What To Know About Harm OCD in Children

Many of us experience violent thoughts or thoughts that feel “bad” or “wrong” from time to time, but we are usually able to brush them away and move on with our day. For those with harm OCD, a subtype of obsessive compulsive disorder (OCD), these intrusive thoughts seem to repeat unstoppably. The thoughts become a source of fear and shame, and they can make it difficult to function. 

Children can experience extreme discomfort from OCD, too, and harm OCD may cause significant distress, as children often struggle to understand what is happening when these thoughts repeatedly enter their minds. Harm OCD can also lead to other issues, like avoidance, compulsive behavior, and needing constant reassurance. Harm OCD may be frightening for both kids and their parents.

Here, we’ll discuss what harm OCD is, whether it’s ever dangerous, what symptoms to watch for—and most importantly, some effective treatments for harm OCD in kids.

What Is Harm OCD in Children?

Having aggressive, violent thoughts is a common symptom of obsessive compulsive disorder (OCD). Harm OCD is the term commonly used to describe these symptoms. When the thoughts involve self-harm, the term self-harm OCD may be used.

People who experience harm OCD suffer from obsessive compulsive disorder (OCD), a common condition that affects 1-2% of children and teens. We sometimes think of those with OCD as exhibiting odd or repetitive behaviors, like needing to wash their hands obsessively, or needing to turn a light switch on and off a certain number of times each time they enter a room. But the rituals of OCD stem from obsessive, intrusive thoughts, and the behaviors usually occur as a result of these thoughts.

Unwanted OCD thoughts tend to recur throughout the day and feel extremely distressing to the person experiencing them. The ritualistic behaviors—called “compulsions—that occur as a result of the unwanted thoughts are a person’s attempt to cope with the anxiety these thoughts provoke. When children and teenagers experience OCD, they may feel like they are stuck in an endless cycle of repetitive thoughts, anxiety about these thoughts, and compulsions they hope will relieve the anxiety.

In addition to harm OCD (i.e., violent, aggressive thoughts about harming oneself or others), people with OCD may experience other obsessive thoughts, including:

• Fears about germs and dirt
• Fears about doing something wrong
• Fears about someone being mad at you
• A nagging feeling that everything must be “just right”
• Obsessions with luck and superstitions
• Worries about breaking rules

It’s common for kids to have worries and fears, but for a child to be diagnosed with OCD, they must experience these thoughts and compulsions for at least one hour a day, according to the Academy of American Pediatrics (AAA). They also must have difficulty controlling their thoughts/compulsions. Finally, obsessive thoughts and compulsions must have significant impacts at home, at school, and on a child’s social life.

Is Harm OCD Dangerous?

One of the biggest fears both kids and their parents have about harm OCD is that it might result in dangerous behavior. Can these violent thoughts lead to the child becoming violent? Can self-destructive thoughts lead to self-destructive behavior?

You can take a deep breath: children with OCD don’t act on their violent thoughts. In fact, children who have harm OCD are just as scared by their violent thoughts as you are! That’s what creates the anxiety for the child. They want these thoughts to disappear, and yet they feel unable to control them. To be clear: in Harm OCD, violent thoughts are not something the child wants to do, but something they are afraid they might do.

Harm OCD Symptoms in Children

You may be wondering: what are some common intrusive thoughts associated with harm OCD in children?

According to the Anxiety & Depression Association of American (ADAA), harm OCD thoughts usually revolve around what is perceived to be the most awful thing the adult or child can think of. That might look like:

• Fear of harming someone you love, including your friends, siblings, or parents
• Fear of exploding in anger and doing something enormously destructive, like committing murder or even a mass murder
• Fear of harming yourself or dying by suicide
• Fear of engaging in violent sexual acts
• Fear that you are going to experience a mental illness that will make you act out on these thoughts and fears

Some of these thoughts may come in the form of “what if” questions, says the ADAA. So the child may experience thoughts like:

• What if I were to push my friend in front of the school bus?
• What if I jumped off this building?
• What if I have a secret identity as a killer?

• In addition to these scary thoughts, children with harm OCD develop compulsions around these thoughts in an attempt to quell or make them go away. This might look like: Avoiding situations where they fear the thoughts will be triggered
• Having rituals that they must do or certain phrases they must say that they believe will make the thoughts go away
• Needing constant reassurance from parents and others that they are okay and safe

Effective Treatments for Harm OCD in Children

Here’s some reassuring news: harm OCD in children can be effectively treated with therapy. The most common type of therapy used to treat OCD in kids is cognitive behavioral therapy (CBT). This therapy type has been shown to be effective both on its own as well as in conjunction with selective serotonin reuptake inhibitors (SSRIs), antidepressants that can also treat anxiety disorders like OCD.

CBT is a type of therapy where children learn to become more aware of their thoughts and learn to understand how thoughts affect feelings and behaviors. They also learn exercises to cope with and reduce these unwanted thoughts. 

When it comes to OCD, therapists often use a type of CBT called exposure and response prevention (ERP), which involves breaking the OCD cycle by confronting scary thoughts and feelings rather than running away from them by engaging in compulsions. This is usually done in the safe space of the therapist’s office. Children learn ways of disengaging from thoughts, including techniques for decreasing the power that their thoughts have over them, as well as learning to increase their tolerance for some of the uncomfortable thoughts.

Strategies for Supporting Children with Harm OCD

When it comes to helping children cope with harm OCD, there are many things parents can do to support their child. Your child’s therapist will be able to give you ideas you can do at home to help enhance the effects of therapy. For example, you can cheer your child on when they show courage and progress. Your child’s therapist may also give you tips for reducing behaviors that accommodate or enable your child’s OCD symptoms.

According to the AAP, the following are some ways that family member can support a child with OCD:

• Remember that your child isn’t their OCD and the troubling symptoms you see aren’t their fault or something you should blame your child for.
• Work on family stress: when overall stress in the family is elevated, this can make OCD symptoms in a child worse.
• Consider a written contract, where you outline ways that your family can work together to enhance the skills learned in therapy.
• Get support for yourself, as caring for a child with OCD can be emotionally taxing on parents.

The Bottom Line

Harm OCD is a challenging and scary symptom that can emerge in children who have OCD. While the violent and self-destructive thoughts are not dangerous, they are extremely uncomfortable and frightening for a child to experience. But there’s hope: therapy can be extremely effective for children who have harm OCD.

If you need further support or assistance in helping a child manage their harm OCD, don’t hesitate to reach out for a free consultation from a licensed Handspring Health therapist today. 

Works Cited

Academy of American Pediatrics. Obsessive-Compulsive Disorder in Children and Teens. 

Anxiety & Depression Association of American (ADAA). Harm OCD vs. Being Dangerous.

Anxiety & Depression Association of American (ADAA). Overcoming Harm OCD.

Anxiety & Depression Association of American (ADAA). Suicidal Thinking vs. Harm OCD Intrusive Thoughts: How Are They Similar & How They Are Different.

Lewis A, Stokes C, Heyman I, Turner C, Krebs G. Conceptualizing and managing risk in pediatric OCD: Case examples. Bull Menninger Clin. 2020 Winter;84(1):3-20. doi: 10.1521/bumc_2019_83_06. Epub 2019 Aug 5. PMID: 31380700; PMCID: PMC7145451.

Nemours KidsHealth. Obsessive-Compulsive Disorder. 

Texas Children’s Hospital. Pediatric Obsessive-Compulsive Disorder (OCD).

Wu MS, Storch EA. A Case Report of Harm-Related Obsessions in Pediatric Obsessive-Compulsive Disorder. J Clin Psychol. 2016;72(11):1120-1128. doi:10.1002/jclp.2239