Harm OCD: intrusive thoughts about causing harm and how OCD is treated

The NHS explains that an obsession is an unwanted and unpleasant thought, image or urge that repeatedly enters your mind, causing feelings of anxiety, disgust or unease. A compulsion is a repetitive behaviour or mental act that you feel you need to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought.

Harm obsessions are those centred on the fear of causing or failing to prevent harm. OCD-UK says that compulsive behaviours are carried out to prevent perceived harm happening to themselves or, more often than not, to a loved one, even when there is no correlation between their thoughts and the compulsive behaviour. The charity’s list of types of OCD includes checking, contamination, symmetry and ordering, ruminations or intrusive thoughts, and hoarding, with themes often overlapping.

The NHS notes that during pregnancy or after a baby is born, obsessions may include worrying about harming the baby, with compulsions such as repeatedly checking the baby is breathing. It encourages anyone with these thoughts that affect daily life to speak to a GP or health visitor.

OCD-UK describes intrusive thoughts as obsessional thoughts that are repetitive, disturbing and often horrific and repugnant in nature, for example thoughts of causing violent or sexual harm to loved ones. It also states that such thoughts do not indicate intent (see below).

The charity also describes magical thinking or thought-action fusion, where a person believes that having a thought is as bad as acting on it, or that thinking something can make it happen. Examples it gives include feeling the thought “I may strangle someone” is as reprehensible as actually doing so, or believing that if you do not count to ten just right, harm will come to a family member.

• Unwanted thoughts, images or urges about harming a loved one, a child or oneself.

• Fear of losing control and acting on a thought, despite never wanting to.

• Checking compulsions, such as checking that no harm has occurred, or replaying memories to be certain.

• Reassurance seeking from others or from the internet.

• Avoidance of people, objects or situations linked to the thought.

OCD-UK says it is important to understand that, in the case of some of the more extreme obsessive thoughts of a violent or sexual nature, the thoughts do not precede intent. It explains that a person may struggle to tell the difference between their obsessive thoughts and reality, mistakenly believing that because they have had the thought it means it is a desire they want to act on.

The same source notes that even people without OCD have intrusive thoughts. What differs in OCD is that the thoughts are repetitive and cause marked distress, and that the person tries to neutralise them with compulsions, avoidance or reassurance seeking. If you are worried about a thought, a GP or a talking therapies service can help you understand it without judgement; the NHS says OCD is a health condition like any other and there is nothing to feel ashamed or embarrassed about.

The NHS says people with OCD are sometimes reluctant to seek help because they feel ashamed or embarrassed, but that having OCD does not mean you are “mad” and it is not your fault. There are two main ways to get help: refer yourself directly to an NHS talking therapies service or see a GP, who can ask about your symptoms and refer you to a local talking therapies service if necessary.

It says it is unlikely OCD will get better without proper treatment and support. If you or someone else is in immediate danger of harm, call 999. If you are supporting someone, the NHS suggests talking to them about your concerns and suggesting they get help.

The NHS says there are effective treatments for OCD that can help reduce its impact. The main treatments are talking therapy, usually cognitive behavioural therapy (CBT), which helps you face your fears and obsessive thoughts without putting them right through compulsions, and medicine, usually a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI).

It adds that CBT will usually have an effect quite quickly, and that it can take up to 12 weeks before you notice the effects of SSRIs, but most people eventually benefit. If these treatments do not help, you may be offered an alternative SSRI, a combination of an SSRI and CBT, or an antidepressant called clomipramine, and some people are referred to a specialist mental health service.

The NHS says it is not clear what causes OCD, and that a number of factors may play a part, including family history, differences in the brain such as low levels of serotonin, life events (OCD may be more common in people who have been bullied, abused or neglected, and sometimes starts after an event such as childbirth or a bereavement), and personality, with neat, meticulous people with high personal standards or a very strong sense of responsibility more likely to develop it.

OCD-UK adds that OCD frequently fixates on what is important to a person. This may help explain why harm obsessions so often focus on loved ones: the content attaches to what matters most.

NHS talking therapies services offer CBT-based treatment for OCD and can be self-referred. The NHS says some people are referred to a specialist mental health service for further treatment. OCD-UK, OCD Action and TOP UK are named by the NHS as support organisations that can also tell you about local support groups.

Some people choose private therapy to start sooner. If you do, look for a therapist experienced in CBT for OCD. The NHS describes CBT as helping you face fears and obsessive thoughts without putting them right through compulsions, and OCD-UK lists reassurance seeking among compulsions.