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.
Peopleย experiencingย harm-related OCDย often begin treatment with the unspoken belief that having a disturbing thought is as bad as engaging in a disturbing behavior. Theyย have spent a lifetime tryingย desperatelyย to not have their intrusive thoughts.ย Theirย extreme discomfort with intrusive thoughtsย kicks off a vicious cycle ofย constantly trying to avoid havingย thoseย thoughts, leading to an increase in theย very thoughtsย they are working so hard tonot have.ย In other words, the more we try to not have a thought, the more we willย haveย 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 โ 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 becauseย theylove children, often have harm-related OCD thoughts aroundย losing control and engagingย inย inappropriate behaviorsย with their students.ย Forย aย new mother whoย isย so deeply in love withย herย newborn, OCD may show up with thoughts aroundย losingย controlย and harmingย herย preciousย little baby.ย A newlywed may have intrusive thoughts around losing control and engaging in sexually inappropriate behaviors with someone who is notย a spouse.If the teachers did not care about their students,ย the mother did not care about her newborn,ย and the newlywedsย did not care about their spouses,ย OCD would not waste its time with thisย material.ย So one thing you can remind yourselfย ofโย in the face of aย harm-related OCD thoughtย โย 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.
