OCD wants us to believe that the world shouldn’t have any sharp edges.

OCD is a malevolent advisor that wants to deceive us about the fundamental nature of the world.

It wants us to believe that the world shouldn’t have any sharp edges and that our experience should be as smooth and snag-free as possible.

If snags are apparent, it tells us that we should exchange our current experience for one that is more perfect.

Although nice in theory, embracing such a philosophy creates an impossible situation.

After all, there is no snag-free world to inhabit.

Even the best world is fundamentally flawed.

The more we become preoccupied by the pursuit of perfection, the more hyperaware we become of life’s flaws.

As Dr. Jon Grayson writes, as soon as we begin comparing anything real to the ideal, the real becomes intolerably cheapened in the comparison. Reality, no matter how good, can never live up to the fantasy.

OCD is one of the most variable and least variable of all the DSM diagnoses.

It’s incredible in its symptomatic diversity; no two individuals experience OCD in exactly the same way.  At the same time, OCD is remarkably consistent across domains when considered from the vantage point of wishes.

All symptoms involve wishing for something that is impossible: wishing for perfect certainty, wishing for perfect safety, wishing for that perfect feeling…  When wishes alone do not suffice, rituals allow the sufferer to try to manifest the wish in the real world.  Although these rituals are well-intentioned, they are ultimately malignant.

Sometimes the only way to live a good life is to give up the wishes and learn to accept and co-exist with life’s imperfections.

Questions?  Comments?  Thoughts about the fundamental nature of OCD?  Sound off below.

This article, What is OCD?, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

(Image by Anday [click picture for source])

Scary, unwanted thoughts sometimes masquerade as truths. Although these thoughts may have the appearance of danger, their form is intended to deceive.

It’s nearly Halloween, and kids around the country are digging through dusty closets and plundering the aisles of local Halloween shops in search of the perfect costume.

Halloween is the one night of the year when we give ourselves permission to be silly, scary, or fantastical. We can act a little weird, and nobody will disapprove.

On Halloween, it’s normal to see the ghastly holding hands with the divine; fairy princesses walk amongst zombies, lions, and super heroes.

There is something thrilling about handing over the reins to your imagination…even if it’s only for a single night.

But what would happen if the masks got stuck?

What if every goblin remained a goblin and every ghost remained a ghost? The children underneath the make-up would still be our children, but their appearance would remain altered. How would we feel then?

At first, it would be scary to inhabit a world populated by monsters. We would be angry. We would be confused. However, eventually we would learn to distrust our senses in the knowledge that beneath every scary facade is simply a child.

Despite appearances, there is no danger here. We might wish that things could go back to the way they used to be, but eventually we would accept this new world as our reality.

Sometimes our thoughts like to play dress-up, too.

Scary, unwanted thoughts can masquerade as truths. Possibilities can take on the form of probabilities. Although these thoughts may have the appearance of danger, their form is intended to deceive. The semblance of danger is not danger.

In the real world on Halloween night, beneath every sheet, mask, or painted face is a smile.

Beneath every scary thought is simply a person.

This article, Scary Thoughts as Costumes: The Illusion of Danger, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

OCD Awareness Week is an initiative by IOCDF to help increase public awareness about OCD.

The International OCD Foundation (IOCDF) is sponsoring OCD Awareness Week, which means that organizations around the world are hosting special OCD-related events this week.

South Floridians, we invite you to join us for our monthly support group meeting tonight (10/9/12) at 6:30pm in our Palm Beach Gardens, Florida office.

You might also want to check out some of the amazing OCD Awareness Week events that are hosted online.

Please note that the list below is just a sampling of all the incredible events that are going on this week. Feel free to cross-post to Facebook, Twitter, or your personal blog to help spread the word.

Happy OCD Awareness Week 2012!

List of OCD Awareness Week Events
http://www.ocfoundation.org/awarenessweek

2012 Dare to Believe Contest Winners – Listen, read, and watch incredible projects created by talented individuals to promote OCD awareness.
http://ocfoundation.org/anighttobelieve/

OCD Film Festival and Discussion hosted by OCD Texas
http://ocdfilmfest.blogspot.com/p/welcome-to-ocd-film-festival.html

Series of Daily Twitter Chats (10/8/12-10/12/12) @ 1pm EST featuring OCD Experts (#OCDchat)
http://www.ocfoundation.org/twitterchats/
Monday – Dr. Jeff Szymanski will be answering general OCD questions.
Tuesday – Dr. Nestadt and Dr. Fuesner will be answering OCD medication and treatment questions.
Wednesday – Dr. Abramowitz will be answering questions about OCD and its effects on relationships.
Thursday – Dr. Penzel will be answering questions from teens about OCD.
Friday – Dr. Neziroglu will be answering questions about hoarding, BDD, Tourette’s, and other disorders related to OCD. Learn more here.

OCD Awareness Video Featuring Jeff Bell
http://www.youtube.com/watch?v=vC-CT2jcnVY

This article, OCD Awareness Week, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Emetophobia is the fear of vomiting. Although vomit phobia may appear to be a specific phobia, it may actually be a symptom of OCD, social anxiety, or agoraphobia.

Flu season will be quickly upon us and with it comes an unfortunate increase in the likelihood of experiencing fevers, coughs, runny noses, vomiting, and the like.

Although no one enjoys being sick, this time of year poses particular challenges for individuals suffering from “vomit phobia”, or emetophobia, the fear of throwing up.

The fear of vomiting can affect individuals of all ages. It sometimes emerges in childhood and, if untreated, may follow a relatively chronic course. However, it can also develop well into adulthood, sometimes taking root after a negative health experience (e.g., after getting food poisoning or after experiencing an episode of severe or uncontrolled vomiting).

Vomit Phobia in Children and Teens

Consequences associated with the fear of throwing up can be extreme. In children, vomit phobia can lead to school refusal and avoidance. Academic performance may suffer, and children may miss out on certain developmentally important social milestones. If a child or teenager is afraid of getting nauseous or throwing up, he or she may avoid birthday parties, sleepovers, dating, and eating out at restaurants. Missing out on these activities can affect relationships and impact social development, which may lead to chronic social impairments. Even when longstanding social problems do not develop, children with vomit phobia still experience a great deal of unhappiness, fear, anxiety, and distress.

Fear of Vomiting in Adults

Adults with the fear of vomiting may also be significantly impaired by their symptoms. They may have more absences from work and may avoid work-related travel, which can affect opportunities for advancement. They will often dread meetings, during which they may feel trapped and uncomfortable, and may avoid certain job responsibilities like public-speaking or presenting.  This can leave otherwise bright and capable individuals stagnating in jobs that are beneath their true capabilities. Vomit phobia also affects travel for leisure and dining out, and can wreak havoc on romantic relationships.

Women with the fear of vomiting may experience extreme distress at the thought of becoming pregnant and experiencing morning sickness. Women with the fear of morning sickness may delay starting families, and some may choose to never have children at all due to the fear of recurrent vomiting during pregnancy. Clearly, this can have profound and lasting effects on one’s life.

What is Emetophobia?

Emetophobia is defined as an excessive or irrational fear about the act, or possibility, of vomiting. However, this relatively straightforward definition belies the many, rather complex factors that may explain the development of the fear of vomiting in different individuals.

In my South Florida psychological practice (Palm Beach County, FL), I rarely encounter cases of “vomit phobia” that truly represent simple phobias.

In the individuals I typically treat who have the fear of vomiting, symptoms are often best explained by another underlying condition, such as obsessive-compulsive disorder (OCD), social anxiety, or agoraphobia. In this post, we’ll discuss these different possible etiologies. But first, let’s talk about some of the behaviors that are common to these different manifestations of vomit phobia.

Symptoms of vomit phobia are diverse and include 1) behaviors that are designed to reduce the possibility of getting sick or throwing up, 2) checking behaviors used to detect early signs of illness, 3) health-promoting behaviors used to reduce the impact of illness, and 4) avoidance of situations in which vomiting might be particularly embarrassing or distressing. Common symptoms of emetophobia include:

Symptoms of Vomit Phobia

• Avoidance of foods or smells associated with past vomiting episodes.
• Avoidance of germs, hospitals, and sick people.
• Holding one’s breath when around other people.
• Refusing to shake hands with others.
• Avoidance of garbage and other foul-smelling or dirty things.
• Excessive handwashing or bathing.
• Excessive use of vitamins.
• Excessive cleaning of foods.
• Excessive cleaning of food prep surfaces.
• Avoidance of non-packaged foods.
• Throwing away food before it has reached its expiration date.
• Checking other people for signs of illness.
• Excessive smelling and checking of food.
• Overcooking food to kill potential pathogens.
• Avoidance of eating new foods (or extreme anxiety when eating new foods).
• Eating the same (limited) foods over and over again to avoid stomach upset.
• Avoidance of foods that look “weird.”
• Anorexia, i.e., the complete avoidance of eating or severe restrictions in eating.
• Preemptive use of antacids.
• Avoidance of eating foods when away from home.
• Checking for the locations of bathrooms (when away from home).
• Restricting travel away from home (staying at home, avoiding social activities).
• School avoidance or work avoidance.
• Taking one’s temperature excessively or monitoring one’s body for other signs of illness (e.g., checking lymph nodes).
• Superstitious rituals designed to avoid getting sick.
• Only eating foods after other people have already eaten them.
• When eating in public, monitoring other people’s reactions to their food.
• Excessive concern about non-documented food allergies.
• Avoidance of public speaking responsibilities or other situations in which one is the center of attention.
• Avoidance of meetings or other situations in which one might feel trapped, or situations in which one could not easily escape if they became ill.
• Avoidance of planes, cars, and/or public transportation in order to avoid feeling trapped.

Vomit phobia may develop spontaneously, or it may develop following a traumatic vomiting experience. Ironically, some of the rituals and avoidance behaviors that people develop in response to the fear of vomiting may actually lead to increased nausea sensitivity.

In many cases, emetophobia is a sign of another underlying condition. To clarify the underlying cause of your vomit phobia (if any), you might ask yourself this simple question:

What would be so bad about vomiting?

Your answer to this question might help you determine if your vomit phobia reflects underlying OCD, agoraphobia, or social anxiety. See if your answer to the above question is similar to any of the answers below:

A) What could be worse? Vomiting could be the sign of something seriously wrong with me. People die of influenza every year.

B) It would be humiliating. What if I can’t make it to a bathroom in time, and my friends or co-workers see me throw up? It would be too embarrassing, and I don’t know how I could face them again.

C) I could get trapped somewhere. What if I couldn’t find a bathroom in time?

D) Vomiting is just too awful, and I just couldn’t handle it.

Fear of Vomiting as Agoraphobia

People with agoraphobia would most likely relate to options B and C. Remember that although most people think about agoraphobia in the context of panic attacks, agoraphobia can also be conceptualized more broadly as the fear of having a physical symptom attack in a setting in which escaping or getting help would be difficult.  If your primary fear is not focused on the act of vomiting itself but rather on the possibility of getting sick in a situation in which escape would be difficult, embarrassing, or impossible, then agoraphobia might underlie your vomit phobia.  As such, people with agoraphobia might cope well with vomiting when at home but would be fearful of vomiting when outside of their own household.

OCD & Vomit Phobia

People with OCD may be more likely to endorse items A and D.  People whose vomit phobia is driven by OCD may consider vomiting as a sign of something dangerous and may also underestimate their ability to cope with the act of vomiting itself.  People with OCD-related emetophobia may tend to exhibit more global fears about vomiting relative to those with agoraphobia or social anxiety.  Vomiting may be experienced as equally dangerous or distressing regardless of the setting in which it occurs.  Other characteristics of OCD-related fear of throwing up may include a greater variety of cleaning and checking rituals, as well as avoidance behaviors.  Individuals with OCD often recognize logically that their rituals are excessive and yet feel powerless to reduce them.

Fear of Throwing Up Associated with Social Phobia (Social Anxiety)

People with social anxiety are more likely to select B and C, which can make it hard to differentiate from agoraphobia.  This is understandable, given that many individuals with the fear of throwing up have symptoms consistent with both social anxiety and agoraphobia.  The difference between these two possibilities is that individuals with vomit phobia related to social anxiety would be relatively okay with the idea of getting sick in a remote or secluded place (e.g., when walking alone in the forest).  People with agoraphobia would likely find this possibility distressing because it might be difficult to get help (if needed).  Thus, social anxiety-related vomit phobia is primarily concerned with the social consequences of being sick in public rather than the availability of help/escape.

Please note that the above descriptions are oversimplifications of complex phenomena.  OCD, agoraphobia, and social anxiety are not mutually exclusive, and individuals may have symptoms consistent with several different forms of anxiety at the same time.

Treatment of Vomit Phobia

Treatment of emetophobia is best accomplished through cognitive behavioral therapy (CBT), which uses specific tools to reduce symptoms of vomit phobia. Treatment of vomit phobia involves correcting faulty beliefs about illness and disease, reducing avoidance behaviors, confronting challenging situations, and ultimately overcoming your fears.

For more information about cognitive behavioral treatment of emetophobia, please contact my South Florida psychological practice in Palm Beach Gardens, Florida.

Questions? Comments? Struggling with the fear of throwing up? Sound off below.

This article, Vomit Phobia – Fear of Vomiting (Emetophobia), was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Postpartum OCD is a form of acute-onset OCD that develops after the arrival of a new baby. Parents with postpartum OCD often experience unwanted aggressive or sexual thoughts about their infant.

Parenting can be joyful, but it can also be terrifying.

Parenting comes with many important responsibilities, and it can be intimidating–if not downright frightening–to be responsible for protecting and caring for a vulnerable new life.

What is Postpartum OCD (ppOCD)?

For some parents (mothers and fathers alike), new parenthood may spark postpartum obsessive-compulsive disorder (OCD), a surprisingly common anxiety disorder that is associated with violent and disturbing thoughts, images, or urges (Fairbrother & Abramowitz, 2007). Symptoms may begin suddenly after the new baby arrives home, or pre-existing OCD symptoms may be exacerbated by new parental responsibilities.

Postpartum OCD symptoms can involve virtually any type of OCD symptom, but harm obsessions and sexual obsessions are especially common. Harm obsessions may include fears of accidental harm or intentional harm coming to the infant.

Postpartum OCD – Unwanted Violent Thoughts

Consider the mother of a colicky young infant who, frustrated by her baby’s crying, has a mental image of herself throwing her baby down the stairs. This thought occurs unexpectedly and feels dangerous, and the woman becomes extremely upset by this thought.

This mother might think:
“Why am I having this thought? Does this mean I might harm my baby? What if I lose control and throw my baby down the stairs? Mothers shouldn’t have thoughts like this.”

In response to these thoughts, the mother may avoid going near staircases while holding her infant or may hold her baby extra tightly whenever she is near the stairs. She may become especially fearful of caring for her baby whenever it is crying, for fear that she might do something impulsive or dangerous. If certain parenting activities feel especially risky, these responsibilities may be delegated to other caregivers.

Postpartum OCD – Unwanted Thoughts About Danger or Accidents

Another common type of postpartum OCD symptom is the recurrent, intrusive fear that something bad has happened to the baby. For example, a parent might experience recurrent thoughts or intrusive images of their baby choking or suffocating in their crib.

This parent might think:
“It’s my responsibility to prevent any harm from coming to my child. If I have a dangerous thought, it’s important that I check every time just to make sure my baby’s okay. After all, that’s what a good parent would do. If I have a worry and don’t check and then something bad actually does happen, then my baby’s death will be all my fault.”

In response to these thoughts, the parent may engage in repeated checking behaviors to make sure that the baby is okay. These checks may occur many hundreds of times a day. However, the relief that comes from each check is fleeting. Whenever a new doubt pops up, the parent feels compelled to check again, just to make sure.

Postpartum OCD – Unwanted Sexual Thoughts

A third common postpartum OCD symptom involves having unwanted sexual thoughts about your child. These may frequently occur when changing your baby’s diapers or giving your baby a bath. These obsessions may consist of thoughts (e.g., What if I just touched my child inappropriately? What if I’m aroused by this?), graphic sexual images involving the child, or impulses to act in a sexually inappropriate way.

A father with these types of obsessions might think:
“What kind of person has thoughts like this? Does this mean that I’m a pedophile or that I might be capable of molesting my child? This is sick. I shouldn’t be having thoughts like this.”

In response to these unwanted thoughts, the father might begin to avoid the infant. Avoidance may be especially evident in situations involving nudity (e.g., changing diapers, giving baths, changing clothes). Parents with postpartum sexual obsessions often avoid physical contact with the child (e.g., hugging the child, having the child sit on your lap) or being alone with the child.

Postpartum OCD: Fear of Harming Your Baby

In the examples above, a spontaneous, unexpected thought gives rise to the fear that the parent might pose a threat to their baby or might act in a way to put their baby at risk. Parents with postpartum OCD have no desire or intention to harm–however, the occurrence of an unwanted or threatening thought leads them to question their baby’s safety, their own intentions, their own morality, or their own fitness to parent.

Despite these fears, postpartum obsessive-compulsive disorder (ppOCD) is not associated with an increased risk of harm to the child or infant (Fairbrother & Abramowitz, 2007).

As with all forms of OCD, individuals with postpartum OCD engage in a variety of rituals and avoidance behaviors in response to their obsessions. These typically include checking behaviors, washing behaviors, situational avoidance, and mental rituals (Fairbrother & Abramowitz, 2007). These rituals maintain symptoms of the illness, because they prevent disconfirmation of faulty OCD-related beliefs.

Given the way that postpartum OCD works, the more intensely the parent scrutinizes their unwanted thoughts, the more severe their OCD becomes. The more the person tries to figure out why the thought is occurring or how to make it stop, the more often the thought will reoccur. Parents with severe postpartum OCD may have near-constant unwanted thoughts about their child. These symptoms may cause the parent to dread spending time with the child, which affects bonding and can wreak havoc on the parent-child relationship.

Because violent and sexual obsessions stand in stark contrast to what new parents feel they “should” be feeling, postpartum OCD symptoms often cause a great deal of guilt, shame, and confusion. Due to the nature of ppOCD symptoms, postpartum OCD often results in extreme isolation, alienation, and depression and is sometimes a primary contributor to parental separation or divorce.

Although many people are acquainted with postpartum depression, fewer are familiar with postpartum OCD. This is true for several reasons. First, postpartum OCD tends to be relatively uncommon in comparison to postpartum depression. In a relatively small-scale study, Wenzel, Haugen, Jackson, and Brendle (2005) estimated that ppOCD affects about 2.6% of mothers (when assessed 8 weeks after giving birth). Second–and perhaps more importantly–the symptoms of ppOCD can be so disturbing that few sufferers speak out about what they’re experiencing. They fear the looks of horror and disgust from their loved ones, the possibility that their children will be taken away, or that their doctors will determine that they’re “crazy” and institutionalize them.

The reality is that, just like other forms of OCD, postpartum OCD is a treatable condition. The treatment of choice for ppOCD is exposure and response prevention (ERP), a specific form of cognitive behavioral therapy (CBT) that was designed explicitly to address symptoms of OCD.

For more information about postpartum OCD, feel free to contact my South Florida psychological practice which is located in Palm Beach County, Florida, or review the list of common ppOCD symptoms below.

Symptoms of Postpartum OCD (ppOCD)

Common symptoms of postpartum OCD include fears of accidentally or intentionally harming your child.

• Fear that you will act on an unwanted urge to hurt or kill your child.
  • Fear of stabbing your child.
  • Fear of beating your child to death.
  • Fear of choking your child.
  • Fear of shaking your baby to death.
  • Fear that you may lose control and drown your child during bathing.
  • Fear of throwing your baby down the stairs.
• Fear of acting in a sexually inappropriate manner toward your child, which may occur during changing, bathing, or dressing your child.
  • Fear that you may secretly want to molest your child.
  • Fear that you have inappropriately touched your child.
  • Fear that you are sexually attracted to your child.
• Fear that your irresponsibility will lead to your child’s death.
  • Fear of accidentally poisoning your child by not properly cleaning their bottles or toys.
  • Fear of accidentally exposing your child to chemicals (e.g., cleaning products).
  • Fear that not checking on your child enough will result in Sudden Infant Death Syndrome (SIDS).
  • Fear of your baby suffocating or choking due to your own carelessness.

NOTE: These thoughts are often associated with graphic mental images of violence.

Questions? Comments? Struggling with symptoms of postpartum OCD? Sound off below.

This article, Postpartum OCD – Fear of Harming Your Baby, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Hope to see you in Chicago for the 2012 meeting of the International Obsessive-Compulsive Foundation!

Just a few quick announcements:

1) The 2012 meeting of the International Obsessive-Compulsive Foundation (IOCDF) is just a week away.

The IOCDF conference marks the perfect convergence of all things OCD-related. In attendance are some of the best clinicians and researchers in the field.  Many of these individuals will be presenting talks related to OCD diagnosis and treatment.

Hundreds of individuals with OCD will also be at the conference, some of whom will be leading workshops and sharing stories of recovery. This year’s roster of presentations looks to be exceptional.

If you haven’t registered yet, there’s still time. This year’s meeting will be held in the Windy City: Chicago, Illinois. I’ll be attending–hope to see you there!

Also…I may try to be more active on Twitter during the conference.  Feel free to follow me here.

2) I have revamped the description of my Intensive Outpatient Program (IOP) for OCD and have posted an updated summary page on my practice website.

This program is not for everyone…but is appropriate for:

• Local OR out-of-town patients (with any level of OCD symptoms) who wish to complete treatment in the shortest amount of time possible.
• Individuals who have stubborn symptoms of OCD that have not responded well to traditional outpatient therapy.
• Individuals with severe symptoms who are seeking an alternative to residential treatment or to psychiatric hospitalization (inpatient treatment).

We offer specific programs for adults, kids, and teens.  Click the above link to access the program description.

3) In other news, I’d like to announce that I’ll soon be starting a 6-week, CBT-based group therapy treatment program for panic disorder. This group is designed as an introduction to cognitive behavioral therapy for panic. Although you won’t be panic-free in 6 weeks, you’ll have some of the basic skills and knowledge you’ll need to kickstart your recovery.  Moreover, because this intervention is a  therapy group, you’ll get to work alongside others with similar symptoms.

Till next time…

Questions? Comments? Will you be at the 2012 IOCDF Conference in Chicago? Sound off below.

This article, IOCDF Conference, IOP for OCD Program, & Group Therapy for Panic…, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Suicide obsessions involve the fear of killing yourself, whereas self-harm obsessions focus on the fear of self-mutilation.

Thoughts of death, dying, and suicide are an unfortunate reality for many individuals. In the U.S. alone between 2008 and 2009, approximately 3.7% of adults (8.3 million Americans) reported having suicidal thoughts (Crosby et al., 2011).

During that same time frame, approximately 2.2 million U.S. adults reported making specific plans to commit suicide. An estimated 1 million Americans attempted suicide, and 36,035 individuals died as the result of suicide.

Clearly, suicidal thoughts and actions impact a significant number of Americans.

Although suicidal thoughts are most often associated with depression, suicidal thoughts are not experienced exclusively by those who are clinically depressed. Suicidal thoughts may also accompany other mental health conditions and may even occur in healthy individuals in the general population.

Not all thoughts related to suicide pose the same level of risk. Suicidal thoughts can range in intensity. Some thoughts may be fleeting, whereas others may involve detailed planning of the suicidal act. In addition to variations in the level of danger associated with different types of suicidal thoughts, some individuals may be at a greater/lower risk for acting on their thoughts.

Suicide obsessions are a specific category of suicidal thoughts that are unique to individuals with OCD. If you’ve read my previous posts on harm obsessions, you might conceptualize suicide obsessions as aggressive obsessions directed inward. Suicide obsessions involve repetitive, unwanted thoughts of suicide that cause severe distress. In contrast to other types of suicidal thoughts, suicide obsessions are symptoms of OCD that do not reflect a “true” intention to kill or harm oneself but rather reflect a repetitive thought loop that gets stuck.

Suicide obsessions can occur spontaneously, seemingly out of nowhere, or may be triggered by unpleasant (or even pleasant!) activities. These repeated, unwanted thoughts about death, suicide, or self-harm may occur many times throughout the day.

Not all obsessions in this category involve death. Some individuals have unwanted thoughts involving self-injurious or self-mutilating behaviors, which instead might be more accurately referred to as “self-harm obsessions” rather than “suicide obsessions.”

Suicide Obsessions & Self-Harm Obsessions

Here are some common examples of suicide and self-harm obsessions.

• Fear of committing suicide in the absence of a desire to do so (e.g., fear of slitting your wrists, hanging yourself, or overdosing on medications).
• Fear of becoming depressed and then feeling compelled to commit suicide.
• Fear of jumping off of a building or another high place.
• Fear of stepping out into oncoming traffic and being hit by a car.
• Fear of jumping in front of an oncoming train or subway.
• Fear of sticking your head in a hot oven.
• Fear of putting your hand in a blender and turning it on.
• Fear of grabbing ahold of a hot pan or stove burner.
• Fear of putting your arm down the garbage disposal and turning it on.
• Fear of driving off bridges or intentionally crashing head-on into other vehicles.
• Fear of intentionally disfiguring your face with a curling iron.
• Fear of intentionally crushing your car or yourself under the garage door.
• Fear of losing control and intentionally blinding yourself.
• Fear of mutilating yourself in other ways listed above.

Unwanted Suicidal Thoughts & Self-Harm Obsessions

Suicide and self-harm obsessions can be experienced in several different ways. Some individuals fear acting on their unwanted suicidal thoughts (i.e., actually killing or harming themselves), whereas others fear the moral or spiritual implications of simply having unwanted thoughts related to suicide or self-harm. For example, some people worry that having thoughts about suicide means they are “bad,” “evil,” or “sinful.” Others fear that thoughts of committing suicide may signal something dangerous, such as the onset of depression, schizophrenia, or another type of severe mental illness.

Suicide obsessions may consist of thoughts (“I want to kill myself.”) but they may also be experienced as impulses (“What if I lose control, pick up that knife, and kill myself?”) or images (e.g., mental movies focusing on self-harm behaviors like cutting, shooting, hanging, or overdosing). Regardless of the form, in many cases, suicide and self-harm obsessions are accompanied by thoughts like, “What if I secretly want to follow through on these thoughts?”

Individuals who know for sure that they want to commit suicide or engage in self-harm ARE NOT having suicide obsessions.

Suicide obsessions occur in the absence of a desire to hurt oneself, or they may be associated with debilitating doubt about whether or not one wants to act on their thoughts. Unfortunately, many individuals with OCD who have obsessions involving suicide cannot tell if their thoughts reflect obsessions or true desires to harm themselves.

The doubt and uncertainty that are characteristic of OCD make this determination difficult, if not impossible. This is further complicated by the fact that attempts to determine unequivocally if these thoughts reflect obsessions or true desires can turn into a mental checking ritual. This is problematic in that mental checking rituals, such as intention checking, actually perpetuate OCD and increase symptoms in the long run.

Because many individuals with OCD also have comorbid depression, it can be confusing to differentiate suicidal obsessions (a symptom of OCD) from suicidal thoughts related to depression. One clue may be the primary emotion associated with the thoughts. In cases of suicidal obsessions, the predominant emotion tends to be anxiety, fear, or horror. Individuals with suicide obsessions are usually terrified about the prospect of acting on thoughts about killing or harming themselves. Suicidal thoughts linked to depression tend to be somewhat less fear-based and instead are more likely to be associated with feelings of hopelessness or depression (both of which, incidentally, can also occur in OCD).

Let’s summarize some possible differences between suicidal obsessions and suicidal thoughts.

What are some characteristics of suicide obsessions (unwanted suicidal thoughts)?

• Suicide obsessions tend to be associated with fear about the possibility of acting on suicidal thoughts.
• In some cases, suicide obsessions may be primarily associated with fear about the implications of having suicidal thoughts — e.g., the fear of being bad or sinful, the fear of offending God, the fear of becoming depressed, the fear of developing a severe mental illness, or the fear of having to undergo an involuntary psychiatric hospitalization.
• Suicide obsessions involve unwanted suicidal thoughts, whereas self-harm obsessions involve unwanted thoughts of hurting oneself.
• People who have suicide obsessions do not want to act on their thoughts, or they may be unsure about whether they “really” want to act on their thoughts.
• People with suicide obsessions often feel extremely guilty about their suicidal thoughts.

What are some characteristics of suicidal thoughts?

• Suicidal thoughts related to depression may be more likely to be associated with hopelessness and despair.
• Individuals with suicidal thoughts may be extremely distressed and may want to act on their thoughts.
• Individuals with suicidal thoughts may be more likely to have a history of suicide attempts or self-injurious behaviors.
• Individuals with suicidal thoughts may be more likely to spend time deliberately planning how they would like to kill themselves.

Clearly, the above criteria are ambiguous. As such, it can be exceedingly difficult to differentiate suicidal obsessions from other types of suicidal thoughts.

To complicate things even further, it is important to note that people with OCD can also have suicidal thoughts that are not obsessions. For example, some individuals become so distressed by their obsessions that they begin to contemplate suicide.

Remember that in contrast to other types of suicidal ideation, suicidal obsessions (by definition) do not reflect an actual intention or desire to hurt oneself.

Let’s take a look at the different ways that suicidal ideation might manifest, which are depicted in the figures below…

Suicide Obsessions vs. Suicidal Thoughts

Figure 1. Suicidal Thoughts Without OCD.

Figure 2. OCD Without Suicidal Thoughts.

Figure 3. OCD: No Suicidal Thoughts Are Obsessions.

Figure 4. OCD: All Suicidal Thoughts Are Obsessions.

Figure 5. OCD: Some Suicidal Thoughts Are Obsessions.

Please note: These categories are hypothetical constructs only and merely reflect the way I conceptualize suicidal thoughts across individuals with and without OCD. To my knowledge, no published research studies have been conducted to determine the prevalence rates of these presumed categories.

Suicide Obsessions – Descriptions

Figure 1 is the simplest figure and illustrates a person without OCD who is experiencing suicidal thoughts. This person does not have OCD, and thus, does not have suicide obsessions. For example, this figure might represent a person who is clinically depressed but does not have OCD.

Figure 2 is also a relatively uncomplicated scenario. As you can see, this figure depicts an individual with OCD who does not have suicidal thoughts. For example, this figure might reflect a person who has obsessions about germs or contamination but who does not have thoughts of suicide.

Starting with Figure 3, things get a bit more complex. Individuals in this category have both obsessions and non-obsessive suicidal thoughts. Examples of people fitting in this category include people with checking compulsions who are feeling so hopeless that they begin to think about suicide as being one option for alleviating their distress. As described earlier, suicidal thoughts vary greatly. Some individuals may have fleeting thoughts of suicide (“I can’t take this anymore, maybe I would be better off dead.”), whereas others may develop specific plans to end their own lives.

Figure 4 is the first figure to depict suicide obsessions. As you can see, this figure shows an individual with OCD whose suicidal thoughts consist exclusively of suicidal obsessions. Individuals falling into this category include people with Pure-O OCD who have intrusive, repetitive thoughts about suicide or self-harm. These obsessions often involve scary, violent images involving suicidal acts or behaviors. These thoughts are frequently shocking and horrifying. Suicide obsessions may “spike” unexpectedly and can literally take one’s breath away… Individuals with suicide obsessions frequently worry about losing control and acting on their unwanted impulses (e.g., “What if I snap and hurt myself?”) or feel incredibly guilty for having such thoughts.

Suicidal obsessions are very confusing for sufferers. Individuals with suicide obsessions are typically horrified by the prospect of committing suicide or engaging in self-harm. Just as in other forms of OCD involving unwanted thoughts, individuals with suicide obsessions often feel that their suicidal thoughts are meaningful or dangerous. They believe that they shouldn’t be having such thoughts and worry that these thoughts must reflect a true, underlying desire to commit suicide.

However, because in Figure 4, all suicidal thoughts are obsessions, the risk for attempted or completed suicide is likely reduced compared to individuals who have non-obsessive suicidal thoughts.

Figure 5 is the most complicated case. Individuals in this category experience both suicidal obsessions and non-obsessive suicidal thoughts. This scenario is particularly confusing for sufferers because it likely involves a combination of lower risk (i.e., suicidal obsessions) and higher risk suicidal thoughts.

For example, someone in this category might experience unwanted sexual obsessions, aggressive obsessions toward others, and suicide obsessions. Due the the overwhelming nature of these symptoms, the individual might also be depressed and may question whether or not life is worth living. For this person, death might seem preferable to a life that feels defined by a near-constant barrage of horrifying impulses and images.

One of the most frustrating aspects of suicide obsessions is that you can never know “for sure” into which category you fit best. I know some individuals with OCD who desperately want their symptoms to fit Category 4 rather than Categories 3 or 5. This is because all suicidal thoughts in Category 4 can be attributed to obsessions, which makes this category feel relatively “safe” compared to the alternatives.

Unfortunately, attempts to definitively categorize yourself are doomed to fail; just as with most things related to OCD, there are some things we can never really know with 100% certainty.

Thankfully, certainty is not a prerequisite for recovery, and there are evidence-based treatments for both depression and OCD (including treatments for suicide and self-harm obsessions).

If you are experiencing these symptoms, it’s important that you work with an individual therapist to address these issues.

Self-Harm Obsessions – Concluding Thoughts

This is a very sensitive topic, and I went back-and-forth many times about whether or not I should publish this article. On the one hand, I feel that these symptoms are a hidden, often agonizing symptom of OCD. Sufferers often don’t talk about these symptoms, and I think that it’s important to have access to information about this topic. After all, individuals who are experiencing these symptoms are often in a great deal of distress.

At the same time, true suicidal thoughts can pose fatal risks to some individuals, and I do not want individuals with OCD to mislabel their suicidal thoughts as suicidal obsessions if this is not actually the case. If you are having suicidal thoughts, it is critical that you work individually with a mental health professional in order to address these symptoms. Suicidal thoughts can be dangerous and should not be taken lightly.

For these reasons and due to the sensitive nature of this topic, I cannot respond to emails or queries regarding whether or not your symptoms reflect suicidal obsessions or actual suicidal thoughts. I cannot and will not make this determination.

This determination must be made by your provider on the basis of a formal psychological evaluation. For the same reason, I am also choosing to disallow comments on this post. My concern is that leaving comments open will potentially add more confusion to this already confusing topic.

Questions? Comments? Struggling with suicide or self-harm obsessions? Please discuss these symptoms with your provider.

This article, Suicide Obsessions: Fear of Killing/Harming Yourself, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Some individuals with OCD fear accidentally harming others through carelessness or negligence.

The fear of harming others can be a sign of obsessive-compulsive disorder (OCD), a neurobiological condition that is associated with repetitive, intrusive, distressing thoughts that can’t easily be dismissed.

Fear of Harming Other People On Purpose

Some aggressive obsessions involve the fear of harming others intentionally. In my last post about the fear of hurting other people on purpose, I identified several specific examples of harm obsessions. These included the fear of losing control and murdering your child, the fear of stabbing a loved one, and a variety of other fears involving violent, murderous, or criminal acts.

Fear of Harming Other People By Accident

Other harm obsessions involve the fear of causing accidental harm, usually through negligence or carelessness. Individuals with these fears often feel that if they notice a situation that might be dangerous or harmful, they are morally obligated to act “responsibly” in order to avert potential danger.

Many years ago, I treated a student who would carefully remove all sticks, rocks, and other assorted debris from the sidewalks and hallways leading to and from his classes.  He felt that if he noticed a rock that could potentially cause someone to trip and fall and did not move it out of the way, he would be responsible if someone got hurt.  This was further complicated by the fact that the floors in the student’s school were very scuffed and worn, and it was hard to tell the difference between scuffs and actual debris. Because of this, he felt compelled to kick each scuff just to make sure that it wasn’t really a stick or rock. Before treatment, on good days, the process of walking to class took many minutes.  On rough days, it could take hours…causing him to be late or miss class entirely.

For this individual, and for many other people with OCD who fear harming others through negligence, an inflated sense of responsibility leads one to take excessive precautions and to be conscientious to the point of sacrificing one’s own welfare. For some people, failing to prevent harm can feel almost as bad as causing that harm directly.

Other situations where people worry about causing harm through negligence include the following…

Fear of Accidentally Hurting Other People (Examples)

• Fear of insufficiently cleaning dishes, pots and pans, baby bottles, toys, or cooking/cleaning surfaces, which might result in illness or death.
• Fear of accidentally contaminating food with chemicals or poisonous materials.
• Fear of leaving your car unlocked and having a young child climb inside and get trapped, causing death or injury.
• Fear of leaving household doors or windows unlocked, which might result in violent crime against a family member.
• Situations involving turning off stoves, unplugging items with electrical cords, and other checking-related fears.
• Fear that someone might slip and fall on the bathroom floor if it’s not completely dry.
• Fear that someone might trip over items left on the ground – clothing, uneven rugs, towels, etc.
• Fear that items might shift or become dislodged from shelves/closets, resulting in items falling on or crushing family members.
• Fear that leaving electric razors, curling irons, electric toothbrushes, etc. plugged in might result in accidental electrocution.
• Fear of having potentially dangerous items in the household in case someone might get hurt–knives, firearms, chemicals, etc.
• Fear that someone else might commit a violent crime using one of your possessions.
• Fear that someone might choke on food you’ve prepared.
• Fears related to hit and run OCD (e.g., hitting pedestrians while turning right on red, backing up, driving in outer lanes).

Fear of Hurting Other People: Compulsions/Rituals

As with all forms of OCD, the fear of hurting other people through carelessness is strengthened by avoidance and compulsive behaviors (rituals).  Compulsions include:

• Removing debris from sidewalks, stairways, rooms, hallways, or other public walkways.
• Excessively cleaning items in the kitchen.
• Checking inside the oven, microwave, washing machine, or clothes dryer.
• Listening intently for sounds of someone who has been injured or is trapped.
• Monitoring the news (TV, radio, internet) to make sure that someone hasn’t been injured or killed in locations you’ve visited.
• Revisiting locations to make sure that nothing bad has happened.
• Reminding other people to “be careful” and providing repeated warnings about potential danger.
• Repeatedly calling, texting, or contacting others to make sure they’re okay.
• Trying to convince yourself that you’ve been 100% responsible and that nothing bad will happen.
• Reviewing your memory to make sure that you’ve been thorough.
• Asking other people for reassurance that everything is going to turn out okay.
• Praying rituals designed to keep bad things from happening.
• Checking items for stability, including tapping, shaking, and repositioning.
• Repeatedly drying bathroom, bathtub, and shower floors.
• Driving-related rituals.

It’s important to note that an inflated sense of responsibility can be “deflated” through active efforts on your part.

This is neither simple nor easy, but it’s a critical component of taking your life back from OCD.

Basic knowledge about how OCD works can be helpful in this regard. Knowing how compulsions are related to obsessions, that efforts to not feel anxious today can paradoxically lead to greater anxiety tomorrow…is essential information. It’s also important to become aware of the various mental traps to which our minds are susceptible — jumping to conclusions, emotional reasoning, mind reading, mental filtering of information, over-generalization, as well as a variety of other cognitive distortions…

Unfortunately, knowledge alone isn’t sufficient for freeing yourself from OCD’s clutches. You must also back up this knowledge with your behaviors.

As your behaviors shift and begin to challenge OCD-based beliefs, you will inevitably experience some doubt, guilt, and fear in the process of recovery. However, this temporary spike in fear and doubt is an investment in your future. When these emotions are activated intentionally as part of a healthy recovery plan, you gain something in return: mastery and control over OCD.

OCD tells you that you can never be too diligent, careful, or thorough. It tells you that you must do everything in your power to prevent harm to other people.

It’s easy to embrace these statements. They seem obvious and self-evident. After all, who wouldn’t want to avoid harming other people?

However, if you can learn to look behind the seeming appeal of these statements, you’ll notice that there actually are some good reasons to give up efforts to be “perfectly responsible.”

Most importantly, what has it been like trying to live up to these ideals? Has it worked?

Your experience tells you that no matter what you do, OCD is never satisfied. It always demands more. Whatever preventative action was sufficient to please OCD in the past is now completely insufficient for getting OCD off your back. Rituals that you used to perform one time only are now rituals that you must perform at least ten times. Somewhere along the way you’ve fallen into the habit of using your emotions as a metric to tell you how many times you need to do something.

OCD treatment involves recalibrating your belief system and creating experiences to teach the emotional part of your brain what the logical part of your brain already knows. Recovering from the fear of harming others doesn’t mean that you have to promote harm or actively endanger people, it just means that you have to work on disentangling yourself from the OCD parts of your behavior. It means embracing the philosophy of doing things in a way that is “good enough” rather than “perfect”.

Recovery from the fear of accidentally harming others involves learning to live less responsibly…and learning to be okay with that.

Questions? Comments? Struggling with the fear of hurting others through carelessness or negligence? Sound off below.

This article, Fear of Hurting Other People, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Aggressive obsessions involve the fear of intentionally harming or killing others.

These symptoms of obsessive-compulsive disorder (OCD) involve the fear of harming or killing other people. In other cases, aggressive obsessions are directed at the self, such as when individuals experience unwanted, intrusive, and recurrent thoughts about hurting or killing themselves (suicide obsessions).

This post will focus on aggressive obsessions that involve the fear of harming or killing other people. Aggressive obsessions involving suicide and self-harm will be addressed in a subsequent post.

Fear of Harming or Killing Others

Aggressive obsessions often focus on violent, murderous (stabbing, shooting, choking, poisoning), or criminal (arson, bank robberies) acts and involve graphic mental images of blood, injury, and death. Individuals with violent obsessions may fear becoming serial killers or deliberately hurting someone they love. Aggressive obsessions affect individuals of all ages, including adults, adolescents, and children.

Common examples include:

• Fear of going on a murderous rampage, involving stabbing or cutting.
• Fear of grabbing a nearby policeman’s gun and shooting someone.
• Fear of choking your baby or partner to death.
• Fear of snapping your child or pet’s neck.
• Fear of pushing or throwing someone off a building or other high place.
• Fear of intentionally poisoning someone (e.g., putting rat poison into your loved one’s food).
• Fear of hitting, striking, or beating someone to death.
• Fear of pushing/throwing someone down the stairs (e.g., babies).
• Fear of walking up behind someone and slitting their throat.
• Fear of smothering your baby or partner while they are sleeping.
• Fear of drowning your child while swimming or giving him/her a bath (postpartum OCD).
• Fear of committing a bank robbery.
• Fear of committing arson.
• Fear of getting angry and shaking your child to death (perinatal OCD)
• Fear of side-swiping and killing a pedestrian or cyclist while you are driving.
• Fear of aggressively pushing your grocery cart into other shoppers who are in your way.
• When riding in the car as a passenger, fear of grabbing the steering wheel and causing an accident.
• Fear of putting your baby or pet into an oven, microwave, washing machine, or clothes dryer.

Similar to what occurs in the case of sexual obsessions, individuals with aggressive obsessions are often afraid of acting on unwanted impulses.  However, sometimes violent obsessions are not associated with urges to act. In such cases, symptoms may consist of unwanted thoughts or vivid, disturbing mental images of violent behaviors. Individuals with these types of symptoms will often wonder why these unwanted thoughts keep occurring and may feel extreme guilt and horror over not being able to control their thoughts.

Some individuals have a very confusing form of OCD that causes them to be unsure about whether or not a thought actually represents a memory. These individuals may mistakenly believe that they have acted on their thoughts because their obsessions are vivid, detailed images that “feel” more like memories than thoughts. They may engage in a variety of checking compulsions to make sure that these “false memories” haven’t actually occurred.

Aggressive Obsessions & Compulsions/Rituals

As with all forms of OCD, violent/harm obsessions are reinforced through compulsive behaviors (rituals) and avoidance.  Compulsions involving the fear of harming others include:

• Checking written items (forms, envelopes) to see if you accidentally wrote out your bad thoughts or to make sure that you haven’t written out a confession.
• Monitoring the news (TV, radio, internet) to make sure a violent crime hasn’t occurred nearby.
• Revisiting locations to make sure that nothing bad has happened.
• Trying to convince yourself that you would never act on your thoughts.
• Reviewing your past to see if you’re capable of murder.
• Asking other people for reassurance that you’re a good person.
• Mental rituals involving figuring out, undoing, resetting, or trying to clean your mental slate.
• Analyzing your thoughts to determine if they reflect the “real you.”
• Trying not to think unwanted thoughts.
• Holding onto handles, belt loops, or other surfaces to make sure that your hands don’t perform an unwanted act.
• Praying rituals designed to keep you from acting on an unwanted thought.
• Neutralizing unwanted thoughts or images by mentally flipping them upside down, replaying them backwards, or converting them into something “good.”

Aggressive Obsessions & Avoidance Behaviors

Avoidance behaviors involve limiting exposure to places, situations, people, or objects that might trigger your unwanted thoughts. Here are some avoidance behaviors that are common for individuals who are afraid of killing or harming other people.

• Removing all “weapons” from the house – sharp items, blunt objects, poisonous chemicals, ropes, guns, etc.
• Over-controlling your body (keeping overly rigid) when around others.
• Keeping your hands in your pockets or keeping them far away from other people.
• Delegating cooking or food preparation responsibilities to others.
• Avoidance of sex, intimacy, and other situations involving physical vulnerability.
• Avoidance of child-care responsibilities.
• Avoidance of being alone with children, pets, the elderly, or other vulnerable populations.
• Avoidance of television shows or newspaper stories featuring violent themes.
• Avoidance of the police and other security personnel.
• Avoidance of physical contact with others, especially the neck area (avoiding hugs, neck rubs).
• Avoidance of scary/horror movies.
• Avoidance of church and confession (alternatively, may have rituals involving compulsive prayer or confession).
• Avoiding knives, scissors, or razor blades.

How to Tell if You’re Secretly a Serial Killer

Many individuals with aggressive obsessions worry about losing control and acting on their unwanted thoughts. Many interpret their thoughts as proof that they are, in fact, secretly murderers or serial killers. However, in actuality, these thoughts are simply a consequence of OCD, a neurobiological condition. The occurrence of these thoughts is a stressful symptom of OCD, but it doesn’t reflect a defect of character or a predisposition to violence. In fact, as I discussed in my previous post, it more likely reflects the opposite.

The following questions can be a helpful litmus test for individuals with violent obsessions.

Do you enjoy the thoughts you’re experiencing? Are your violent thoughts pleasurable?

Many individuals with aggressive obsessions are extremely distressed when they have thoughts about harming or killing others. However, this “test” won’t work for everyone. Because OCD involves debilitating doubt and uncertainty, there are many of you out there who are now probably saying, “Well, then I definitely don’t have OCD. I’m worried that I actually like my thoughts and want to act on them.”

If that sounds like you, you might ask yourself a different question:

If you could, would you choose to have your violent thoughts occur MORE OFTEN?

Treatment of violent obsessions is based around developing a new relationship with these unwanted, intrusive thoughts and learning that these thoughts are not dangerous or predictive of the future.

Questions? Comments? Struggling with aggressive obsessions? Sound off below.

This article, Aggressive Obsessions: Fear of Harming or Killing Others, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.

Harm obsessions involve unwanted thoughts, impulses, or images about hurting or killing yourself or others.

Alternatively, picture yourself as a young child who is intensely afraid of playing with your new puppy…not because you’re afraid of dogs but because you are afraid that if you touch it, you might lose control and snap its neck.

In either scenario, the most horrifying part is that you’re afraid that you might secretly want to act on these unwanted thoughts.

After all, why would the thought keep coming if it didn’t mean something?

Violent Obsessions, Harm Obsessions, & Bad Thoughts

This is the daily reality for many adults, teens, and children who experience harm obsessions, also known as violent obsessions, a type of OCD symptom that involves unwanted, repetitive violent thoughts, impulses, or images. Harm obsessions are typically shocking, distressing, and disturbing, and they may occur thousands of times every day. They often involve themes of violence, death, murder, self-harm, and suicide. Obsessions involving death are also sometimes referred to as “morbid obsessions.”

Much like sexual obsessions, violent obsessions can be a debilitating symptom of OCD because they can “pop in” at any time and in any place. They are sometimes associated with the presence of triggers like particular people (e.g., loved ones) or vulnerable populations (e.g., fear of children or the elderly), but they may also occur with strangers. In other cases, they may seemingly emerge out of the blue with little provocation or warning. They can even occur when you’re alone or in the absence of an easily identifiable external trigger.

Because of this, many people with violent obsessions begin avoiding people they care about. They may also become fearful of being alone or being bored and may go to great lengths to keep themselves busy, because their unwanted thoughts may frequently occur during periods of downtime or relaxation. Consequently, many individuals with harm obsessions feel that they can never really relax. They become masters at distraction and often dread bedtime when they are alone with their thoughts.

Who gets violent obsessions?

Unfortunately, most people in the general population are unfamiliar with harm obsessions. Popular TV shows like Glee that feature characters with OCD (e.g., guidance counselor Emma) do not often depict individuals with violent obsessions. Even medical professionals like doctors, nurses, or mental health workers may not initially recognize the fear of killing/harming others as a symptom of OCD.

Because of the violent, gruesome nature of their OCD symptoms, many people who have the fear of harming/killing others mistakenly conclude that they must have dark, twisted personalities. This couldn’t be further from the truth. If you attended my OCD support group and tried to pick out the people with harm obsessions on the basis of their personalities or physical appearance, you would nearly always guess incorrectly. Many individuals with harm obsessions are friendly, kind-hearted, and warm. Furthermore, even very young, happy children can develop morbid obsessions.

Interestingly, people with violent obsessions tend to be some of the nicest, most conscientious individuals who visit my Palm Beach Gardens, Florida, psychological practice. Why might this be?

OCD tends to hit you where it can hit hardest.

People with harm obsessions tend to be hypersensitive to bad thoughts and are often hyper-moral. Compared to individuals without OCD, they are more attuned to the content of their thoughts and are more likely to “police” their thoughts. As such, they often engage in mental rituals that involve examining their thoughts for potentially dangerous content. We all experience unwanted thoughts at times, but people with harm obsessions are more likely to fear that their unwanted thoughts are meaningful.

For people with harm obsessions, unwanted thoughts feel so distressing because they are often distinctly opposite of the types of thoughts that the individual wants to have. Thus, when bad thoughts do POP, these individuals are shocked and horrified and often go to great lengths to avoid or neutralize. Because avoidance and neutralization perpetuate OCD, without treatment, symptoms tend to escalate and become more out-of-control over time.

After having a bad thought, it is common for individuals with harm obsessions to jump to the following erroneous conclusions:

Fears about Violent Obsessions

• These symptoms mean I’m going crazy.
• Seeing violent images in my head must mean I’m developing schizophrenia.
• If anyone found out I’m thinking these things, I would be institutionalized.
• These thoughts mean that at my core, I am a truly horrible person.
• Experiencing these impulses means that I’m turning into a serial killer or pedophile.
• Only a monster would think about murdering their kids.
• If my spouse knew I was thinking these things, s/he would freak out and never look at me the same way again.
• Having these thoughts means I’m a bad person.
• I should be able to control my thoughts.
• What if the only way for me to have any peace is to act on my thoughts?
• The more often I have these thoughts, the more likely it is that I’ll act on them.
• I should only be thinking good things.
• My thoughts reflect my true desires.
• I’ve heard that some people with OCD have scary, unwanted thoughts…but what if this isn’t OCD?

These maladaptive beliefs cause many individuals with violent obsessions to be very secretive about their thoughts. They often live in fear, desperation, isolation, and depression for many years before understanding that they suffer from OCD, a treatable anxiety disorder. Having harm obsessions can feel like being locked away in your own private hell.

Fortunately, the internet has made it easier for internet-savvy OCD sufferers to discover that thousands of other people also share these disturbing symptoms. If you decide to attend an OCD support group, there’s also a comfort that comes in knowing that many other people have strikingly similar symptoms. Furthermore, these individuals tend to look more like kind-hearted individuals with OCD than budding serial killers.

In my next post, I identify some specific examples of aggressive obsessions.

Questions? Comments? Struggling with the fear of harming others? Sound off below.

This article, Harm Obsessions & Violent Obsessions, was originally published on Steven J. Seay, Ph.D. You may read more about the author here.