Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Fears about self harm

By Danielle McDowell, LCSW

Sep 2, 20225 minute read

Reviewed byPatrick Carey

What is self-harm OCD?

Self-Harm OCD is a common subtype of obsessive-compulsive disorder (OCD) that can cause a person to experience intrusive and unwanted thoughts, images, or urges of causing harm to others or themselves. A person suffering from Self-Harm OCD feels great distress and fear that their intrusive thoughts might come true. 

Everyone has intrusive thoughts, and people without OCD are often able to dismiss them with little to no effort or discomfort. OCD, on the other hand, can cause those thoughts to get stuck when a person tries to attach meaning to them or make sense of them. These thoughts are ego-dystonic, meaning they are not in line with a person’s beliefs, values, or morals. As a result, these thoughts—called obsessions—can cause great distress, shame, and anxiety in people with OCD, who aren’t able to dismiss them as random or insignificant. 

As a result of this distress, people with OCD then perform compulsions—physical or mental acts done to relieve the anxiety that comes from obsessions—such as reassurance-seeking or rumination. While compulsions may provide short-term relief, they do not keep obsessions from coming back, and they keep people stuck in repetitive cycles of obsessions, anxiety, and compulsive behavior. 

Self-harm OCD – Common obsessions

  • What if I snap some day and kill myself?
  • What if I become so depressed that I kill myself?
  • What if I drive my car off this bridge?
  • What if I jump off this bridge or balcony? 
  • What if I really want to end my life?
  • What if I swallowed this whole bottle of pills?
  • What would it take to make me feel suicidal?
  • Was that thought I had actually suicidality?  
  • Images of doing fatal harm to oneself

Common triggers

People with self-harm themes in Harm OCD may be triggered by situations involving dangerous items or locations, as well as depictions of self-harm, severe depression, or suicidality.

Triggers for people with self-harm OCD include:

  • Using or being near kitchen knives or other dangerous implements
  • Using or being near dangerous chemicals
  • Skin picking or scratching
  • Standing near high, open ledges or balconies
  • Reading, viewing, or listening to media about self-harm, depression, or suicidality

How can I tell if I’m suffering from self-harm OCD fears, and not depression or an actual desire to harm myself?

Unlike people who intentionally self-harm, those suffering from self-harm related Harm OCD do not want to hurt themselves as a means to manage numbness or distress. The intrusive thoughts may present as fears of cutting, burning, or harming their bodies, even though they do not want to. A person suffering from self-harm related Harm OCD may have thoughts like, “What if I snap and stab myself with that knife on the counter?” It may cause a person to engage in compulsive avoidance, avoiding anything that they fear they may use as a weapon against their own body (i.e., knives, lighters, razors, etc).

While it is important to talk to a professional therapist about any thoughts related to harm of self or others to assess for safety, people suffering from self-harm related Harm OCD are not at more risk for harming themselves or others. 

Having these intrusive thoughts triggers anxiety and fears that are not easily dismissed by the sufferer. This leads to compulsive behavior to try and reduce or eliminate the anxiety. Unfortunately, compulsions only lead to a temporary reduction of anxiety and distress, creating a vicious cycle.

Compulsive behaviors in people suffering from self-harm themes may include:  

  • Hiding perceived dangerous objects from sight or reach (knives, razors, lighters, ropes)
  • Avoiding any movies, shows, books, music, or articles that talk about self-harm or violence
  • Excessive praying to be safe
  • Monitoring thoughts and actions constantly to ensure they are safe
  • Avoiding being by themselves
  • Asking others what they think for reassurance
  • Performing rituals (counting, tapping, touching, etc.) to prevent something bad from happening
  • Excessive computer searching to prove/disprove their fears. 

How to treat OCD fear of self-harm

Fear of self-harm OCD can be debilitating for people who struggle with it, but it is highly treatable. Self-harm OCD is treated the same way any subset of OCD is treated—with Exposure and Response Prevention Therapy (ERP). ERP is considered the gold standard treatment for OCD. 

ERP therapy consists of creating exposures that gradually bring about the fears that result from one’s intrusive thoughts, with the help of an OCD specialist, and working to resist engaging in or completing compulsions during and after the exposures. 

Over time, with consistency and repetition, the brain creates a new response to the intrusive thoughts, as it learns that they don’t pose any actual danger, and anxiety levels go down in the long term.
ERP is about learning how to tolerate distress and live in uncertainty. OCD thrives on demanding certainty and in order to get better, and ERP helps you learn to stop giving in. Recovery from OCD is possible. 

As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

We look forward to working with you.

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