In my last post, I outlined what "harm OCD" is. In this post, I will detail clear advice for what to do about it based on both my experience as an OCD specialist and research on the treatment of OCD. The gold standard treatment for OCD is Exposure and Response Prevention (ERP), so all of this advice is based on the philosophy and techniques of ERP.
1. Recognize that your moral compass is "over-calibrated."
If you have harm OCD, you can probably recognize that you tend to have a lower threshold than most people for questioning the morality of your actions. Even though the emotional part of your brain makes it feel like each moral question that pops up really does matter and really is questionable, the logical part of your brain can probably see that you are going a little overboard.
Let's use a very common example that we see a lot in harm OCD: fear of using knives, especially around other people. Many people with harm OCD are afraid of using knives because they think they might stab someone close to them. Someone with this fear might avoid chopping vegetables because they think it is morally wrong to put people around them at risk of being stabbed.
It is clearly not morally wrong or even risky for someone to chop vegetables (even while having thoughts about hurting people). But if you have harm OCD, your moral compass is calibrated to put a red flag up for this as being morally questionable. One of the first steps in overcoming harm OCD is recognizing that just if your brain flags something as morally questionable, that does not mean it's actually morally questionable.
In fact, I would go as far as saying that if you have harm OCD and feel unsure whether an action is morally acceptable or not, that means that it definitely is morally acceptable. If your brain is questioning it, that means we must be so far below the threshold of what most people would find morally questionable that we can be certain this action is morally acceptable. This reasoning leads to the second piece of advice.
2. If you're not sure whether something is morally right or wrong, don't analyze it ... do it!
OCD fears get better by confronting them. This is the key principle of ERP. If you have harm OCD, the thing you will need to confront is the risk of doing something morally wrong by risking hurting people.
You need to teach your brain that the things it thinks are morally questionable are actually safe, and your brain will only learn this through experience. Many people with harm OCD are not sure where to draw the line, and so they spend a lot of time analyzing their moral questions. But again, if your harm OCD brain is questioning whether an action is over the line or not, that means it isn't, and you should do it. There's nothing that needs analyzing. You will eventually get used to taking these risks, and your brain won't treat them as dangerous anymore, and that's how the OCD gets better.
3. Do things that make you feel like you are risking hurting other people.
Whatever your OCD brain is telling you to avoid because you might hurt other people, that's what you'll have to do to overcome your OCD. If you're afraid of knives, carry a knife around the house with you. If you're afraid of hitting people while driving, practice driving around parking lots with lots of pedestrians. Doing things like these teach your brain that these things are not risky, and the fear is not actually dangerous.
4. Make quick moral decisions.
Avoiding things that make you anxious in the short term keeps the anxiety going in the long term. One of the avoidance behaviors in OCD can be avoiding uncertainty about moral questions by taking a long time to decide whether certain actions are OK or not (e.g., "Is it OK for me to chop vegetables tonight?"). Spend as little time in decision-making mode about this stuff as possible. Just say to yourself, "I want to not suffer from harm OCD anymore, and the fact that I have harm OCD means my brain is probably wrong about this, so screw it, I'm just going to do it." Decide that it is OK to do what you're worried about doing and decide it quickly.
5. Remember that thoughts are just thoughts.
Having thoughts about hurting someone is different from actually hurting them. There is nothing wrong with the thoughts themselves. Stop taking your mind and your thoughts so seriously.
If you have harm OCD, I assure you: Your thoughts mean nothing and are not worthy of being given any importance at all. Give your mind and your thoughts the disrespect they deserve. It's all just random neurons firing in your brain. It's your mind taking a fart. The thoughts are completely meaningless; treat them as such.
6. Purposely think about hurting people.
Most folks with harm OCD are horrified by the thoughts they have about hurting other people. They, therefore, take great pains to try to avoid thinking these thoughts, but of course, that just makes you think about them more. Instead, try thinking the thoughts more, on purpose. And be graphic about it, don't make anything taboo, and don't shy away from anything.
Think about what it would actually look like to stab someone; imagine the gore, imagine all the blood, imagine the horror on the person's face. I know this sounds horrible, but again: Thoughts are just thoughts. You're not hurting anyone by thinking these things, but you are helping yourself by teaching your brain that these thoughts are not dangerous.
7. Get therapy from an OCD specialist.
If harm OCD is really impacting your life and your functioning, there is no better advice I can give you than to seek help from a therapist who really knows what they are doing with OCD. Choose a therapist that does Exposure and Response Prevention, and they can help you stay on track when you're having a hard time and get the details of the exposures right to make sure they work.
To find a therapist, please visit the Psychology Today Therapy Directory.