Obsessive-Compulsive Disorder Of Fear Of Harm: Symptoms, Causes 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 about innocent and harmless things like a meadow with flowers, the shopping list or that time we went to a restaurant we liked.
Other times, however, somewhat shady ideas come to mind, such as wanting to stab someone while we are walking, cutting off our boss’s head, or punching that neighbor who keeps playing the music loudly.
It’s not that they are the most desirable thoughts we can have, but we are all human and it is inevitable that these ideas come to us sometimes, no matter how aggressive they may be, 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 happens if we are not able to forget them? What happens 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 asked people with OCD fear of harm.
Most people have occasional violent thoughts, unwanted images and ideas that they imagine harming other people or themselves.
For example, we may have the brief fantasy of wanting to pull the bun of that customer who has gotten all over our face in the line at the bakery. This is normal and, although we do not like to think these types of things, the truth is that it is believed that about 85% of people have these types of violent thoughts from time to time.
Normally, these occasional violent ideas do not change our behavior or be seen as a problem.. They are part of the many different things we think about every day and we hardly give them much importance. However, these types of thoughts are seen as very disturbing by people diagnosed with obsessive-compulsive disorder (OCD), since having these ideas where they imagine they are hurting other people or themselves become intrusive thoughts, taking over. his mind, turning into a case of fear of harm OCD.
Fear of harm OCD, also called impulse phobia or impulsive phobia within OCD, is a subtype of classic Obsessive-Compulsive Disorder. This mental disorder is characterized by having aggressive and intrusive thoughts about behaving violently towards someone or oneself. and that these come true, carrying out harmful behavior both intentionally and unintentionally due to losing control.
Some examples of violent behaviors that the person thinks about and are afraid will become reality are: stabbing their partner with a knife, drowning their baby while bathing them, throwing someone onto the subway tracks, picking up a scalpel and stabbing them. on the chest…
As we have mentioned, it is normal to have these types of thoughts from time to time. A person without OCD can have violent thoughts and then immediately recognize them for what they are, simply thoughts, not predictions of something that will inevitably happen. On the other hand, people diagnosed with fear of harm OCD worry a lot after having thought something violent, attributing to it the meaning that it is going to happen no matter what. The idea of “if I think about it, I really am capable of doing it” repeats in his mind.
Having these types of thoughts leads the person with OCD to fear harming others. 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 again feel anxiety, doubt and fear at the possibility that what they have thought could happen and, consequently, they will perform it again. ritualistic behaviors.
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 cannot ignore or suppress.
In the fear of harming form of OCD, these obsessions focus on thoughts of harming oneself or others. Furthermore, and as in many other types of OCD, in this modality compulsions also occur, that is, The person uses all kinds of means to ensure that the obsessions never happen..
Taking this into account, we can give 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 she could harm her newborn baby while she is bathing him (obsession) and, therefore, she always delegates this task to her 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 prevent them from coming true.
As we have mentioned, the most characteristic symptom of this disorder is having aggressive thoughts or seeing images of violence in their minds, which they interpret with great concern as something they are really capable of carrying out. This also fixes in their mind 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 OCD subtype may be driving and hit a pothole. After a few hours you begin to think that you have really run over someone, you have hurt them a lot and, because you didn’t realize it at the time it happened, on top of that you have run away without wanting to. Although this situation is unlikely, he begins to think about it more and more, and seriously considers not driving again.
The fear of what they can do is so great that they feel afraid of what they believe they are going to do harm to, 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 adjusted people even without putting efforts 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 who suffer from 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 they have thought about.
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…), medications, ropes, razor blades, drills… Hide any object that is supposedly dangerous or with which he has thought he could harm himself or others in order to avoid being tempted to use it.
Also It is common for patients with this psychopathology to review each and every one of their actions. to make sure they are not doing harm or have not done so inadvertently. They monitor your every action, and if they notice that you have done something in the past that they believe could have remotely inflicted harm on someone, they begin to become extremely concerned.
People with fear of harm OCD avoid watching the news and using the media so as not to encounter movies, television series or videos with violent content. They fear that if they see violent acts they may get ideas and, if this is not the case, there is also the fear that this will reactivate the conscious thought of harmful ideas.
On the other hand, it also happens that they may spend excessive time researching violent crimes on the Internet, searching for what the perpetrator did and to what extent the person with this disorder shares traits. That is, in order to make sure that he or she is not going to harm other people, try to see to what extent he or she has something in common with real murderers.
Some of them may pray compulsively or use 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 a definitive answer, and until they find it, they won’t stop worrying about the contents of your mind. The problem is that they will never find the answer that convinces them that they are not violent people nor that their thoughts are just that, thoughts.
Treatment
There are several treatments for fear of harm OCD.
1. Exposure therapy and response prevention
One of the therapies considered most appropriate for this subtype of OCD is exposure and response prevention (EPR)..
ERP involves having the patient voluntarily expose themselves to the source of their fear over and over again, but preventing them from later carrying out ritualistic compulsions or any other behavior they do to neutralize or reduce their 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 cause harm.
We should not have the mistaken idea that fear of harm OCD treatment is aimed at proving that the patient is not a danger to himself or others. This is not a real objective nor should it be assumed that the patient could 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 who does not suffer from the disorder.
An example of ERP treatment for people with fear of harm OCD is having a person who fears they might stab someone expose yourself to the object that causes phobia 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 cutlery, a further level of difficulty will be raisedthis time having a more threatening object in his pocket such as a metal fork.
The idea is to increase the danger of the object to be carried, until reaching 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 the pattern of negative thinking and behaviors.
These same patients are provided with problem-solving skills during therapy sessions and are subsequently taught to practice them alone so that they create positive habits. Generally in this therapy the following is done:
2.1. Psychoeducation
The patient is taught what the impulsive phobia characteristic of his disorder is. and how it can come to dominate the lives of people who suffer from it.
2.2. Identification of obsessions and compulsions
It helps the person 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 anxious symptoms as a method of protection so that these thoughts do not reach them. to happen. If the person is able to identify them, then it will be easier for them not to carry them out..
23. Relaxation
The patient is taught relaxation and breathing techniques with the intention that he learns to relax quickly and effectively in the face of any situation that he considers could make the violent thoughts he thinks come true.
3. Psychotropic drugs
There are pharmacological treatments for fear of harm OCD and they are considered a useful aid for the patient’s improvement and well-being, 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), medications that improve serotonin levels and are often used to treat depressive and anxiety disorders. Among these drugs we find 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 accept the presence of their intrusive thoughts, but not assign meaning to them or convince themselves that they are a potentially dangerous person.
Some people with fear of harm OCD manage to recover completely thanks to EPR therapy, while others, although they manage to improve noticeably, cannot get rid of their obsessions completely.
This does not mean that the therapy has failed with them, but that it is very difficult to completely eliminate obsessions and really the recovery and improvement of well-being in patients with OCD has more to do with the management of the emotions associated with their recurring thoughts.
Are you looking for psychotherapeutic support?
If you are looking for psychotherapy services to overcome Obsessive-Compulsive Disorder, contact our team of professionals.
In Cribecca We work serving people of all ages and offer support in cases with or without psychological disorders involved, either in person at our center located in Seville or online.
