​To anyone reading this who has intrusive thoughts about harming others, I would like to remind you that you are not a monster. I treat many clients who experience these debilitating fears of harming others (and/ or themselves), often referred to as harm OCD (Hershfield, 2019). These thoughts, of course, are incredibly difficult for my clients to tolerate because they find these thoughts to be horrible and unforgivable. They experience tremendous fear that they will act on their intrusions some day or even worse, that they already have. Because these thoughts so strongly contradict their moral compass, they attend to them and monitor them closely to ensure that “the monster” does not take over and harm innocent bystanders. However, I would like to share that my clients with harm OCD tend to be some of the most conscientious and kind people I have ever met. I would trust them more than the general population to not cause intentional or unintentional harm on others. Why is this? Because their top values are protecting others and remaining conscientious of the impact of their behavior. They also typically find topics like murder or rape to be so morally incomprehensible and deplorable, that even the thought of one of these topics makes them feel guilt, shame, and dread that some day they could do something awful. Due to the harsh inner voice that often comes with harm intrusions, Jon Hershfield (2018), the director of the Center for OCD and Anxiety at Sheppard Pratt in Towson, Maryland and author of Overcoming Harm OCD: Mindfulness and CBT Tools for Coping with Unwanted Violent Thoughts, emphasizes the need for self-compassion when managing these unyielding harm intrusions. 

Before examining why self-compassion is so critical for overcoming harm OCD, it is important to further define harm OCD. Many of my clients, as described by Hershfield (2019), report both intrusive thoughts and images involving harming others, ranging from intrusive images of running someone over while driving, to “urges” to pick up a knife and stab someone, to thoughts of dropping a baby. However, as described by Hershfield (2019), these urges are not actually urges. Instead, they are intrusive feelings (or intrusive thoughts paired with a “sensation in the body,” (Hershfield, 2019, p. 13)), such as feeling like your hand may want to grab the knife in the kitchen. However, these “urges” to cause harm go against all authentic desires in someone with harm OCD. In fact, someone with harm OCD feels like such an intrusive feeling is morally repulsive and is entirely inconsistent with their values. Therefore, it is not actually an urge; it is just an intrusive feeling. Hershfield (2018) labels these thoughts, images, and intrusive feelings as ego-dystonic, or not representative of self-concept.  

Hershfield (2019) outlines many recommendations in his book, Overcoming Harm OCD, including exposure and response prevention therapy (ERP, see https://www.oakheartcenter.com/exposure-and-response-prevention.html) and self-compassion work. I have found that incorporating self-compassion and self-love techniques into ERP is critical for successful treatment of harm OCD. For those reading this with harm OCD, you may be asking, how could I possibly love myself when I am having these atrocious thoughts and feelings? Well the answer is simple: Everyone has these thoughts from time to time. So if you are “sick or defected” (Hershfield, 2018, p. 82), then we are all sick and defected. It is part of the human experience to have intrusive thoughts, including violent and sexual intrusions. However, most people do not even really register these thoughts; instead, they just call them odd and continue on with their day. They brush them off and do not bother to analyze them further or to talk about them with others. However, someone with OCD has an intense reaction to such intrusions and often asks “why am I having that awful thought, what does that mean, does this mean I want to be having that thought? That would be terrible. I must be a monster for having that thought…I must want to act on that thought. Do I want to do that?” This intense fear reaction then further intensifies the fear. Self-compassion is a critical step to stopping this cycle. The fact that you are so alarmed by this thought and so attuned to it clearly means it is not a thought that you want to be having. So instead of calling yourself a monster, I am asking that you start calling yourself human and focusing on three core elements of self-compassion described by compassion researcher, Kristin Neff (as cited in Hershfield, 2018). 
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• Mindfulness: Observe your thoughts without judgment, as they are, not as OCD makes them out to be. For instance, I am having a harm intrusion and I fear it means I am bad. vs. I am an awful human being for having these thoughts (Hershfield, 2018). 
• Common Humanity: Intrusive, taboo thoughts are normal. Take a moment to remind yourself that you are a human being (Hershfield, 2018). 
• Self-Kindness: Treat “yourself as you would treat anyone else you cared about who was suffering” (Hershfield, 2018, p. 60). Remind yourself that you are doing the best you can and are trying to be the best person you can be. 

Instead of listening to the critical voice of shame, I encourage you to make room for these three elements of self-compassion and generally for self-love when having intrusive thoughts. Despite feeling that these thoughts make you a monster, I am here to remind you that they reflect quite the opposite of that. The fact that you are so deeply bothered by these intrusions means that you have incredibly high moral integrity, means you would never harm someone else on purpose, and means that it is likely that your odds of causing accidental harm is generally lower because you are so vigilant of this possibility. So please stop calling yourself a monster. It is not accurate or kind and will only intensify your intrusions and fears. To anyone suffering with harm OCD, I encourage you to seek out exposure and response prevention therapy which incorporates self-compassion work so that you can start believing in your moral compass and true intentions again. 

​If you would like help overcoming your reaction to your intrusive thoughts, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.

References

Hershfield, J. (2019, May 2). Overcoming harm OCD. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/overcoming-harm-ocd

Hershfield, J. (2018). Overcoming Harm OCD. New Harbinger Publications, Inc. 

Most individuals with OCD have strict criteria for rituals to ensure their fears do not come true, despite the rituals or compulsions often seeming illogical to someone without OCD. I talk to my clients about how OCD is far from logical and, as you know, if you are reading this and have OCD, rituals do not rationally or logically reduce the level of threat. This appears to be true for most OCD presentations, from fears of contaminating self or others to fears of seriously harming self or others. For example, circling the block repeatedly to ensure you did not run someone over does not decrease the likelihood that you already ran someone over. Instead, it actually might increase the likelihood of subsequently hitting someone because you will be less focused while checking for pedestrians on the side of the road. 

So if OCD is not logical, one strategy that I have seen to be helpful for my clients is to use the phrase “it’s already done.” In other words, if you really did run someone over, it is already done and there is nothing you can do now. If you accidentally poisoned your cat via Chocolate, it will already be done and you will have to deal with the ramifications after. If you accidentally contracted a deadly disease in the Target bathroom, no amount of showers will help reduce the odds of that already happening. It’s already done. 

This ‘it’s already done’ strategy can be a helpful tool in exposure and response prevention, which aims to assist with tolerating uncertainty. One great reason for striving to tolerate uncertainty is because we can’t turn back the clock to prevent mistakes. Mistakes might happen and we will be made aware of them if they do. Your cat will either get sick or they won’t get sick but you will not know without the passing of time, and it must be accepted that the chocolate has already been consumed and there is nothing that can be done about it (and luckily you will know quickly if they did eat it, as they will become very clearly ill!). At the same time, it is highly unlikely that your cat ate the chocolate without your knowledge, especially if this is something you are very mindful of. However, in the very slim chance that your eyes have deceived you, It’s already done. We can’t go back in time. If some awful thing has already happened, then we will have to deal with the consequences which will become apparent to you at some point. Although sitting with this uncertainty feels awful for both people with and without OCD, it is a fact that all of us could accidentally make some awful mistake. Exposure and response prevention therapy aims to assist you with learning to tolerate this strategy, alongside many others, to help you overcome your OCD. 

​If you would like help overcoming your reaction to your intrusive thoughts, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.