Intrusive thoughts are common
Research shows that most people experience unwanted intrusive thoughts, including violent or shocking ones. Most people dismiss them as meaningless. In OCD, the same thoughts “stick” because the person interprets them as important, dangerous or revealing something about their character.
Common harm obsessions
- Images of stabbing a loved one when holding a knife.
- Fear of pushing someone in front of a train or off a platform.
- Fear of harming a baby or child, common after childbirth.
- Fear of losing control and acting on an impulse.
- Fear of running someone over while driving and not noticing.
- Intrusive thoughts of self-harm without wanting to die.
Compulsions and avoidance
- Hiding or avoiding knives, scissors or other sharp objects.
- Avoiding being alone with children, partners or pets.
- Checking that people are unharmed, or driving back to check.
- Seeking reassurance that you would never do it.
- Mentally reviewing past events for evidence of harm.
- Trying to replace “bad” thoughts with “good” ones, or praying.
Why harm OCD does not mean you are dangerous
People with harm OCD find their thoughts abhorrent and go to great lengths to prevent harm. This is the opposite of genuine intent, where thoughts of harm are wanted, planned or accompanied by anger and justification. There is no evidence that people with harm OCD are more likely to act on their obsessions.
The distress, guilt and avoidance are signs of how much the person cares about not causing harm.
Harm thoughts after having a baby
Many new parents experience sudden intrusive thoughts of harming their baby, such as dropping them or hurting them in the bath. These thoughts are common, and for some develop into perinatal OCD with avoidance and checking. Talking to a midwife, health visitor or doctor is safe and can lead to effective help.
See postpartum anxiety.
The OCD cycle
An intrusive thought leads to anxiety and doubt, which leads to a compulsion such as avoidance or reassurance-seeking. The compulsion brings short-term relief but teaches the brain that the thought was dangerous, so it returns more often and more strongly. Trying hard not to think the thought also makes it more frequent.
Treatment: exposure and response prevention
Cognitive behavioural therapy with exposure and response prevention is the recommended treatment. With a therapist, the person gradually approaches situations they have been avoiding, such as using a kitchen knife near others, while resisting checking and reassurance. They may also practise allowing intrusive thoughts to come and go without reacting.
This helps the brain learn that thoughts are not actions and that anxiety reduces on its own.
Other helpful approaches
- Cognitive therapy to challenge beliefs about thoughts, such as “thinking it makes it more likely”.
- Acceptance and commitment therapy (ACT) and mindfulness to relate differently to thoughts.
- SSRI medication for moderate to severe OCD.
- Psychoeducation for partners and family to reduce reassurance-giving.
Talking about harm thoughts
Many people with harm OCD fear that telling a professional will lead to their children being taken away or to being judged as dangerous. Mental health professionals trained in OCD recognise harm obsessions and understand that they are a symptom of anxiety, not a risk. Being open allows the right treatment to begin.
Things you can try
- Label the thought: “this is an OCD thought”.
- Allow the thought without arguing with it or pushing it away.
- Gradually reduce avoidance and checking.
- Use grounding and breathing skills for anxiety; see grounding techniques for anxiety.
- Read reputable OCD self-help resources based on CBT.
When to seek help urgently
- You feel unable to cope, hopeless or very low.
- You have thoughts of suicide or self-harm that you feel you might act on: contact emergency services or a crisis line.
- Thoughts of harming others feel wanted, justified or are accompanied by plans: seek urgent help.
- Avoidance is stopping you caring for yourself or your children.
Key points to remember
- Harm OCD involves unwanted thoughts of harm that cause great distress.
- These thoughts do not mean you are dangerous.
- Avoidance, checking and reassurance keep the cycle going.
- ERP therapy, sometimes with SSRIs, is effective.
Questions about harm OCD
These answers are general information and do not replace an examination or individual medical advice.
Does harm OCD mean I will hurt someone?
No. There is no evidence that people with harm OCD act on their obsessions.
How do I know if it is OCD or real intent?
OCD thoughts are unwanted and distressing and you try to avoid acting on them.
Is it normal to have violent intrusive thoughts?
Yes. Most people have them occasionally.
Can harm OCD be cured?
Many people recover or improve greatly with ERP therapy.
Should I avoid knives if I have harm OCD?
Avoidance keeps OCD going; a therapist can help you gradually reduce it.
Is it safe to tell my doctor about these thoughts?
Yes. Professionals who understand OCD recognise these thoughts as symptoms.
Can new parents get harm OCD?
Yes. Intrusive thoughts about harming a baby are common after birth and treatable.
Sources
- NHS · Obsessive compulsive disorder (OCD)
- NIMH · Obsessive-compulsive disorder
- NICE CG31 · Obsessive-compulsive disorder and body dysmorphic disorder: treatment
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.