Imagine yourself preparing a delicious Sunday dinner with your friend. The two of you are laughing and discussing your favorite scenes from a television show you both follow. You reach to grab a large knife from the knife block in order to dice the chicken you are cooking when you are suddenly gripped with the image of taking that knife and stabbing your friend repeatedly in the chest. You are shocked and horrified. You know you would never hurt anyone and have no history of being violent. However, this thought is very distressing to you. Mortified, you drop the knife. Maybe this wasn’t the first time you have had a thought like this. What kind of person thinks this? What does this mean about you as a person? And what does it mean that this thought keeps coming back? Does it mean that you secretly want to act upon your thought?

Have you ever experienced an intrusive thought such as this? Maybe it wasn’t about stabbing someone. Maybe it was about hitting or mutilating your family, children, strangers, animals, or yourself. If so, you are not alone. OCD is marked by intrusive thoughts, images, or impulses that are unwanted and cause anxiety. While there are many different types of obsessions and compulsions that one may experience in OCD, one such category is known as violent or harm obsessions. This type of OCD symptoms include the unwanted thought, image, or even an impulse to act violently against others or yourself. Because of the nature of these obsessions, harm obsessions may be particularly shocking, distressing, and disturbing.  People who experience these types of obsessions may believe they are insane or psychopaths. Often it can be helpful to identify such thoughts as a symptom of OCD and to realize that you are not the only one to have harm obsessions.

Like almost all symptoms of OCD, a person may experience harm obsessions at any point during the day. However, there may be times when they are vulnerable to experiencing these thoughts. For example, a person may be particularly triggered by certain people (i.e., their children) or in certain situations (i.e., being in a kitchen where knives are present). In an effort to avoid having these thoughts (thereby avoiding the associated anxiety and distress) or perhaps due to the fear that something terrible might happen, a person with harm obsessions may begin avoiding these triggers. They may throw away sharp or pointed objects, avoid family and other loved ones, stop driving automobiles, or repeatedly ask others for reassurance. If they do experience the harm obsession, they then may perform compulsions or rituals. Such avoidances and compulsions, while in the short term may reduce anxiety, ultimately perpetuate the cycle of OCD.

How do you break this cycle? Exposure and ritual prevention (ERP) is an evidenced-based treatment in the treatment of OCD. It involves the systematic approach in confronting the feared thoughts, images, and impulses while refraining from compulsive behaviors. For more information, please view Dr. Fred Penzel’s article on the International OCD Foundation’s website (http://www.ocfoundation.org/eo_violent.aspx) or contact the OCD & Anxiety Program of Southern California.