Having someone’s hands around my throat; just another day at the office. Harm OCD explained.

Having someone’s hands around my throat; just another day at the office.

Harm OCD explained.

Imagine having a constant fear that you may seriously harm your child or a loved one; unfortunately for some this is a reality. It’s not that this person is having a psychotic episode, or turning into a psychopath, the likelihood is that this person is experiencing a common form of Obsessive Compulsive Disorder (OCD), called Harm OCD.
Harm OCD is an extremely distressing manifestation of OCD, in which the person experiences unwanted, distressing thoughts and images of causing harm to others. This form of OCD can be experienced by children, who may fear harming their parents and by adults who may develop fears around harming their loved ones, including new born babies. Moments that should be filled with happiness and peace, become contaminated by violent and intrusive thoughts.
Whilst working as an CBT therapist at The Chelmsford Wellbeing Centre I have worked frequently with Harm OCD and by helping my clients’ recognise and relabel their obsessive thoughts and guiding them through a graded Exposure and Response Prevention (ERP) programme, I have generally achieved great results.
I worked with one client who believed he would harm his nephew and to help him challenge this I gradually encouraged him to stop avoiding his nephew and from seeking reassurance from family members. As part of therapy I asked him to write down that he wanted to harm me on a piece of paper, then sit together and see what happened. Nothing happened proving writing or thinking things does not make them any more likely to happen. Eventually my client could connect with his nephew again without experiencing feelings of intense fear and guilt.
More recently I worked with a teenager who started experiencing Harm OCD when she started tutoring younger children. As part of her ERP session, I had her build up to gradually having her hands around my throat to see if she acted on the thoughts and as a final stage she held a knife and finished standing holding the knife behind my back until her anxiety levels reduced. When she realised she didn’t act on her thoughts she could confidently return back to her tutoring job.
Why would you put yourself in this seemingly vulnerable position at work people may ask? The reason is, is that it is extremely unlikely that these individuals will act on these thoughts (in fact I have never heard of a case of Harm OCD where a person has seriously harmed another). The literature suggests that these individuals usually have extremely high morals and in my experience they are usually very kind and caring individuals.
We all have unusual thoughts from time to time, i.e. when standing in front of a train we may have a thought of, ‘what if I jump in front of that train’. Most individuals however can dismiss this thought, label it as a ‘bizarre thought’ and carry on with their day.
However, for the Harm OCD individuals this is not such an easy thing to do, due to differences in how the brain works. Individuals with OCD are unable to differentiate between what’s important and what isn’t and have difficulties filtering information. They would therefore focus on the bizarre thought and experience doubt, possibly throw it on to the important pile, being unable to label it as ‘unimportant’.
The thought remains in the mind, is focused on and feels more important, you experience anxiety and feel an urge to do something about it, to get rid of it. You may develop behaviours or compulsions to relieve yourself, such as avoid knives, stop looking at violent programmes which make you think about it more. In the short term this all makes sense, who wants to constantly fear they will harm their child for example. In the long term however the avoidance can reinforce your harm beliefs.
What makes the situation worse is that the area that manages behaviour in the OCD brain is unable to switch off once an action is carried out. We may wash our hands and the brain goes ‘ahh that’s fine, action complete, move on’. In the OCD brain the behaviour switch is faulty, it doesn’t switch off so you doubt completing the action, so feel compelled to do it again. In Harm OCD you may for example keep checking your child again and again to make sure you haven’t harmed them.
The repetitive behaviour also causes the brain to examine the thought further. The person can therefore get stuck in an awful loop with a thought going round and round, resulting in them carrying out more and more behaviours in an attempt to get rid of their thoughts and distress. Harm OCD sufferers start to wonder maybe this does have meaning, maybe I really do want to harm my child, some even fear they may be turning into a psychopath.
If you were a psychopath however, why would you feel intense fear and guilt and do anything possible to not act on these thoughts? The key difference is that a psychopath enjoys having thoughts about potentially hurting others. They would have feelings of excitement, pleasure even, they would not feel significant daily distress like a Harm OCD sufferer.
So next time someone asks why would I allow an individual diagnosed with Harm OCD to sit with their hands around my neck at the office, I would say ‘’easy, I am providing this distressed individual with the opportunity to see that their obsessions are meaningless. I am showing them that this is not a factual thought based on reality, it is a belief we need to challenge using Exposure Response Prevention; I am helping free that person from their worst imagined fears and teaching them to manage their debilitating illness’.
So, when I’m sitting in the office with someone’s hands round my neck, I hope you can see more clearly, it really is quite simply just another day at the office.

Claire Littlejohn, BABCP Accredited CBT Therapist and Marketing Director.

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