Fears about harming one’s spouse

What is OCD related to spouse harm?

If you’re experiencing intrusive thoughts about causing harm to your spouse, or about harm coming to your spouse, it may be a sign of obsessive-compulsive disorder, or OCD. Defined by intrusive, disturbing, and often “taboo” thoughts, OCD can manifest in the form of such harm-related obsessions. Harm OCD can be categorized by aggressive obsessions, which are unwanted thoughts, images, and even urges of violence towards oneself and or others.  People with OCD also engage in compulsions, which are physical or mental acts done in an attempt to challenge these thoughts, reduce the anxiety and distress these thoughts cause, or avoid a feared outcome, such as actually harming their spouse. Each time someone engages in a compulsion, the idea is being reinforced that their obsessions posed a real threat or danger, and that these compulsions are the only way to obtain relief from the distress caused by their obsessions. The OCD cycle is then strengthened, continuing over time and leading to greater distress and compulsive behavior. Common fears one may experience regarding spousal harm relate to thoughts, urges, or images of engaging in either a direct/purposeful or inadvertent harmful act towards their spouse/partner. One may question whether their behavior or thoughts regarding harm are true in nature or if there is a “hidden piece” within themselves that wants to act out on these harm related thoughts. Harm OCD may make one question their present and past physical acts and mental thoughts. OCD will look to get an individual to ruminate and feed into an obsessive thought, looking to strengthen the OCD cycle and gain control.

Spouse harm related OCD – Common obsessions

Common fears one may experience regarding spousal harm often involve thoughts, urges, or images of engaging in either a direct/purposeful or inadvertent harmful act towards their spouse/partner. One may question if there is a “hidden piece” within themselves that wants to act out on these harm-related thoughts. Harm OCD may make one question their present and past physical acts and mental thoughts. OCD will cause urges to ruminate continually on an obsessive thought, looking to strengthen the OCD cycle and gain control.

Obsessions experienced by people with OCD related to spouse harm may include:

• Fear of acting on a harm-related impulse
• Fears about aggressive behaviors towards one spouse/partner.
• “What if I lose my temper, lose control, and kill them?”
• Excessive and recurrent doubts related to safety
• Urges/sensations (i.e., intrusive urge to grab a knife, unwanted sensation that feels like you could hit your spouse, etc.)
• Images related to harming your spouse
• “False memory” obsessions, such as obsessive concern that a harmful act occurred and was somehow blacked out of memory 
• What if I never stop obsessing about this, and it ruins my relationship?

Common triggers

• The spouse/partner themselves
• Any remotely aggressive behaviors towards one’s partner (for example, raising voice when mad)
• Knives, guns, chemicals, medications–anything that could potentially be used to cause harm
• Locations where harm can occur: ledges, isolated areas, kitchens with knives, bedrooms, or any place one is alone with the spouse
• Violent shows/movies/video games/news media
• Negative emotions towards spouse/partner–anger, frustration, impatience, jealousy, etc.
• Any stories related to divorce, spousal abuse, or homicide involving couples

How can I tell if this is OCD and not an actual desire to harm my spouse?

With OCD, the primary emotion that accompanies obsessional fears about harming loved ones is anxiety. Obsessions in OCD are known as “ego-dystonic,” meaning that the content of the intrusive thought or image goes against someone’s true intent and beliefs. If these obsessions cause fear, anxiety, and distress, then they are likely a symptom of OCD. People who actually engage in violent and lethal acts towards their spouses tend not to experience such anxiety and fear.

It is important to find an OCD specialist when seeking help to ensure an accurate diagnosis and to rule out other differential diagnoses. Feelings of shame and the stigma with these thoughts may prevent one from seeking treatment. Fears that may deter one from seeking help can include worrying that a professional may report them to the police because of these thoughts. With the many different subtypes of OCD that exist, a trained professional will be able to ensure an accurate diagnosis and effective treatment.

Common compulsions

When people with Harm OCD experience intrusive thoughts, images, feelings or urges related to harming their spouse or partner, they may engage in a mental or physical ritual known as a compulsion. One may engage in a compulsion to gain a sense of relief from the intrusive, obsessive thought, or to avoid a feared outcome. OCD will offer the compulsion to get short term relief. When one engages in a compulsion, the OCD cycle is strengthened and continues long-term. Short term relief with the compulsions will lead to long term distress from OCD.

Some common compulsions for people who fear harming their spouse are listed below: 

• Online research of people who have committed violent acts or research on violent thoughts and whether they can become violent acts.
• Self-reassurance (“I’m not going to hurt them, I’m not going to hurt them, I’m not going to hurt them…”)
• Mental review: replaying past interactions with spouse to “check” if they have done anything violent or harmful towards them before
• Reassurance-seeking from others (“Do you think I am capable of hurting others?”)
• Avoidance, especially of partner/spouse/family/loved ones, or of dangerous objects or situations
• Reviewing intentions (“I’m so anngry they did that. Does that I mean I want to hurt them?”)
• Replacing “bad” thoughts with good ones.
• Playing out fearful scenarios to review how they would handle them.
• Rationalizations for why they would never commit a violent act.
• Superstitious rituals.
• Compulsive praying or carrying and using spiritual items so that they won’t lose control.

How to treat fear of harming spouse

Exposure and Response Prevention (ERP) therapy: ERP is a form of cognitive behavioral therapy that was developed specifically to treat people with OCD. 

In ERP, one will learn how to identify triggers in their life as well as how to cope with triggers. Triggers can be internal or external factors. Individuals will engage in exposures, or situations that will cause some level of distress based upon their obsessions. Once engaged in an exposure, one learns to practice different response prevention skills, with the goal of resisting compulsive behaviors. 

Exposures are done in a safe environment, with the collaborative aid of one’s therapist. The goal is to break the OCD cycle and manage intrusive thoughts while learning to respond differently to the feelings that bring about compulsive behaviors. 

Through the ERP process, one will gain a sense of acceptance and comfort in uncomfortable situations, and reduce the urge to engage in compulsions as a response. One will learn how to accept these obsessions and thoughts, and to be comfortable in the uncomfortable.

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.