there.
And compulsions, which are rituals that you perform
to decrease the anxiety that the obsessions create.
You can have either obsessions or compulsions or both.
You may wonder if the rituals or compulsions
are to neutralize the anxiety of the obsessions.
How can you have only compulsions without obsessions?
Good question,
it's probably not that common to only have obsessions
but here's an example.
Suppose you don't feel comfortable going to bed
without checking all of the locks on your doors,
checking the house alarm,
making sure you set your alarm clock,
and turning off the stovetop.
And all of this stuff is fairly time consuming,
especially if you repeatedly do them.
But you've got it down to a science
and you go through the routine every single night.
You do this, because of fear of not being safe
or missing something,
like not waking up in time for something.
And let's say both of these situations
or things that happened to you,
like there was a break in, in your neighborhood
someone just next door,
or you overslept for an important event
that you forgot to set your alarm clock for.
These incidents set off a cascade
of checking behavior in you,
but it's not like you think about
these situations all that much.
It's a nighttime ritual,
and as soon as you get out of the house
and get your day started
you don't really think much about the safety issues
or think about missing things.
If you had a corresponding obsession though,
you may be at work
and suddenly start thinking about being harmed
or being late to a meeting
because you didn't set a reminder.
Then you start checking your watch
or asking people you know, if you've missed something.
That's how it would look if you had the combination
of obsessions and compulsions,
instead of just checking compulsions.
There are different themes to OCD,
common ones are: contamination,
order, unacceptable thoughts, doubting things and harm.
Religious OCD is an example of a type
of OCD where you experience both the doubting
and unacceptable thoughts.
I talk about religious OCD in this video.
Harm OCD also contains the themes of doubt
and unacceptable thoughts.
With it, you're consumed with fear of harming yourself
or someone else or someone close to you being harmed,
even if it's not anything that you caused.
These thoughts around Harm cause a lot of distress
because not only do you have the thought,
but you can see an image of it, you can see it play out.
For example, you may walk to the kitchen
and then when your spouse enters the room,
you picture them hanging from a rope.
Even if you know that you would never
have anything to do with that happening to your spouse
just seeing your loved one look like that,
rattles you to the core.
Another thing about real OCD
as opposed to occasionally having an intrusive thought
is sometimes OCD will cause you to have poor insight
to where you question if some of your beliefs are true.
Or in this case, seeing images of your loved ones harmed
can make you believe that your thoughts are an omen,
you're seeing their future.
Or if you see it, then it must be that it's going to happen,
seeing it makes it happen.
And that belief can generate other unacceptable thoughts
about yourself, other people, or the future.
And more fears leads to more rituals.
Some of the common fears with Harm OCD
are fear of losing control and giving into a violent urge.
This is where the poor insight
can play a role in distorting your thoughts.
Since OCD can change the way you think about yourself,
you can believe that you're inherently violent
and you can't be trusted.
Another common fear
is that you will lose control of the wheel
while driving and hit or run over someone.
Another fear is that the weight of the anxiety
and the distress that you experience will cause you to snap
and then hurt someone or hurt yourself.
And then a last fear that I'll talk about
is a fear of harming someone through a sexual act.
And this would be a consensual act,
but you're afraid that you'll just lose control
and get violent.
What are some of the common compulsions
that you can use to neutralize the obsessions?
Lots of checking, this can be retracing your driving path
to see if you hit someone or checking your body
or someone else's body for injuries.
You can avoid things that trigger the thoughts
like not watching the news or movies
where people are harmed,
especially if the images from those movies are replayed
in your violent thoughts.
Another thing that you can do,
is seek reassurance from others
that they weren't harmed in your presence
or that they believed that you would never harm them.
And this would be more than an occasional ask.
This is excessively asking, did I hurt you?
Are you okay?
You know, I would never hurt you, right?
And you ask these things excessively,
because you need to repeatedly hear the answers
to reduce your anxiety.
That kind of asking would be noticeable to others.
But another thing you can do,
is mentally review the sequence of events
and perform a deep analysis of the situation
looking for clues that no one was harmed.
And this experience
is like being locked in a mental prison of thought
where you suffer silently and alone.
If you were doing it in someone's presence,
they may just see that you look like you're lost in thought
but they wouldn't know how much distress you're experiencing
with your mental rituals.
So that brings me to, what do we do about this?
OCD is not something that goes away on its own,
especially once you start having symptoms
that cause problems.
It's like pacing back and forth in the dirt
and having your path get deeper and deeper.
It's hard to break the rituals
without some professional help.
The gold-standard treatment
is exposure therapy with response prevention.
With this therapy,
you allow yourself to experience the thoughts
or you expose yourself to a feared situation
while you hold back from engaging in the compulsions.
This experience shows you that you can tolerate the fear,
and what you fear will happen
if you do allow yourself to experience it doesn't happen.
In situations where you're imagining really upsetting things
like seeing yourself harm your child as an example,
you allow yourself to experience the distress
that the image creates,
then see that you can handle this distress
and the image is not reality.
When you don't run from the image,
you reinforce that seeing your loved one
with a broken neck on the ground
doesn't mean that it happened or will happen.
And you can recover from seeing that in your mind.
In fact, the more you imagine it,
the less shocking the image becomes.
Another therapeutic approach
is mindfulness-based cognitive behavior therapy.
This therapy addresses some of your cognitive distortions
like the world is unsafe,
you are dangerous and your thoughts are reality.
Exposure with response prevention addresses your behavior
and eliminates your compulsions.
Mindfulness CBT,
teaches you how to live in the present moment
and separate yourself from the negative assumptions
that you've come to rely on.
Many cognitive behavior therapists
will combine both therapies.
If you want to know more about OCD in general,
take a look at this video that explains more about it
and this one on religious or moral OCD,
also called scrupulosity.
Thanks for watching, see you next time.