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Harm-Related OCD — The Terrorist Within

By Debra Kissen

Image uploaded for Light On Anxiety.

My favorite clients to work with are individuals struggling with harm-related obsessive-compulsive disorder (OCD).

Without exception, every client I have seen who has sought treatment for this has been conscientious, kind and loving. These are people I would trust as babysitters, teachers and caretakers. The sad irony is that those who meet criteria for harm-related OCD often view themselves as depraved monsters who would be rejected from society if anyone knew of their intrusive thoughts.

People experiencing harm-related OCD often begin treatment with the unspoken belief that having a disturbing thought is as bad as engaging in a disturbing behavior. They have spent a lifetime trying desperately to not have their intrusive thoughts. Their extreme discomfort with intrusive thoughts kicks off a vicious cycle of constantly trying to avoid having those thoughts, leading to an increase in the very thoughts they are working so hard tonot have. In other words, the more we try to not have a thought, the more we will have that thought.

Effective treatment for harm-related OCD entails assistingclients in making contact with their scary thoughts (exposure) over and over again until their brains grow bored with them. This process is similar to watching a scary movie until it loses its shock value and shifts from being frightening to absurd. At the same time, clients learnstrategies and receive support to give up all thought-control behaviors (response prevention). This treatment approach is called exposure and response prevention (ERP) for OCD.

What I enjoy so much about working with those seeking to overcome harm-related OCD is how rapid a recovery they can make — once they begin to see their disturbing thoughts from a new vantage point. The flip side of any harm-related obsession is a value. If you are ever unclear about what is important in your life, just see what material OCD chooses to terrify you about. OCD will never invade a territory that is irrelevant in your life. The goal of OCD is to alert you to potential danger and then have you engage in behavior to make things better immediately. OCD goes after what you care most about and what would be most devastating if things went wrong.

The teachers I work with, who enter the field because theylove children, often have harm-related OCD thoughts around losing control and engaging in inappropriate behaviors with their students. For a new mother who is so deeply in love with her newborn, OCD may show up with thoughts around losing control and harming her precious little baby. A newlywed may have intrusive thoughts around losing control and engaging in sexually inappropriate behaviors with someone who is not a spouse.If the teachers did not care about their students, the mother did not care about her newborn, and the newlyweds did not care about their spouses, OCD would not waste its time with this material. So one thing you can remind yourself of— in the face of a harm-related OCD thought — is thatthere is some related core value in your life that OCD is ineffectively attempting to protect.

If you are struggling with these kinds of harm-related intrusive thoughts, I encourage you to seek out cognitive-behavioral therapy (CBT) for OCD and inquire if your mental health provider offers exposure and response prevention (ERP). Be wary, though: An untrained clinician may take these intrusive thoughts to be actual desires. You may want to print out this article when start a discussion with a clinician about harm-related OCD. 

And always remember that the net sum of your life is not what you think, but what you do. Live a life according to your values even if intrusive harm-related thoughts occasionally come along for the ride.

Dr. Debra Kissen is CEO of Light On Anxiety CBT Treatment Center. Dr. Kissen specializes in Cognitive Behavioral Therapy (CBT)...

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