What If Something Bad Happens Because of Me? A Look at Harm OCD
TL;DR
Harm OCD involves unwanted, distressing thoughts or images about causing harm to yourself or others, often followed by compulsions meant to prevent danger or gain reassurance. These intrusive thoughts typically conflict with a person’s values, but their intensity can make them difficult to dismiss. A clinician experienced with OCD can help distinguish harm-related obsessions from genuine safety concerns. OCD treatment using Exposure and Response Prevention (ERP) can help people gradually face feared situations, resist compulsions, tolerate uncertainty, and reduce the power these thoughts have over daily life.
"Yes, I am a prisoner of sorts, but my prison isn't the house. It's my own thoughts that lock me up!" — V.C. Andrews
You’ll stab your mom.
If I don’t keep my hands in my pockets, I lose control and hit someone.
You could kill yourself.
These thoughts create absolute terror for those with harm OCD. OCD can involve intrusive thoughts like these, or intrusive images of killing or hurting others. “Intrusive” is the key point here. These thoughts are unwanted and incredibly disturbing. They cause fear because it is usually the last thing that the person with OCD wants to do. And because they are so terrifying, the thoughts and images loop and loop, becoming torturous. This is what harm OCD can look like.
What is Harm OCD?
Harm OCD is one of many possible OCD themes. When folks have harm OCD, their symptoms involve a fear of harming others. Usually, the core fear is that you will cause yourself or someone else to die or become irreparably harmed. It could also involve a fear of being a bad person or your life being ruined by going to jail for hurting or killing someone.
In response to these intrusive thoughts or fears (called “obsessions”), people with OCD engage in behaviors meant to prevent their worst fear from happening or to reduce their anxiety. These are compulsions.
Examples of harm-related obsessions, with examples of specific intrusive thoughts:
Feeling responsible for preventing harm to others
If I’m not careful enough, it will be my fault that someone gets sick or is injured or killed by accident
Fear of secretly being the kind of person who would hurt or kill others
Disturbing, even gory intrusive thoughts of physically harming or killing a loved one
Concerns about stabbing your child
Fear of impulsive harm to others
Fear you will somehow lose control or ‘snap’ and murder your whole family
What if I push this person down the stairs?
Concern you will hurt or kill yourself
I am feeling sad today, does that mean I’m going to kill myself?
Examples of Harm-Related Compulsions, for different obsessions:
Feeling responsible for preventing harm to others
Keeping everything clean and sterile so that others don’t get sick
Avoiding cleaning using chemicals like bleach
Looking out for and fixing potential hazards (such as a tripping hazard)
Triple-checking that food is cooked to the correct temperature before serving to others
Fear of secretly being the kind of person who would hurt or kill others
Avoiding watching the news, police TV shows, or horror movies
Mentally reviewing the reasons why you are not a murderer to assure yourself
Confessing the intrusive thoughts every time they happen
Neutralizing violent thoughts with “safe” thoughts
Fear of impulsive harm to others
Locking up knives or asking your partner to do all the vegetable chopping
Asking for reassurance from others that you wouldn’t hurt someone
Mentally reviewing memories of situations to check whether you harmed someone
Reciting prayers to protect from hurting anyone
Keeping your hands in your pockets when around others
Concern you will hurt or kill yourself
Avoiding going near high places, being around potential weapons, or locking up pills
Avoiding being alone
Checking your emotions and whether you feel depressed or suicidal
Repeatedly reassuring yourself you would never kill yourself
Seeking reassurance from others about whether you would kill yourself
Avoiding all reference to suicide, or even to death, in the media or online
As you can see, there are many different ways that harm OCD can manifest, and there are many more possibilities that I did not list here. The main theme is the fear of harm coming to yourself or others, and you being responsible for it.
How Do You Know It’s Really OCD?
Ah, the age-old question. If there were a blood test for OCD, whoever created it would be very rich. There isn’t one, and there’s no way of knowing with absolute, 100% certainty that someone has OCD and is not actually a secret killer. That being said, there are people who actually kill other people, and it is important to be evaluated by a clinician knowledgeable about OCD to determine your diagnosis.
In his book,Overcoming Harm OCD, OCD expert Jon Hershfield, MFT, recommends exploring the following questions with a mental health professional well-versed in OCD. Do you…
Have a history of violent acts? Not hitting your sister for stealing your last piece of candy once when you were a child, but resolving problems through violence.
Voluntarily fantasize about your violent thoughts coming true?
Wish you could get away with acting out your violent thoughts?
Unwanted thoughts present as thoughts, commands, or voices?
Have a history of suicide attempts or suicidal behavior?
How would you feel if you were to hurt someone?
Do the thoughts seem completely reasonable? Or do they conflict with your sense of self?
Do you currently have a committed desire and intent to kill yourself, with a plan of how you will do it and when? If the answer to this question is yes, go to your nearest emergency room or contact the 988 Suicide and Crisis Lifeline.
For thoughts of suicide, the situation can be trickier, as suicidal thoughts are very common for people suffering from OCD. A mental health professional well-versed in OCD should be able to help differentiate obsessive thoughts and true suicidal thinking.
How to Treat Harm OCD
Just like all other OCD themes, the gold standard therapy for harm OCD is exposure and response prevention (ERP). It involves intentionally exposing oneself to situations or activities that trigger intrusive thoughts and anxiety (exposure) and resisting any compulsions or attempts to avoid (response prevention). There is a lot of research backing it up, and it can be extremely effective in getting OCD symptoms under control.
How do you do an exposure when the fear is killing someone?
Not by killing someone, of course. It’s by putting yourself in situations where your anxiety is telling you that you could kill someone. For example, my favorite exposure is having a client put a knife to my throat or my wrist. Since I’m fully virtual now, I don’t get to be the potential victim anymore. Instead, exposures at Leap Counseling might involve bringing a close loved one in (with everyone’s consent) and holding a knife pointed at the loved one. You might use scissors while sitting next to your child. You might intentionally imagine and write out a whole scenario in which you do actually ‘snap’ and hurt someone.
The point is that we get creative. The idea may seem odd, but it is very effective. The point of exposure is not to actually hurt someone or to put anyone at an unreasonable level of risk. For example, it would NOT be appropriate to not buckle your child in when driving with them, but it might be appropriate to not check whether you buckled them in after you did so. The point is to feel uncertain about whether you will harm someone.
Ready to Find Freedom From Harm OCD? Evidence-Based OCD Treatment in Wauwatosa, WI, Can Help
If intrusive fears about hurting yourself or someone you love leave you questioning whether you can trust yourself, OCD treatment can help you understand what is keeping that fear alive. With specialized support, you can learn to respond to unwanted thoughts without avoiding, checking, or seeking reassurance, allowing them to have less control over your life.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders, including harm OCD. Using evidence-based approaches such as Exposure and Response Prevention (ERP), Dr. Wood helps clients face harm-related fears safely, reduce compulsive responses, and become more comfortable living with uncertainty. You can begin with three simple steps:
Reach out to discuss what you’ve been experiencing and schedule a free 15-minute consultation
Work one-on-one with an experienced OCD therapist in Wauwatosa who understands harm-related obsessions and compulsions
Begin changing how you respond to intrusive thoughts so you can spend less time controlled by fear and more time living according to your values.
Other Services Leap Counseling Offers Online in Wauwatosa, Wisconsin, and All PSYPACT States
Harm OCD can make intrusive thoughts feel significant or dangerous, leading to cycles of avoidance, checking, reassurance seeking, and other compulsions. Through specialized OCD therapy, you can learn to relate to these thoughts differently, tolerate uncertainty, and gradually regain confidence in yourself and your ability to move through everyday life.
Harm OCD is only one of the concerns I treat through my Wisconsin-based online therapy practice. Because OCD and anxiety can take many forms, I offer individualized support for a range of anxiety-related conditions. In addition to OCD treatment, I provide therapy for Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin with authorization to practice in all PSYPACT states, I can provide specialized online care to clients across many locations.
You don’t have to spend your life trying to eliminate every frightening thought or guarantee that nothing bad will happen. With evidence-based support, it is possible to loosen OCD’s grip and make choices based more on your values than your fears. Explore my mental health blog for additional information about OCD and anxiety, and reach out when you’re ready to schedule an appointment and begin moving forward.
About the Author
Dr. Johanna Wood is a Wisconsin-based clinical psychologist who specializes in evidence-based therapy for OCD and anxiety disorders. Her expertise includes a PhD in Clinical Psychology from Northern Illinois University, a doctoral internship in Rogers Behavioral Health’s OCD and Anxiety Adult Residential Program, and experience supervising its OCD, Anxiety, and Depression Adult Residential Program. Dr. Wood also brings lived understanding to her work after navigating relationship OCD herself.
She knows how frightening unwanted thoughts can feel and how easily they can lead to avoidance, reassurance seeking, and attempts to guarantee that nothing bad will happen. Her own ERP treatment taught her to move toward uncertainty rather than seek absolute safety. That “leap of faith” now shapes how she supports clients struggling with harm OCD and other OCD themes. Licensed in Wisconsin with PSYPACT authorization and actively involved with the International OCD Foundation, Dr. Wood combines specialized training with personal insight to provide compassionate, practical therapy for OCD through her online practice.
