Obsessive-Compulsive Disorder of Fear of Harm: Symptoms, Causes and Treatment
These are the main characteristics of OCD of fear of doing harm.
One of the characteristics of the way we experience thoughts is that we cannot completely control their contents.. The mind is that place through which all kinds of thoughts, good and bad, pass. Sometimes we think of innocent and harmless things like a meadow with flowers, the shopping list or that time we went to a restaurant we liked.
Other times, on the other hand, we think of somewhat murky ideas such as wanting to stab someone while walking, cutting off our boss's head or punching that neighbor who keeps playing loud music.
It is not that they are the most desirable thoughts we can have, but we are all human and it is inevitable that these ideas come to us sometimes, no matter how aggressive they are, although it is normal that as quickly as they have come we stop thinking about them, not giving them too much importance.
But what happens if we are not able to forget them? What happens if we think again and again about the possibility of hurting someone? Does it mean that we are capable of making them come true? These are some of the questions that people with people with OCD fear of doing harm ask themselves.
What is OCD fear of doing harm?
Most people have occasional violent thoughts, images and unwanted ideas with which they imagine harming other people or themselves.
For example, we may have a brief fantasy of wanting to pull the bun of that customer who has slipped in our face in line at the bakery. This is normal and, although we may not like to think these kinds of things, it is believed that about 85% of people have these kinds of violent thoughts from time to time.
It is normal that these occasional violent thoughts do not change our behavior and are not seen as a problem.. They are part of the many different things we think about every day and we hardly give them any importance. However, these types of thoughts are seen as very disturbing by people diagnosed with obsessive compulsive disorder (OCD), since having these ideas where they imagine injuring other people or themselves become intrusive thoughts, taking over their mind, becoming a case of OCD fear of doing harm.
Fear of harm OCD, also called impulse phobia or impulse phobia within OCD, is a subtype of classic Obsessive-Compulsive Disorder. This mental disorder is characterized by having aggressive and intrusive thoughts about behaving violently towards someone or oneself and that these come true, carrying out a harmful behavior both willingly and unwillingly because of losing control.
Some examples of violent behaviors that the person thinks and is afraid of becoming a reality are: plunging a knife into his partner, drowning his baby while bathing him, throwing someone onto the subway tracks, taking a scalpel and stabbing him in the chest....
As we have mentioned, it is normal to have these kinds of thoughts from time to time. A person without OCD can have violent thoughts and then recognize them for what they are, simply thoughts, not predictions of something that will inevitably occur. In contrast, people diagnosed with OCD of fear of doing harm worry a lot after having thought something violent, attributing to it the meaning that it is going to happen. In their mind they repeat the idea of "if I think it, I am really capable of doing it".
Having these kinds of thoughts leads the person with OCD fear of doing harm to compulsions and rituals to reduce the anxiety caused by these thoughts.. Once the ritual has been completed, the person feels less anxious but, when the violent thought returns, the individual will again feel anxiety, doubt and fear that what he or she has thought might happen and, consequently, will return to ritualistic behaviors.
Obsessions in OCD
In the DSM-5 explains that obsessions, such as those present in OCD, are thoughts, impulses, images or other mental aspects that cause anxiety and discomfort and that the subject can neither ignore nor suppress..
In the OCD modality of fear of doing harm these obsessions focus on thoughts of harming oneself or others. In addition, and as in many other types of OCD, in this modality compulsions also occur, i.e., the person puts all kinds of means so that the obsessions never happen..
Taking this into account, we can give an example of OCD of fear of doing harm with obsessions and compulsions included. Let's say that the person has recurrent and intrusive thoughts that he could hurt his newborn baby while bathing him (obsession) and, for that reason, he always delegates this task to his partner (compulsion).
- Article related: "What is anxiety: how to recognize it and what to do".
Symptomatology of this subtype of OCD.
The people who suffer from OCD of fear to make damage present a Wide range of symptoms, manifested in form of intrusive thoughts of different nature and compulsive behaviors with the belief that they will serve him to avoid that they will become reality.
As we have mentioned, the most characteristic symptom of this disorder is having aggressive thoughts or seeing images in their minds of violence, which they interpret with great concern as something they are actually capable of carrying out. This also causes them to fixate in their mind the idea that they may inadvertently cause harm and that, even after they have done something and after several hours or days have passed, they begin to They may even begin to ruminate on the possibility that they hurt someone with that action and that they are now in trouble..
For example, a person with this subtype of OCD may be driving and go over a pothole. After a few hours he/she starts to think that he/she has really hit someone, hurt him/her badly and, since he/she did not realize it at the time it happened, he/she has unintentionally hit the road. Although this situation is unlikely, you start to think about it again and again, and you seriously consider not driving again.
The fear of what they might do is so great that they feel frightened by what they believe they are going to do impulsively, and they begin to believe the idea that they are going to harm themselves and their children. they begin to believe that they are really violent and dangerous people.They are hiding their true nature under the facade of socially adapted people even without putting any effort into it. They fear that one day they really cannot contain themselves any longer and act out violently, losing control completely.
In response to these intrusive thought patterns, i.e. obsessions, people suffering from OCD fear of doing harm perform different compulsions and ritualistic behaviors in order to reduce their anxiety and also the "possibility" that they will actually perform the violent behaviors they have thought about.
One of the most common is to hide dangerous (or perceived dangerous) objects in his home, such as knives, chemicals (bleach, detergent, battery acid...), medications, ropes, razor blades, drills... He hides any object that is supposedly dangerous or with which he has thought he could harm himself or others in order to avoid being tempted to use them.
Also It is also common for patients with this psychopathology to check each and every one of their actions to make sure that they are not to make sure that they are not doing harm or that they have not done it inadvertently. They watch their every action and, if they become aware that they have done something in the past that they believe could have remotely inflicted harm on someone else, they begin to worry about it.
People with OCD fear of doing harm avoid watching the news and using the media so as not to come across movies, TV series or videos with violent content. They fear that if they see violent acts they may get ideas and, in case this is not the case, there is also the fear that this will reactivate the conscious thinking of harmful ideas.
On the other hand, it also happens that they may spend excessive time researching violent crimes on the Internet, looking for what the perpetrator did and to what extent the person with this disorder shares traits. In other words, in order to make sure that he or she is not going to harm other people, they try to see to what extent he or she has something in common with real murderers.
Some of them may go so far as to pray compulsively or use amulets, believing that it will help them.believing that it will help them avoid losing control. However, this is not enough for them, which is why they are also motivated to compulsively ask their entire inner circle if they believe he or she can harm others. They want to receive a definitive answer and, until they find it, they will not stop worrying about the contents of their mind. The problem is that they will never find the answer that will convince them that they are not violent people or that their thoughts are just that, thoughts.
Treatment
There are several treatments for fear of harm OCD.
1. Exposure and response prevention therapy.
One of the therapies considered most appropriate for this subtype of OCD is exposure and response prevention (ERP) therapy..
ERP involves having the patient voluntarily expose himself to the source of his fear over and over again, but preventing him from then carrying out compulsions in the form of ritual or any other behavior he does to neutralize or reduce his anxiety. By repeatedly exposing himself to the source or idea that causes fear, it is believed that over time the patient will see how irrational it is to believe that he will do harm.
We should not be under the misconception that OCD treatment of fear of doing harm is aimed at proving that the patient is not a danger to himself or others. This is not a real goal, nor should it be assumed that the patient can be a real threat in any sense. A patient with this modality of OCD is no more likely to act out a negative thought than a person who does not have the disorder.
An example of ERP treatment for people with fear-of-harm OCD is to have a person who fears that he or she might stab someone be exposed to the phobic object directly..
First, he may be asked to carry a plastic fork or knife in his pocket on a daily basis, even on the street or while at work. The idea is that he creates an association with this item and becomes accustomed to its presence, even if it is not a knife or fork like the ones that are present in his injurious obsessions.
As time goes by and as the person becomes accustomed to the plastic cutlery, we will proceed to move up a level, the difficulty level will be raised to a higher level.This time having in his pocket a more threatening object such as a metal fork.
The idea is to increase the dangerousness of the object to be carried, until the person does not feel excessively nervous or tense when holding potentially dangerous objects such as a kitchen knife, large scissors, a surgical scalpel, etc., in close proximity.
2. Cognitive-behavioral therapy
Another therapeutic option is based on awareness, within the context of cognitive-behavioral therapy (CBT). In this therapy people with OCD are taught to identify, understand and change their negative thought patterns and behaviors..
These same patients are provided with problem-solving skills during therapy sessions and are then taught to put these skills into practice in solitude to build positive habits. Generally, the following is done in this therapy:
Psychoeducation
The patient is taught what the drive phobia characteristic of his or her disorder is and how it can dominate the life of the sufferer. and how it can come to dominate the life of the people who suffer from it.
2.2. Identification of obsessions and compulsions
The person is helped to identify his obsessions and compulsions, in this case violent thoughts that cause him special concern and the ritualistic behaviors that he carries out with the intention of reducing the anxious symptomatology as a method of protection so that those thoughts do not come to occur. If the person is able to identify them, then it will be easier for him/her not to carry them out..
2.3. Relaxation
The patient is taught relaxation and breathing techniques with the intention that he/she learns to relax quickly and effectively in any situation that he/she feels could make the violent thoughts he/she is thinking come true.
3. Psychopharmaceuticals
There are pharmacological treatments for OCD of fear of doing harm and they are considered a useful aid for the improvement and well-being of the patient, although they are not a replacement for the therapies of the patient. are not a replacement for psychological therapies..
The main group of psychotropic drugs used to treat OCD are selective serotonin reuptake inhibitors (SSRIs), drugs that improve serotonin levels and are often used to treat depressive and anxiety disorders. These drugs include Lexapro, Prozac, Paxil and Zoloft.
What is the goal of therapy?
Whatever the modality of psychological therapy used, they all have in common that the patient must be made to accept the presence of his or her intrusive thoughts, but not to assign meaning to them or to convince him or herself that he or she is a potentially dangerous person.
Some people with fear-of-harm OCD make a full recovery with ERP therapy, while others, while achieving marked improvement, are unable to get rid of their obsessions completely.
This does not mean that the therapy has failed with them, but that it is very difficult to get rid of obsessions completely and really the recovery and improvement of well-being in OCD patients has more to do with managing the emotions associated with their recurrent thoughts.
Looking for psychotherapeutic support?
If you are looking for psychotherapy services to overcome Obsessive-Compulsive Disorder, contact our team of professionals.
At Cribecca we work with people of all ages and offer support in cases with or without psychological disorders involved, either in person at our center located in Seville or online.
(Updated at Apr 14 / 2024)