Harm OCD is a theme within Obsessive-Compulsive Disorder where a person experiences intrusive, unwanted thoughts, images, or urges about causing harm—to themselves, to others, or both. These thoughts feel deeply disturbing, out of character, and ego-dystonic, leading to intense fear, guilt, avoidance, and compulsive safety behaviors.

Harm OCD is not about intent. People with Harm OCD are not more dangerous, violent, or impulsive than anyone else. What makes Harm OCD debilitating is the mental struggle to neutralize, analyze, or prevent these thoughts, not the thoughts themselves.

People with Harm OCD often experience one or more of the following patterns:

• “What if I stab someone while cooking?”
• “What if I snap and push someone in front of a train?”
• “What if I lose control and hurt my partner or my child?”
   

• “What if I hit someone while driving and didn’t notice?”
• “What if I left the stove on and caused a fire?”
• “What if I contaminated something and made someone sick?”
   

These are fears of accidentally hurting yourself, not suicidal intent:

• “What if I jump off this balcony without meaning to?”
• “What if I swerve on the freeway?”
• “What if I use a kitchen knife on myself by accident?”
   

(If someone is experiencing active suicidal intent, that is a separate clinical issue—not OCD—and requires immediate attention.)

People with Harm OCD often engage in:

• Reassurance-seeking (“Would I ever do this? Does this mean I’m dangerous?”)
• Rumination, analysis, mental reviewing
• Checking emotional responses (“Did I want that thought?”)
   

• Avoiding knives, driving, holding their baby, or being alone with loved ones
• Repeatedly checking locks, appliances, and surroundings
• Seeking reassurance from partners, therapists, or online communities
   

• Suppressing thoughts
• Trying to “think good thoughts”
• Avoiding certain rooms, places, or situations
   

Compulsions always make the cycle worse over time, even though they feel necessary in the moment.

Harm OCD attacks the things you care about most—your loved ones, your values, your identity, your sense of safety and control. The more disturbing a thought feels, the more your brain flags it as dangerous.

This misinterpretation creates a feedback loop:
Intrusive Thought → Fear → Compulsion → Short-Term Relief → Stronger Thought Next Time

ERP therapy breaks that loop.

Exposure and Response Prevention (ERP) is the gold-standard, evidence-based treatment for OCD, recommended by the APA and International OCD Foundation. ERP helps by:

• Teaching you to allow intrusive thoughts without reacting to them
• Reducing fear and urgency around “dangerous” thoughts
• Stopping compulsions so the brain learns the thought is not a threat
• Rebuilding confidence in your ability to tolerate uncertainty
   

Examples of ERP exercises for Harm OCD may include:

• Holding a kitchen knife while cooking normally
• Driving without checking mirrors repeatedly
• Writing out feared thoughts and practicing non-engagement
• Being around loved ones without reassurance rituals
   

ERP is done gradually, collaboratively, and always at a pace that feels workable.

Harm OCD can affect anyone, at any age. Many of my clients describe:

• Feeling terrified they’re “a bad person”
• Avoiding loved ones due to fear of losing control
• Feeling ashamed of intrusive thoughts
• Worrying about becoming a risk, even with no history of violence
   

Harm OCD often overlaps with:

• Harm / Responsibility OCD
• Intrusive thought OCD
• Contamination OCD
• Moral scrupulosity
• Postpartum OCD
• Driving OCD
• Existential OCD
   

You’re more likely to be dealing with Harm OCD if:

• The thoughts feel repulsive, not aligned with your values
• They cause panic, guilt, fear, or disgust
• You spend time analyzing, checking, or seeking reassurance
• You avoid situations or objects you believe could make you act
• You fear being alone with children, partners, or clients
• You fear “snapping,” “losing control,” or “becoming violent” despite no history of violence
   

Whatif provides ERP therapy via telehealth across California, including:
Los Angeles • San Francisco • San Diego • Orange County • Sacramento • Long Beach • Riverside • Oakland • San Jose • Fresno • Bakersfield • and statewide.