What is Harm OCD?
There are many different fears that OCD may latch onto, and all of them can cause severe distress. However, when OCD manifests as violent or sexually violent thoughts and images, it can bring a particular torment to parenting with harm OCD. These subjects are so taboo, so many people live in pain and avoidance rather than share the contents of their thoughts and seek help. Since harm OCD is not in the mainstream consciousness like other subsets, for example contamination OCD, it often goes unrecognized and untreated. After all, if you were having repetitive, graphic images of stabbing your spouse or your children you might be wary of sharing them.
All thoughts really are normal
Harm OCD is a common subset of Obsessive-Compulsive Disorder. Although not frequently discussed, violent and sexually violent thoughts are not unusual in the general population. Harm OCD thoughts are so common that 85% of people without OCD admit to having similar uninvited violent thoughts about harming themselves or their loved ones. The difference is that for OCD sufferers, the thoughts and graphic images that enter their minds cause a tremendous amount of discomfort and distress. Having repetitive unwanted thoughts is not due to a flaw in moral character, but due to a misfiring in the brain. For those with OCD, the thoughts “stick” and become obsessions that cause a tremendous amount of anxiety. In order to reduce the discomfort and try to get certainty that they will not act on their thoughts, people with harm OCD reassure themselves with mental compulsions or by avoiding situations that trigger the thoughts. For instance, a parent may avoid using a knife to prepare dinner if a child is present for fear of hurting the child with the knife.
Parenting with Harm OCD
Whatever thoughts and images a person finds most distressing are the ones they will do their best to control or resist. The more someone with harm OCD tries to push out the morbid thoughts, the more they stick. Parents are innately protective of their children. So, if you are a parent, imagine your worst fear. What is the scariest thing you can think of? Someone else hurting your children would be up there on the list as well as your child’s injury due to your negligence. Perhaps the worst would be you injuring, molesting or murdering your own children. These thoughts can create extreme distress for parents with harm OCD.
Common harm OCD thoughts related to children
- Stabbing, hitting with objects, strangling them
- Molesting them
- Raping them
- Suffocating them
Common harm OCD compulsions related to childrenAvoidance compulsions
- Avoid spending time with them
- Avoid bathing them or changing diapers
- Avoid physical contact like sitting on lap
- Avoid knives and scissors (avoidance of cooking, engaging in activities that involve cutting)
- Avoid taking them to playgrounds, parks and school
- Avoid disciplining children or any circumstance that may cause the parent to become angry
- Did I touch my child in an appropriate way?
- Was I sexually aroused around my child?
- Do I still have feelings of love for my child?
- Did I feel an urge to act on my thoughts?
- Asking others for reassurance that you would never act on your thoughts or that you are a good person/parent
- Researching cases of parents hurting their children
- Self-reassurance (“I know I would not hurt my child because..”)
- Confessing to others that you may have touched your child in an inappropriate way or acted in an inappropriate way
What if I go crazy and snap?
A common hurdle in treatment of parents with harm OCD is acceptance of the thoughts. The constant fear of having the thoughts and images maintains the obsessions and compulsions. “If I accept these thoughts, I might act on them. I am not 100% sure that these thoughts are OCD.” It is that persistent need for certainty that drives the obsessions and compulsions. Of all the OCD thoughts to accept, it is understandable that those concerning harming your own child would be among the most difficult.
What does this mean about me?
It is common for parents with harm OCD to assign too much meaning to a thought, assuming that they must have violent desires. If unchecked by compulsions, they worry they will “snap” and act on what feels like an urge. A parent with harm OCD may think they secretly want to act on their thoughts and that they are “fooling everyone.” The fear of having a violent thought or image is different from being in a delusional state and committing a violent act.
Postpartum OCD vs. Postpartum Psychosis
Since many people have heard of postpartum psychosis leading to violent acts in the media, it can be particularly difficult for new mothers experiencing postpartum OCD including harm thoughts to seek proper diagnosis and treatment. Research has shown that 3-5% of new mothers have obsessive postpartum thoughts of harming their children. Anxiety is the driving force behind these thoughts, not delusion and are rarely acted upon. In postpartum OCD, the thoughts of harming their child terrify sufferers. They do everything they can to dismiss the thought or avoid having it. This creates a significant increase in distress because in our inner world of thought and feeling what ever is resisted tends to persist and escalate equal to our resistance. There is no guarantee that thoughts won’t be acted upon by anyone including those with postpartum OCD, but the chances are very low. An individual suffering OCD does not care how low the probability is anyway because the disorder demands a complete and total elimination of risk, now and for the future. Who do you know that is capable of complete elimination of risk in their life in any facet? We all live daily with countless low probability fears, a bad auto accident for instance but is that a reason to worry one’s life away? It serves us well to learn to live with uncertainty.
Conversely violent thoughts are experienced very differently by parents experiencing postpartum psychosis. The thoughts seem in line with the person’s world views that may include other bizarre beliefs. Hurting their baby may seem like a “good idea” during a delusional episode. This is in stark contrast to someone suffering from postpartum harm OCD.
Parenting with harm OCD - The actual danger
OCD sows doubt and can often lead to a lack of self-trust in a parent suffering with violent or sexual obsessive thoughts. Parents with harm OCD often do not seek treatment due to shame, the fear that they will be misunderstood and someone will make a mandated report, fear of alienating a partner or that vocalizing the thoughts will make them more likely to come true. The actual danger here is not that the person with OCD will act on their thoughts. It is the repercussions for their family if they live without treatment for the OCD. It may be difficult to see the harm that compulsions cause to your family:
- Avoidance causes lack of physical affection
- Lack of physical and mental presence in child’s life
- Tension between partners and caregivers
- Lack of healthy bonding between parent and child
Effective Treatment for Harm OCD
Although harm OCD may seem very different from OCD about contamination, the driving engine behind nearly all OCD is the need for certainty and the treatment for people stuck in the OCD cycle is the same.
The ability to develop a nonjudgmental viewpoint, manage anxiety and live in the present can be nurtured through mindfulness. Cognitive restructuring of thoughts and beliefs through CBT is important. As with other subsets of OCD, harm OCD is most effectively treated by a type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP) therapy.
What to expect from ERP for harm OCD
Through ERP, people with OCD gradually learn to face the thoughts or situations they fear most while they resist engaging in the compulsions that they typically use to relieve their anxiety. It is difficult for parents with harm OCD to expose to unwanted thoughts and stop compulsions when the feared consequence is harm to their child. However, ERP is a highly effective, evidence-based treatment with a success rate upwards of 80%.
Examples of exposures
ERP treatment for harm OCD related to children will include in vivo, media and imaginal exposures.
In vivo exposures
(engaging in these activities while allowing the unwanted thoughts to come in instead of resisting them)
- Spending time alone with your children, including engaging in crafts with scissors or other objects that could cause harm to your child.
- Cooking or using knives in the presence of your children.
- Bathing or diapering your children and doing other caregiver routines with them.
- Resist asking for reassurance from friends and/or partner.
- Writing and/or recording a story describing in detail your unwanted thoughts. The script will include events you imagine and the consequences of acting on the thoughts, both immediate and far reaching.
- Writing a description of the consequences of accepting uncertainty about the meaning of your thoughts and that you will never know for certain that you will not act on your thoughts.
- Reading articles or watching movies with similar subject matter to your thoughts that cause anxiety, such as articles about parents harming their children while in a violent rage or articles about pedophilia or films with similar themes. You will be asked to resist engaging in reassurance and compulsions that lessen the anxiety.