Misunderstood & Misdiagnosed: Harm OCD
At The Center for Anxiety & OCD at GroundWork Counseling in Orlando, we find that one of the most misunderstood themes in Obsessive Compulsive Disorder (OCD) is Harm-OCD. Harm-OCD consists of obsessive thoughts that include killing or harming others or one’s self, or of acting out sexually in inappropriate or unnatural ways (e.g. rape, pedophilia or sex with animals). Because individuals with this type of OCD do not have overt compulsive behaviors, it is often referred to as Pure O. It’s important to point out that individuals with “Pure O” do engage in compulsions.
These compulsive behaviors typically consist of:
- Avoiding people that might be harmed
- Avoiding objects that could be used to harm someone
- Avoiding movies, articles and news stories with violent content
- Avoiding being alone
- Asking for reassurance
- Researching symptoms
- Mental reviewing of recent events
- Analyzing and figuring out what this means
- Neutralizing thoughts
- Reassurance seeking
Individuals with “Pure O” or Harm-OCD are horrified by their thoughts. They constantly analyze and question why they are having the thoughts, “If I am thinking these thoughts that must mean I want to do it”; “Maybe I will snap and actually do it”; “Maybe I’m a pervert”; “Only a monster would have these thoughts”. For the individual with this type of OCD, these thoughts are extremely unpleasant, and often debilitating. The person suffering with Pure O often thinks he is “going psychotic”.
Sadly, many individuals who experience Harm-OCD go through their torment alone. Because of the violent, inappropriate and upsetting nature of these intrusive thoughts and misunderstandings about mental health conditions, many individuals with Pure O suffer in silence for their entire lives. Psychologists, psychiatrists and psychotherapists unfamiliar with this type of OCD may see the individual as a threat and report him or her to child protective services or to the police or have them admitted to a psychiatric ward. The misdiagnosis is usually bipolar disorder, psychosis, schizophrenia or schizoaffective disorder.
It is extremely important to realize that individuals suffering from this type of OCD are in no way dangerous. They are horrified by their thoughts and have no desire to act on them. The thoughts and impulses are considered to be ego-dystonic, which means that the thoughts are inconsistent with the individual’s sense of self, their beliefs, values and desires, which is why they cause the sufferer so much agony.
We all have unpleasant thoughts. We have probably all had thoughts of hurting someone or sexual thoughts we wouldn’t actually act on. We may even talk about some of these thoughts quite casually. For instance, a woman might say, “My husband drives me nuts. Sometimes I feel like strangling him or shooting him”. There is no feeling of horror or shock. She feels comfortable expressing these thoughts, she is not embarrassed by them and she understands she would never literally act on them. Yet someone with OCD would likely think, “I shouldn’t have had that thought. What’s wrong with me? I must be some kind of monster and I better figure out what this thought means”. The person with OCD takes these types of thoughts very seriously and thinks that the thought is very deserving of a response and this is what begins the cycle of the obsessions and compulsions. And no amount of thinking, researching, avoidance or reassurance will ever be enough for the person with OCD.
Pure O and Harm OCD is as treatable as any other presentation of Obsessive Compulsive Disorder. It is important to find a psychotherapist who is an expert in treating OCD with Exposure and Response Prevention (ERP). ERP therapy exposes you to the unpleasant thoughts and images that trigger anxiety and helps you to learn tools that prevent you from trying to reduce your anxiety by giving in to compulsive behaviors and rituals. When seeking a therapist, be sure to ask prospective psychotherapists about their experience, expertise, training and qualifications in treating individuals with OCD so that you can receive effective treatment.
Speak With An Orlando OCD Specialist