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I Have Thoughts of Killing…

By October 31, 2015November 19th, 2020Blogs, Dr. Jenny Yip

How often do you hear this? Unless you frequently treat OCD, hopefully not often. Yet, this poses a direct dilemma for those who don’t usually work with OCD sufferers and are suddenly challenged with the task of treating such a person with Harm OCD.
What is it? Harm OCD is one of many categories of OCD that involves morbid obsessions of killing or harming others and/or oneself.
Is it dangerous? Well, that is the main question. Let’s take a closer look at what OCD actually is to answer this daunting question thoughtfully.

Just like other OCD themes, Harm OCD involves intrusive, unwanted, repetitive obsessions that can take on the form of specific thoughts, images, and urges, or even vague feelings and sensations. The content of harm obsessions are typically violent, gruesome, morbid, and can also include aggressive sexual acts. While most people who may have such fleeting thoughts can readily dismiss them and move on with their lives, those suffering from Harm OCD bestow credence and significant meaning to these horrifying obsessions. As a result, they attribute negative self-value of guilt, shame, horror, and disgust to their identity.

Harm OCD can appear in as many varieties as one’s imagination can create. I’ve had patients from early grade school to late adulthood who aversively see themselves stabbing, hitting, pushing, injuring, or killing their loved ones, pets, and even strangers. They may have images of molesting their own child, poisoning their newborn, or killing random passersby. They may have urges of pushing others off of stairs, balconies, and windows, or throwing themselves into cars, trains, and out of airplanes.
From the burden of feeling crazy, shame, and disgust for having such morbid thoughts, sufferers of Harm OCD make every attempt to avoid any possibility of such occurrence from actually happening. Thus, they’ll avoid driving, going near windows and balconies, taking the stairs, being near children or pets, and whatever potentially risky situations where they would be responsible. They’ll check to make sure that knives, forks, scissors, ice picks, and whatever sharp, harmful objects imaginable are locked away and out of reach. Some will even lock themselves in the prison of their own home to ensure that they pose no danger to random strangers who pass by.

So back to the main question: Are people with Harm OCD dangerous? I’ve certainly observed many colleagues who believed so. Unfortunately, due to a lack of awareness, training, and experience, there have been clinicians who have broken confidentiality and made Tarasoff reports to local authorities, or they’ve reported parents with Harm OCD to Child Protective Services. These unthoughtful actions and attitudes only serve to perpetuate the erroneous belief that there is something wrong with the OCD sufferer when in reality, they genuinely are not dangerous people because of these thoughts. Why not?
The key word here is “intent.” People with Harm OCD, and OCD in general, do not actually desire to commit the harmful actions. Rather, they are repelled by the thoughts, they make every attempt to avoid the thoughts, and they feel terrible for even having the thoughts to begin with. In fact, that is the whole problem of why obsessions repeat themselves. OCD works paradoxically; the more you try not to think of something disgusting, the more you actually focus energy and attention onto that thing!
Simply having a morbid thought does not make a person “BAD” or a menace to society. Was Francis Bacon dangerous? Has Tim Burton posed any threat to society? Haven’t you ever had thoughts of punching your boss, or kicking your sibling? Does having such violent thoughts make you a dangerous member of society?

With the dozens upon dozens of variables to how OCD can present itself, looking at it through a narrow tunnel vision is a disservice to OCD sufferers, and is actually unethical in many ways. The message here is to consider mental health from a kaleidoscope perspective rather than jumping to quick, thoughtless conclusions, and seek consultations when uncertain. In reality, a thought is a thought is a thought. Unless there is true intention, means, methods, and motive to harm, how is having a random thought dangerous?

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