Harm OCD: A Tale
In the last post, we explored some of the general biological and psychological components of OCD. There is still a lot more to cover, and in the future posts, I’d love to dive deeper in these aspects. For this week, I want to turn attention into a deeper dive on Harm OCD and the related subtypes of Perinatal OCD and Pedophilia OCD, which fall under the dimension of Unacceptable Thoughts (make sure to refer back to blog post 2 for more clarity on the dimensions of OCD). Harm OCD, Perinatal OCD, and Pedophilia OCD are some of the least understood and most distressing, confusing and gut wrenching OCD subtypes. Let’s take a deeper look at what the experience of someone with these subtypes might look like.
Harm OCD: A Tale
Imagine just sleeping in on a lazy Saturday morning. You wake to the faint call of birdsong, your body dense and muscles heavy emerging from slumber. As you roll over and open your eyes, you see your heart and soul: your beloved animal lying soundly asleep curled up beside you. They are breathing slowly, and watching them breathe, you feel an indescribable and subtly deep sense of care, fondness, and love in the center of your chest. You go to pet them and snuggle, and as you touch them, they open their eyes, stretch and look back at you with that similar look of love, care, and sense of safety. They give a big stretch and you embrace them. Just as you close your eyes again to dose back into sleep, you notice an image in your mind's eye surface to your awareness, like a dolphin jumping for air from the seas of the unconscious, of you choking your beloved in your embrace. You see and feel them limp in your arms. Instantly, you notice your chest tighten, your heart races, and an overwhelming sense of confusion and anxiety takes hold of your body. Doubt sets in. Do I really want to choke them? Why in the hell did I just have the thought? What if I accidentally act on it? What does this mean about me? Does this mean I want to kill them? No, of course I don’t want to. But what if I do?! If I didn’t want to, then while the hell would I have the thought of doing so?
The anxiety gets too overwhelming, so you get out of bed, avert your gaze, and go to the bathroom to splash cold water on your face. You still feel anxious, and are now worried to look at them. You then decide that, to pacify your doubts and bring some peace of mind - just to make sure you aren’t crazy - you are going to make them a special meal to show your true love for them, an unknown self-imposed test of character. You go into the kitchen to do so, and enroute pass your partner lying on the couch reading. They say good morning and ask how you slept. Still feeling anxious and confused, you reply absentmindedly “Ok” and continue to go into the kitchen. They can’t know. A doubt flashes in your mind at the speed of light of whether or not you might harm them. You dismiss it, continuing to prepare the special meal, trying to make sure that you actually care, love them, and don’t house covert murderous intent. You do the deed, yet that doesn’t make you feel any less anxious. The doubt in your mental vision intensifies brighter than the lamp beside you to the point you don’t even see the lamp. What if I actually harm them? What if I do something dangerous? What if this means I’m a murderer just waiting to be discovered?
The rest of the day passes by in a haze. Your partner asks what’s wrong. You give a deep sigh and reply “Nothing. I’m just stressed”. Something neutral, of course, something innocuous. You doubt whether or not you should tell them what’s actually going on, but what if they don’t understand and get freaked out? What if they get scared of me? You ask them if they think you’re a bad person, fishing for some sign - or rather for some feeling - of incontrovertible proof. They reply with a subtle tone of shocked concern, “Of course not! What makes you think that?”. The conversation continues and you feel better afterward, but the doubt still sits in the back of your mind…
Something else needs to happen. Something to prove to yourself that you aren’t violent, vengeful, or murderous. So you mentally review in your head all of the acts of service, love and compassion you’ve done in the past and all your redeeming qualities you have now. You then notice your partner laughing at a joke from the comedy special you’re watching together. You didn’t notice it, you’re mind in pursuit of something just out of its reach, like a dog chasing a treat on a treadmill.
The next day you wake up again, this time a little less rested. You see your two loved ones still sleeping silently, breathing slowly and calmly. Looking at them is comforting, and again you notice that same feeling of care, fondness and warmth toward them. Yet, this time, it comes with something else: an imperceptible sense of doubt and uncertainty that feels like an itch that can never be scratched.
Taboo Thoughts
This is just one example, albeit slightly elaborated (and fictional!) for artistic and dramatic effect, of what it looks like to live with Harm OCD, or OCD in general. In Harm OCD, intrusive thoughts manifest as violent images or ideas toward oneself or someone else, creating crippling doubts about one’s character which then drive attempts to try to either prevent, disprove, or make certain - in the form of checking, reassurance seeking, avoidance, or mental rumination - the feared consequences and uncertainty behind those doubts. Perinatal OCD is a related subtype, which develops during pregnancy or after childbirth, and shares overlapping themes with Harm OCD. In Perinatal OCD, intrusive thoughts involve images or ideas of committing or causing harm or violence against one’s new born, unwanted sexual thoughts toward one’s newborn (i.e. fears of molesting the baby), or even religious related obsessions, which cause troubling doubts about one’s true character, competence as a parent, and love for the new born, leading to checking, avoidance, and reassurance seeking compulsions (International OCD Foundation, n.d.). In Pedophilia OCD, intrusive thoughts typically manifest as images of unwanted sexual acts with children and recurrent fears and doubts of whether or not you’ve committed or will commit a sexual transgression, which then drive related checking, prevention, reassurance seeking, and avoidance compulsions.
To use the example above, say instead the sufferer had an intrusive thought of having sex with their pet. They’d still feel as anxious and would likely have the same doubts (Why in the hell did I just have the thought? Do I really want to have sex with them? What if I accidentally act on it? What does this mean about me?) and drive related safety behaviors to ease the uncertainty attached to those doubts (checking and testing behaviors, rumination, avoidance, etc.). Both experiences are OCD, yet we use these different labels to differentiate the content and focus of obsessions, doubts, and safety behaviors. Outwardly, these two different experiences would appear indistinguishable; preparing the meal to check to make sure that they aren’t murderous would look the same to their partner in either case, which highlights a common feature across all OCD subtypes: subtle suffering in silence.
These examples and images may come across as too direct, detailed, taboo, or inappropriate, and if you felt anxiety even just reading these, then I’ve done my job. This is meant to raise awareness and highlight the visceralness of these experiences. Yes, its one thing to say the words “Intrusive thoughts of violence; Harm OCD; Pedophilia OCD; Perinatal OCD”. But it’s another thing to have an understanding of what these labels actually look and feel like. For more detailed information on all of these subtypes please check out these articles published by the International OCD Foundation:
Pedophilia OCD: https://iocdf.org/expert-opinions/am-i-a-monster-an-overview-of-common-features-typical-course-shame-and-treatment-of-pedophilia-ocd-pocd/
Perinatal OCD: https://iocdf.org/perinatal-ocd/what-is-perinatal-ocd/
Harm OCD:
Also, if you are curious more about all the different subtypes, there is a great website aptly titled intrusivethoughts.org, which has amazing information about the frequency of intrusive thoughts and the common symptoms/experiences of each subtype.
Coming Up
In the next article, I am going to explore how (un)certainty drives the OCD cycle, common core fears among OCD sufferers, and ways to help with refraining from compulsions (a.k.a Response Prevention). And as always, thanks for your time and attention, and I’ll see you next week!
References
International OCD Foundation. (n.d.). Am I a monster? An overview of common features, typical course, shame, and treatment of pedophilia OCD (POCD). International OCD Foundation. https://iocdf.org/expert-opinions/am-i-a-monster-an-overview-of-common-features-typical-course-shame-and-treatment-of-pedophilia-ocd-pocd/
International OCD Foundation. (n.d.). Expert opinion: Violent obsessions. International OCD Foundation. https://iocdf.org/expert-opinions/expert-opinion-violent-obsessions/
International OCD Foundation. (n.d.). What is perinatal OCD? International OCD Foundation. https://iocdf.org/perinatal-ocd/what-is-perinatal-ocd/
