Obsessive-Compulsive Disorder of fear of harm: symptoms, causes and treatment
These are the main characteristics of fear of harm OCD.
One of the characteristics of our way of experiencing thoughts is that we cannot completely control their contents . The mind is that place through which all kinds of thoughts pass, good and bad. Sometimes we think of innocent and harmless things like a meadow with flowers, the shopping list or that time we went to a restaurant that we liked.
Others, on the other hand, come to mind somewhat murky ideas such as wanting to stab someone while we are walking, cut off the head of our boss or punch that neighbor who does not stop 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 those ideas come to us sometimes, no matter how aggressive they are, although the normal thing is that as quickly as they have come we stop thinking about them, no giving them too much importance.
But what if we are not able to forget them? What if we think over and over 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 people with OCD ask themselves out of fear of harm.
What is fear of harm OCD?
Most people have occasional violent thoughts, unwanted images and ideas that they imagine they are hurting other people or themselves.
For example, we may have the brief fantasy of wanting to pull that customer’s bun that has crept all over our faces in line at the bakery. This is normal and, although we do not like to think this type of thing, the truth is that it is believed that about 85% of people have this type of violent thoughts from time to time.
Typically, these occasional violent ideas do not change our behavior or be seen as a problem . They are part of the many different things that we think about every day and we hardly attach any importance to them. However, these types of thoughts are seen as something very disturbing by people with a diagnosis of obsessive compulsive disorder (OCD), since having these ideas where they imagine that they harm other people or themselves become intrusive thoughts, taking over his mind, turning into an OCD case of 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 alteration is characterized by having aggressive and intrusive thoughts about behaving in a violent way towards someone or towards oneself and that these come true, carrying out harmful behavior both willingly and unwillingly because of losing control.
Some examples of violent behavior that the person thinks and is afraid of becoming reality are: stabbing his partner with a knife, drowning his baby son while bathing him, throwing someone on the subway tracks, picking up a scalpel and sticking it into him on the chest…
As we have discussed, it is normal to have these types of thoughts from time to time. A person without OCD may have violent thoughts and then recognize them for what they are, simply thoughts, not predictions of something that will inevitably happen. On the other hand, people diagnosed with OCD out of fear of doing harm worry a lot after having thought something violent, attributing to them the meaning that it will happen yes or yes. In his mind the idea of ”if I think about it, I really am capable of doing it” is repeated.
Having these types of thoughts leads the person with OCD from fear of harm to perform compulsions and rituals to reduce the anxiety caused by those thoughts . Once the ritual has been completed, the person feels less anxious but, when the violent thought returns, the individual will feel anxiety, doubt and fear again at the possibility that what they have thought may happen and, consequently, they will do it again. ritualistic behaviors.
Obsessions in OCD
In the DSM-5 it is explained 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 fear of hurting OCD mode, these obsessions focus on thoughts of hurting oneself or others. In addition, and as in many other types of OCD, compulsions also occur in this modality, that is, the person uses all kinds of means so that the obsessions never happen .
Taking this into account, we can put an example of OCD of fear of doing harm with obsessions and compulsions included. Let’s say that the person has recurring and intrusive thoughts that they could harm their newborn baby while bathing him (obsession) and, therefore, he always delegates this task to his partner (compulsion).
Symptoms of this subtype of OCD
People who suffer from fear of harm OCD present a wide range of symptoms, manifested in the form of intrusive thoughts of different kinds and compulsive behaviors with the belief that they will help to prevent them from coming true.
As we have commented, 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 that they are really capable of carrying out. This also causes the idea that they can cause harm without realizing it and that, even after having done something and after several hours or days, they begin to ruminate on the possibility that with that action they hurt someone and that now they are in trouble .
For example, a person with this subtype of OCD may be driving through a pothole. After a few hours you begin to think that you have really run over someone, you have done a lot of damage and, how you did not realize it when it happened, on top of that you have unwittingly fled. Although this situation is unlikely, he begins to go round and round, and seriously considers never driving again.
The fear of what they may do is so great that they feel frightened by what they think they are going to do harm impulsively and they begin to believe the idea that they really are violent and dangerous people , who are hiding their true nature under the facade of socially adapted people even without putting effort into it. They fear that one day they will not really be able to contain themselves anymore and will act violently, losing control completely.
In response to these intrusive thought patterns, that is, obsessions, people with fear of harm OCD carry out different compulsions and ritualistic behaviors in order to reduce their anxiety and also the “possibility” that they actually carry out the violent behaviors you have thought of.
One of the most common is to hide dangerous (or perceived as dangerous) objects in your home, such as knives, chemicals (bleach, detergent, battery acid …), medicines, strings, razor blades, drills … Hide any supposedly dangerous object or with which you have thought that you could harm yourself or others in order to avoid being tempted to use them.
It is also common for patients with this psychopathology to review each and every one of their actions to make sure that they are not doing harm or that they have not done it without realizing it. They monitor all their actions and, if they realize that they have done something in the past that they believe could have remotely inflicted harm on someone, they begin to worry about how.
People with fear of harm OCD avoid watching the news and using the media to avoid encountering movies, television series, or videos with violent content. They fear that if they see violent acts they may pick up ideas and, if they do not, there is also the fear that this will reactivate the conscious thought of the harmful ideas.
On the other hand, it also happens that excessive time can be spent researching on the Internet about violent crimes, looking for what the perpetrator did and to what extent the person with this disorder shares traits. That is, to make sure that he or she is not going to hurt other people, try to see to what extent he has something in common with real killers.
Some of them may come to pray compulsively or wear amulets , believing that it will help them avoid losing control. Likewise, this is not enough for them, which is why they are also motivated to compulsively ask their entire close circle if they believe that 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 content of their mind. The problem is that they will never find the answer that convinces them that they are not violent people or that their thoughts are just that, thoughts.
There are several treatments for fear of harm OCD.
1. Exposure therapy and response prevention
One of the therapies that is considered most appropriate for this subtype of OCD is exposure and response prevention (ERP) .
ERP involves having the patient voluntarily expose himself to the source of his fear over and over again, but preventing him from later performing ritualized compulsions or any other behavior he does to neutralize or reduce his anxiety. By repeatedly exposing yourself 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 it will do harm.
We should not get the misconception that the fear of harm OCD treatment is aimed at showing 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 may be a real threat in any sense. A patient with this form of OCD is no more likely to make a negative thought come true than a person than a person who does not have the disorder.
An example of ERP treatment for people with fear of harm OCD is exposing a person who fears they might stab someone to the phobic object directly .
First, you may be asked to carry a plastic fork or knife in your pocket on a daily basis, even on the street or while working. The idea is that you create an association with this item and get used to its presence, even if it is not a knife or fork like those that are present in your harmful obsessions.
As time goes by and when the person gets used to the plastic cover, they will proceed to go up one more level of difficulty , this time having a more threatening object in their pocket, such as a metal fork.
The idea is to increase the danger of the object to be carried, to the point that the person does not feel excessively nervous or tense when having potentially dangerous objects nearby such as a kitchen knife, large scissors, a surgical scalpel … .
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 negative thinking patterns and behaviors .
These same patients are given problem-solving skills during therapy sessions and, subsequently, are taught to put them into practice alone so that they create positive habits. Generally in this therapy the following is done:
The patient is taught what the characteristic impulse phobia of his disorder is and how it can come to dominate the lives of the people who suffer from it.
2.2. Identification of obsessions and compulsions
It helps the person to identify their obsessions and compulsions, in this case violent thoughts that cause special concern and the ritualistic behaviors that they carry out with the intention of reducing the anxious symptoms as a method of protection so that those thoughts do not come to happen. If the person is able to identify them, then it will be easier for them not to carry them out .
Relaxation and breathing techniques are taught to the patient with the intention of learning how to relax quickly and effectively in any situation that they think might make their violent thoughts come true.
There are pharmacological treatments for fear of harm OCD and they are considered a useful aid for the improvement and well-being of the patient, although they 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 have in common that the patient must be made to accept the presence of his intrusive thoughts, but not to assign meaning to them or to convince himself that he is a potentially dangerous person.
Some people with fear-of-harm OCD make a full recovery from ERP therapy, while others, while improving markedly, are unable to get rid of their obsessions entirely.
This does not mean that the therapy has failed with them, but that it is very difficult to completely eliminate obsessions and actually the recovery and improvement of well-being in patients with OCD has more to do with managing the emotions associated with their recurring thoughts.
Obsessive-Compulsive Disorder of fear of harm: symptoms, causes and treatment