OCD (obsessive-compulsive disorder) and self-harm behaviors are two very different sets of symptoms that can sometimes overlap. Some people with OCD have intrusive thoughts related to harming themselves or others, called harm OCD. These thoughts can encompass a wide range of fears, including accidental harm from things like leaving the stove on or leaving a door unlocked. But while “harm OCD” is colloquially known as a pattern of OCD symptoms, it’s not a clinical diagnosis. 

This article discusses the similarities and differences between harm as it can relate to different presentations of OCD and the “harm” in self-harm. It wraps up with an overview of treatment approaches for these conditions. 

Before you continue reading, if you’re in danger of hurting yourself or someone else, please call or text the 988 Suicide & Crisis Lifeline at 988 for immediate support.

What’s the relationship between self-harm and OCD?

OCD and self-harm are two distinct mental health issues that can sometimes overlap in different ways. While self-harm is not a symptom of OCD itself, some individuals with OCD may engage in self-harm behaviors. They typically use it as a way to cope with the distress and anxiety caused by their obsessions and compulsions. 

Intrusive thoughts can occur in both self-harm and harm OCD. But the underlying mechanisms and motivations are different in each case. When people self-harm, intrusive thoughts may be a contributing factor to the behavior. But the primary motivation is to cope with emotional distress or overwhelming feelings. In “harm OCD,” intrusive thoughts are a core symptom and compulsive behaviors are aimed at reducing anxiety or preventing harm.

If you or someone you know is struggling with OCD, self-harm or both, it’s essential to seek help from a mental health professional who can provide appropriate support and treatment.

How are self-harm behaviors and OCD defined?

“Self-harm” is not a diagnosis but a behavior that can occur in various mental health conditions. So it isn’t specific to OCD. Self-harm or self-injury is the deliberate, non-suicidal act of injuring oneself, such as cutting, burning or hitting. Most often, it’s a maladaptive means of coping with emotional pain, stress or other overwhelming feelings. Self-harm typically isn’t associated with OCD, although individuals with OCD may also engage in self-harm. 

OCD is classified as a standalone disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 is the classification of mental disorders that’s used by mental health professionals in the United States. It’s characterized by time-consuming obsessions and compulsions that cause significant distress or impairment in a person’s day-to-day life. Obsessions are recurring, intrusive thoughts. Compulsions are repetitive behaviors or mental acts aimed at providing relief or a sense of control. 

“Harm OCD” isn’t an official diagnosis or classification. It’s an unofficial subtype of OCD with intrusive, unwanted thoughts, images or urges related to causing harm to oneself or others. These intrusive thoughts of harm cause significant distress, and compulsive behaviors are intended to prevent these things from happening. 

Sometimes, thoughts of self-harm can come along with suicidal ideation. This involves thoughts of ending one’s own life, and it can range from fleeting thoughts to detailed plans. Suicidal ideation can occur in individuals with OCD. But again, it’s not a direct symptom. Suicidal ideation is a serious concern that requires immediate attention and intervention by mental health professionals.

What are the differences between self-harm and OCD?

In general terms, “thoughts of self-harm” are urges or desires to harm oneself, which may or may not come along with distress or a desire to act on them. But deliberate self-harm as a coping mechanism is different from the fear that you could harm yourself or another person. It’s important to recognize how these concepts are different. They represent two very different experiences and motivations. Self-harm is a coping mechanism aimed at self-soothing, while the thoughts in “harm OCD” are intrusive and unwanted. Most often, they lead to compulsive behaviors aimed at preventing harm. Harm OCD also isn’t directly related to suicidal ideation or suicide.

What we typically think of as thoughts of self-harm can coincide with OCD for some individuals. People with both OCD and self-harming behaviors use them as ways to self-soothe or cope with overwhelming emotions. In this case, self-harm behaviors are deliberate though maladaptive. A person with “harm OCD” may be overcome with thoughts of harm to themselves or to others in ways that can be violent but aren’t exclusively so. 

Where do thoughts about self-harm come from? 

Self-harm behaviors are directed only towards oneself, such as cutting, burning or hitting oneself. These behaviors aren’t intended to harm others. People use them to relieve their own emotional distress or cope with overwhelming feelings. 

When people with OCD have intrusive thoughts about harm, they’re usually ego-dystonic. This means they don’t match up with the person’s true values and desires. Their thoughts of harm can be distressing and they may lead to compulsive behaviors. These might include checking, seeking reassurance or avoiding situations that trigger intrusive thoughts. Unlike self-harm, which is self-directed, the thoughts in “harm OCD” may involve harming others, even though the individual has no intention of acting on them. In fact, people with “harm OCD” find these thoughts deeply upsetting.

It’s important to differentiate between intrusive thoughts and actual intentions or capabilities. Just because someone has intrusive thoughts about harming oneself or others doesn’t mean they’re capable of doing so. As a symptom of OCD, these thoughts are often distressing and unwanted. People with OCD aren’t any more or less at risk for violent acts than anyone else. In fact, most have a strong aversion to acting on these thoughts and often go to great lengths to avoid harm.

What treatments help with self-harm and OCD?

It’s important for people with OCD or self-harm behaviors to work with a mental health professional. It’s especially helpful to find someone who specializes in treating their condition. Creating an individualized treatment plan is essential to achieving the best results. In general, treatment approaches for self-harm focus on underlying emotional issues. OCD treatment often involves exposure therapy and cognitive behavioral therapy (CBT). CBT can work well for patients with self-harm behaviors, too. But the specific treatment approach and techniques will vary based on their underlying factors.

Overall, the goal of OCD treatment is to reduce the severity of symptoms, improve daily functioning and enhance quality of life. For people who self-harm, treatment goals can include developing healthier coping mechanisms, improving emotional regulation skills and addressing underlying issues. 

Here’s a bit more detail about treatments for self-harm behaviors, OCD or a combination of the two: 

• Exposure and response prevention therapy (ERP) — ERP is considered the gold standard treatment for OCD, including “harm OCD.” In ERP, individuals gradually expose themselves to situations that trigger their obsessions, such as handling sharp objects. Over time, they learn to resist urges to and compulsions such as checking or avoiding. This helps reduce the anxiety associated with the obsessions and decreases the need to engage in compulsions.
• Cognitive behavioral therapy (CBT) — CBT helps individuals change the negative thought patterns and beliefs that contribute to their OCD. By identifying and challenging these beliefs, people can develop more adaptive ways of thinking. As a result, they reduce the power of their obsessions.
• Medication — In some cases, medication may be prescribed to help manage the symptoms of OCD. Medication such as selective serotonin reuptake inhibitors (SSRIs) is often used alongside therapy for optimal results.
• Mindfulness and relaxation techniques — Learning mindfulness and relaxation techniques can help people manage anxiety and stress associated with their OCD symptoms. These techniques can be used in conjunction with therapy to enhance treatment effectiveness.
• Support groups — Joining a support group with people who have similar diagnoses can provide a sense of community and understanding. It can also be a great source of practical tips for managing symptoms.

Lightfully can help with OCD or self-harm behaviors

Treatment for OCD with and without thoughts of self-harm can be highly effective. Many people experience significant improvement in their symptoms with appropriate care. At Lightfully, we realize that human lives are complex. There’s much more to maintaining mental wellness than eliminating your symptoms. 

We use a process-based therapy (PBT) approach to create a personalized treatment plan for each of our clients. We deliver evidence-based, targeted therapies to work through your problems as well as individual therapy sessions with a compassionate licensed clinician. Here you can talk through the things that give your life meaning.

Do you have more questions? Or do you think you might need treatment for OCD? You’re on the right track. Contact us to set up an assessment. We’re here to help you break the cycle and build resilience so you can live your bravest, most wholehearted life.