Let us now see what kind of compulsions there could be in Harm OCD and how to identify your compulsions. Compulsions are actions (either physical or mental) that you may engage in to deal with the distress caused by the obsessions (Goodman et al., 2014). Compulsions can be recognized by the urgency with which you want to do them. Let us look at some of the common compulsions that have been observed in people with Harm OCD.

Monitoring Your Own Feelings, Sensations and Intentions: You may find yourself monitoring what you feel in the presence of other people and if you have the intention to harm someone (e.g., Am I feeling hatred towards my mother?  Do I feel violently towards my wife?).

Researching and Checking: You may start looking for information about serial killers and violent people by reading articles, books, watching videos and generally excessively researching on the internet (e.g., “signs of being a psychopath?”; “traits of a serial killer”). You may keep testing your feelings or behavior in various situations (e.g., Did I think of my father when I saw that knife? Does this pair of scissors make me want to hurt my friend?).

Reassurance Seeking: You may begin to seek reassurance about your nature. You may keep asking your friends whether they think you are a good person. Or you may ask your family if they have harm thoughts as well. You may constantly also self-reassure by telling yourself that you are not evil and would never harm anyone.

Neutralizing Your Thoughts: When you get a bad thought, you may try to neutralize it with a good thought. If your mind says you want to harm your wife, you may neutralize the thought by saying, ‘I would never do it to her.’ When your mind says you may really want to poison the food, you may try to neutralize the thought by saying, ‘No that is not true. I don’t want to poison people.’ You may even try to recall earlier times when you could have poisoned the food but did not.

Post Facto Rumination: You may go over memories of some past events or situations to try and recollect if you did anything that may have harmed someone. You may wonder if the accidental bumping into that girl would have hurt her badly, whether you left the forks in a way that could hurt someone and so on. Not finding the right or convincing answer may cause you anxiety and lead you to ruminate even more.

Avoidance: Avoiding situations where you could potentially cause harm (e.g., going to the kitchen, etc.) or particular leisure activities (e.g., going for action movies, watching war documentaries on television or reading violent news) are examples of this compulsion. You may think that it is better to avoid these situations than to get triggered and do compulsions. But avoidance is a compulsion in itself. We shall see how avoidance is to be avoided later.

Attempting to Control: You may attempt to control everyone around you so that you are not triggered. You may try to prevent the usage of sharp objects in your proximity. You may instruct your children to not use sharp objects. You may discontinue your family’s swimming club membership. You may stop people from using triggering words around you.

Proxy Compulsion: When you get someone else to do something for you because it would cause you anxiety if you had to do it yourself. This is another form of avoidance, where you would like to get something done but don’t want to be doing it, just so that you can avoid the trigger and not risk becoming anxious. For example, you may get someone else to chop the vegetables for you because chopping them yourself with a knife may trigger your anxiety.  

Negative Self Talk (NST): You may end up engaging in self-criticism or degrading self-talk (e.g., ‘I am selfish’, ‘I am unappreciative’, ‘I am stupid for thinking like this’). You may even begin to believe that you are not good at anything anymore (even things not related to your Harm OCD).

Distraction or Blocking Your Thoughts: You may try to push the thought away from your mind by trying to distract yourself. You may either try to think of a happy memory or you may put on loud music to drown the thought or you may engage in praying or talking to a friend to make the thought go away. You may have read that one must not engage with one’s intrusive thoughts and you may choose to distract yourself because staying with the thoughts may cause you significant discomfort.

Confession: You may develop a distorted view of what is allowed and what is correct and think that everything you do may be amounting to causing harm. This may cause you to confess your thoughts to your caregiver or anyone close to you. For example, if you spill some nail paint on the dining table, you may think you could have accidentally poisoned the food laid on the table, leading you to make a confession.

Apologizing Excessively: You may think you have wronged others and end up apologizing for the smallest of things. Often, they are not even what others would consider mistakes, but you do. Sometimes it may annoy the other person for the number of times you apologize, and the other person may snap at you, which may make you apologize more.

Pre-Planning: Pre-Planning your course of action before entering a trigger in order to minimize your anxiety is a compulsion. When you are aware that you are in a situation where you are likely to get triggered, you may automatically end up planning how to minimize your anxiety if you are triggered. For example, if you decide to enter the swimming pool, you may plan to stay away from other people so that you don’t accidentally end up causing them to drown and die.

Over Explanation: If you accidentally do end up bumping into someone, you may assume that you have hurt them and may launch into an explanation about how it was not your intention to hurt them and how you are a good person and would never do it out of choice. Or, if you have just had an urge to harm someone, and they know about your Harm OCD, you may tell them your thoughts but also follow it up with a lengthy explanation to remind them that it is your Harm OCD and not your real thoughts. You may think that unless you explained the other person may believe that you indeed meant to harm them.

Over-Dependence: You may begin to depend upon your caregivers a little too much. To the extent that you may end up stifling them. For example, your Harm OCD may make you believe that you may not be able to take care of the kids if your husband is not around. So, even if your husband has an important meeting to attend or has planned an evening out with friends, you may beg or blackmail him into staying back and helping you take care of the kids. This may foster resentment in your husband as he may be conflicted between helping you and doing what he wants to. There may be other compulsions that you may be engaging in that may not have been covered here.

Since OCD is a nuanced disorder, both obsessions and compulsions can morph from text-book presentations to something completely unique for you. If you have any compulsions that are not covered here, make a note of them. You will find the list of compulsions as identified in the Y-BOCS (Goodman et al., 1989a, b) as Additional Resource 3.8. Go through them and make a note of everything you go through in your daily life.

Using the previous worksheets (1.5, 3.4, 3.5 and 3.6), write down your compulsions in Worksheet 3.8. First, write down the name of your Harm OCD (such as Jay) in the space provided. Next make a list of all your compulsions from the Y-BOCS checklist.

Next, observe your behavior and identify what your Harm OCD compulsions are. Then convert your compulsions into statements beginning with ‘Jay is telling me to’ or ‘Jay is asking me to’. Complete this exercise before moving to the next chapter.

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