We all have bad thoughts once in a while—it’s just part of being human and totally normal. You might briefly imagine something unpleasant or out of character, but then you brush it off and move on. For kids and teens with Harm OCD, though, these bad thoughts don’t just come and go. Instead, they stick around, looping endlessly in one's own mind and causing intense distress.

Here’s something reassuring: these thoughts are just that—just thoughts. Kids with Harm OCD are no more likely to act on them than anyone else. But without the right support, these worries can lead to exhausting mental loops, compulsive behaviors, and avoiding everyday activities because of their fears.

What is Harm OCD?

Harm OCD is one of the OCD subtypes that revolves around the distressing, intrusive thoughts of causing harm to oneself or others even if they have never committed violent acts before. These very violent thoughts can be particularly challenging for individuals experiencing this form of OCD.

OCD makes one grapple with obsessive thoughts that are often vivid and disturbing. The thoughts related to OCD include fears of using sharp objects, aggressiveness, or violence.

A common misconception is that individuals experiencing Harm OCD are more likely to act on these thoughts, but in reality, a Harm OCD sufferer is as unlikely to act on these thoughts as anyone else.

Due to the internal nature of OCD and the lack of understanding about how OCD manifests, individuals who experience having bad thoughts about hurting someone may be misdiagnosed as depressed or psychotic. I have worked with many children and teens whose Harm OCD landed them in a psychiatric facility because the professionals missed the warning signs.

Obviously, if one has a plan and true feelings of self-harm, then the highest level of care is required. Parents should be especially concerned about repeated statements of harm, if there is a plan, or if they are in a high-risk category. You can listen to my podcast episode on suicide to learn more.

Despite public misunderstanding and negative reactions from uninformed individuals, effective treatment is accessible for those willing to engage in the necessary therapeutic practices for OCD and related disorders.

Common Unwanted Thoughts in Children with Harm OCD:

• Am I a bad person for having these violent thoughts?
• What if I lose control and do something terrible or commit a violent act?
• What if I cause harm without realizing it?
• How can I be sure I didn’t hurt someone in the past?
• What if touching something sharp causes me to act on my thoughts or start acting violently?

• What if I say something that hurts someone emotionally?

Harm OCD Symptoms:

• Unwanted Violent Thoughts
  Unwanted violent thoughts are a hallmark of Harm OCD. These intrusive thoughts about causing pain to others enter the mind involuntarily, causing significant distress and discomfort. Despite their intensity, these thoughts conflict with the individual’s true values and intentions, making it unlikely they will act on them. However, their persistence can disrupt daily functioning and lead to compulsions.
  
  
• Fear of hurting someone unintentionally
  Individuals with Harm OCD may experience unwanted thoughts about unintentionally harming others. These thoughts, often vivid and unsettling, conflict with their moral beliefs, causing heightened emotional distress. The fear of hurting others or being responsible for harm, even unintentionally, can become overwhelming.
  
  
• Fear of Committing Violent Acts
  This aspect of Harm OCD involves a deep fear of losing control and committing harmful actions. These thoughts are intrusive and unwelcome, creating intense anxiety and a fixation on preventing potential harm. This fear can lead to behaviors aimed at avoiding perceived risks.
  
  
• Checking Behaviors
  To reduce anxiety, individuals with Harm OCD may repeatedly check their surroundings, ensure safety measures are in place, or confirm the well-being of a family member. While these actions temporarily ease anxiety, they reinforce the OCD cycle.
  
  
• Seeking Reassurance
  Children and teens with Harm OCD often seek reassurance from others to confirm they are not dangerous or harmful. This can include asking repetitive questions, seeking validation from family and friends, or needing constant affirmation. Unfortunately, reassurance provides only fleeting relief.
  
  
• Mental Rituals and Reviewing
  This involves repeatedly analyzing past interactions or imagining worst-case scenarios to reduce anxiety. This compulsive mental reviewing can leave individuals stuck in a cycle of rumination and prevents progress.
  
  
• Restriction of Activities
  To avoid triggering intrusive thoughts, individuals may limit their daily routines, withdraw from social situations, or avoid perceived risky activities. While this offers temporary relief, it reinforces the belief that these situations are inherently dangerous.
  
  
• Avoidance Behavior
  Avoidance behaviors are common in Harm OCD and may include steering clear of certain objects, environments, or situations associated with intrusive thoughts. While avoidance reduces anxiety in the short term, it strengthens OCD patterns and limits daily life.

Common Harm OCD Obsessions:

• Fear of accidentally harming loved ones or strangers.
• Intrusive thoughts or having mental images about losing control and hurting someone or hurting oneself
• Worry about unintentionally causing harm, such as through negligence (e.g., leaving a stove on).
• Fear of harming oneself, even without intent.
• Distressing thoughts about violent or aggressive actions that go against personal values.
• Concern over causing harm indirectly, like spreading illness or contaminants.
• Worries about moral responsibility for harm happening to others.

Common Harm OCD Compulsions:

• Avoiding sharp objects, like knives or scissors, out of fear of harming someone.
• Repeatedly seeking reassurance from others to confirm they are not dangerous or harmful.
• Mentally reviewing past actions to ensure they didn’t cause harm.
• Excessively apologizing for perceived or imagined harm.
• Avoiding situations where harm could potentially occur (e.g., driving, cooking).
• Common compulsions like engaging in mental rituals, such as counting or praying
• Checking actions repeatedly, like ensuring a door is locked, to prevent harm to others if as though they have an overwhelming responsibility to keep everyone safe.

How Can You Treat OCD?

Harm OCD, while challenging, is a manageable mental health disorder. With the right combination of Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention or ERP Therapy, and response prevention therapy, children and teens can reclaim their lives and find relief from the distressing thoughts that once dominated their existence. ERP therapy often incorporates imaginal exposures and other forms of gradual desensitization to help trigger people to confront their fears in a controlled and supportive way.

Harm OCD sufferers and their families must seek the help of a mental health professional who specializes in the treatment of OCD and assesses isolated areas of harming thoughts of OCD. They should be ready to resisting compulsions and, challenging misconceptions, and work towards a future where they can cope and have the self confidence to carry on with one’s life.

Remember that the use of Selective Serotonin Reuptake Inhibitors may be often suggested as a treatment for Harm OCD, but should never be the first step to addressing the symptoms of OCD or other mental health conditions. Cognitive-behavioral therapy with exposures, which is called ERP therapy, can help manage intrusive mental images and, when combined with other natural solutions, can be an effective treatment plan for OCD and drastically improve a person's life.

A holistic approach to overcoming Harm OCD

Treating violent obsessions starts with calming the brain. My BrainBehaviorReset™ Program offers effective treatment harm strategies, and it starts with calming the nervous system to address the root causes of OCD symptoms. It also incorporates science-backed solutions such as neurofeedback, PEMF therapy, magnesium supplementation, and response prevention ERP therapy which constitute the gold standard treatment for all forms of OCD. If you want to learn more how you can work with us, click here to learn more.

Parent Action Steps 

☐ Understand the symptoms and treatment options of this type of Obsessive Compulsive Disorder.
☐ Reflect on your child's behavior and learn to recognize the signs and common Harm OCD obsessions.
☐ Create a safe space for your child to share their Harm OCD thoughts and feelings.
☐ Reassure your child that they are not a bad person and that it's the mental illness that's causing these various compulsions.
☐ Consult with an OCD specialist for a thorough assessment and OCD treatment.
☐ Consider exposure and response prevention therapy
☐ Take this OCD Quiz to get personalized treatment for your child.
☐ Use the Solutions Matcher to work 1on1 with Dr. Roseann.