Obsessive-Compulsive Disorder of fear of harm: symptoms and treatment

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 go for a walk, cut off the head of our boss or punch that neighbor who does not stop playing the music strong.

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, not giving them too much importance.

But what if we are unable 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 that are asked

people with OCD out of fear of harm.

• Related article: "Obsessive-Compulsive Disorder (OCD): what is it and how does it manifest itself?"

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 with.

For example, we may have the brief fantasy of wanting to tighten the bun of that customer who 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 much importance to them. However, these types of thoughts are seen as very disturbing by people with a diagnosis of obsessive compulsive disorder (OCD), since having these ideas where they imagine that they injure other people or themselves they turn into intrusive thoughts, taking over their mind, becoming a case of OCD of fear to do hurt.

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 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 will become reality are: nailing him a knife to her partner, drowning her baby son while she bathes him, throwing someone on the subway tracks, picking up a scalpel and sticking it in 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 occur. 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 kinds of thoughts leads the person with OCD to fear doing harm to performing 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 return to feel anxiety, doubt and fear at the possibility that what he has thought may happen and, consequently, he will return to perform behaviors ritualists.

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Obsessions in OCD

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 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 puts all kinds of means so that the obsessions never come to pass.

Taking this into account, we can give an example of OCD of fear of doing harm with obsessions and compulsions included. Let's say the person has recurring and intrusive thoughts that he could harm his baby. newborn while she bathes him (obsession) and, therefore, always delegates this task to his partner (compulsion).

• Related article: "What is anxiety: how to recognize it and what to do"

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 thoughts intrusive of different kinds and compulsive behaviors with the belief that they will serve 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 actually capable of leading to cape. This also causes the idea that they can cause harm without realizing it and that, even after they have done something and after several hours or days, they begin to fixate in their mind ruminate on the possibility that they injured someone with that action and are now 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 hurt 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 really won't 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 in which they have thought-out.

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... Conceal 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.

Too it is 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 inadvertently. 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 overly.

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 they can spend excessive time investigating crimes online. violent, 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 charms, 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.

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Treatment

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 fear of it over and over again, but preventing it from then perform ritualized compulsions or any other behavior you do to neutralize or reduce your 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 be misled that the fear of harm OCD treatment is aimed at demonstrating 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 making a person who is afraid they might stab someone expose yourself 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 as the person gets used to the plastic cover, it will proceed to go up one more difficulty level, this time having in his pocket a more threatening object such as a metal fork.

The idea is to increase the danger of the object to be carried, to the point where the person does not feel excessively nervous or tense when potentially dangerous objects such as a kitchen knife, large scissors, a scalpel are nearby surgical...

2. Cognitive behavioral therapy

Another therapeutic option is based on awareness, within the context of cognitive behavioral therapy (TCC). In this therapy people with OCD are taught to identify, understand, and change negative thinking patterns and behaviors.

These same patients are gifted with problem solving skills during therapy sessions and, later, they are taught to put them into practice alone so that they can create positive habits. Generally in this therapy the following is done:

2.1. Psychoeducation

The patient is taught what the characteristic impulse phobia of his disorder is and how it can dominate the lives of those who suffer from it.

• Related article: "Psychoeducation in psychological therapy"

2.2. Identification of obsessions and compulsions

It helps the person identify her obsessions and compulsions, in this case violent thoughts that cause special concern and behaviors ritualists that he carries out with the intention of reducing anxiety symptoms as a method of protection so that these thoughts do not come to occur. If the person is able to identify them, then it will be easier for him not to carry them out.

2.3. Relaxation

Relaxation and breathing techniques are taught to the patient with the intention that she learns to relax quickly and effective in any situation that you think might make the violent thoughts you think come true reality.

3. Psychopharmaceuticals

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 (SSRI), medications 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 your intrusive thoughts, but do not assign meaning to them or convince yourself that you are a potentially dangerous.

Some people with fear of harm OCD make a full recovery thanks to ERP therapy. While others, although they manage to improve noticeably, they cannot get rid of their obsessions of the everything.

This does not mean that the therapy has failed with them, but that it is very difficult to completely eliminate the obsessions and really the recovery and improvement of well-being in patients with OCD has more to do with managing the emotions associated with their thoughts recurring.

Are you looking for psychotherapeutic support?

If you are looking for psychotherapy services to overcome Obsessive-Compulsive Disorder, get in touch with our team of professionals.

On Cribecca We work serving people of all ages and offer support in cases with or without disorders involved, either in person at our center located in Seville or in a on-line.