Self-Harm, OCD, And Psychosis: Can OCD Be Dangerous?

Reviewed by Melinda (Santa) Gladden, LCSW

Published 04/27/2022

While violence and mental disorders may have once been considered synonymous, the past hundred years or so has done a great deal to elucidate the actual mechanisms behind various mental illnesses and disorders. Obsessive-Compulsive Disorder is among these disorders, and increasing bodies of evidence have found many different manifestations of OCD symptoms, including violent OCD thoughts and behaviors. Can OCD violent thoughts prove dangerous to oneself or others?

The Basics Of Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder is an anxiety disorder most commonly known for the desire to be clean and tidy. Although some people with OCD might experience compulsive behavior geared toward cleaning or tidying, this is a very small potential facet of Obsessive-Compulsive Disorder, and many people with the disorder will not have a particularly strong desire for every space to be cleaned and tidied. Instead of focusing on the organization of space, Obsessive-Compulsive disorder is focused on two components of thought and behavior: obsessions and compulsions. Obsessions are thoughts or feelings that run on a loop and are extremely difficult to let go of, while compulsions are "answers" to obsessions and function as a type of self-soothing activity.

OCD is a diagnosed condition, delivered only after a mental health professional or other medical professional has conducted a thorough evaluation of self-reported symptoms and observed signs. Treatment is typically considered vital to management and recovery. It can involve many different forms of intervention, including psychotherapy and medication, and, in some cases, lifestyle interventions to help manage symptoms, such as dietary and activity changes.

Obsessive-Compulsive Disorder is not a personality quirk or series of preferences, such as liking to sleep on one side of the bed or preferring to have books arranged according to color or height. Instead, OCD is a disorder characterized by distressing and overwhelming needs to have thoughts and objects seen and experienced in certain ways. Someone with OCD might prefer to have books arranged according to height but may also feel that entire rooms must be arranged according to height, and failing to do so will elicit feelings of impending doom or terror. If you are uncertain whether you are experiencing personality preferences or legitimate Obsessive-Compulsive symptoms, consider taking an online quiz for OCD. While this is not a recognized diagnostic tool, it can help determine your symptoms' likelihood pointing to OCD.

OCD And Self-Harm

Self-harm is not a standard characteristic of Obsessive-Compulsive Disorder, but compulsive symptoms can result in self-harm. This is because compulsions are essentially unhealthy coping mechanisms designed to help soothe the effect of obsessions on an individual with OCD. Compulsions may involve distractions, such as causing oneself pain or discomfort. Some self-harm can be minor, such as plucking out a few hairs, and some self-harm can be more substantial in scope, such as inflicting physical wounds.

For self-harm to be considered symptomatic of OCD, it must follow a pattern similar to the patterning of the disorder. Self-harm within the bounds of OCD does not occur without rhyme or reason but will occur in response to an obsession or obsessive thought, with or immediately. Someone might obsessively think about losing their teeth, for instance, and imagine scenarios in which a tooth will fall out or a scenario in which a tooth will become damaged, and compulsive pick at their gums therefore. This is only one example but provides insight into the patterning involved in OCD.

Self-harm is not always a symptom of Obsessive-Compulsive Disorder and has the potential to be symptomatic of other issues; all of them worth a second glance. While self-harm is not always completed on a scale that might lead to a fatality, any type of self-harm is an indication that mental health is suffering and needs to be addressed. Whether from OCD, depression, or another condition entirely, self-harm is a symptom of something much deeper at play.

OCD And Psychosis

In some cases, the symptoms of OCD can lead to other mental health issues and can even result in a condition called psychosis, wherein an individual experiences a "break" from reality or loses the ability to discern verifiable truth from thoughts and ideas. Psychosis and OCD are most likely to interact in a non-violent way, and psychosis may come in the form of an overwhelming need to enact compulsions to cope with escalating obsessions. Someone with OCD, then, is unlikely to experience a violent psychotic break but may experience a psychotic break that results in limited daily function when obsessions and compulsions become too overwhelming, intense, or unmanageable.

With consistent and effective treatment, psychosis and Obsessive-Compulsive Disorder are unlikely to be companions. Psychosis is typically a symptom of untreated and unmanaged OCD. Because Obsessive Compulsive Disorder symptoms involve feelings and behaviors that are not rational, there is some degree of "unreality" present in all cases of Obsessive-Compulsive Disorder. However, this "unreality" does not qualify as psychosis until it significantly impairments daily functioning.

Violence In Obsessive-Compulsive Disorder: Harm OCD Urges

Violence in OCD is not uncommon, but the violence experienced in OCD is far more often internally experienced rather than externally engaged in. That is to say, violence and Obsessive-Compulsive Disorder are more commonly turned inward or held internally than they are acted upon outwardly and freely encouraged. People who experience violent thoughts or compulsions are not destined to become perpetrators of violence; instead, they are likely to experience self-esteem damage, increased anxiety, increased isolation, and a number of compulsions designed to counter the thoughts or compulsions of violence. This type of OCD has been coined "harm OCD," or a subset of the disorder that more frequently involves violent thoughts or compulsions than other types of OCD might be known for.

What causes harm to OCD? As with any other form of Obsessive-Compulsive Disorder, the exact cause is not known. A family history of anxiety or depressive disorders can contribute to OCD development, as can a personal history of instability, trauma, or fragmented social and familial bonds. Obsessive-Compulsive Disorder is an anxiety disorder, and harm OCD is simply one manifestation of that anxiety. It does not have to be accompanied by a history of violence, a criminal past, or anything else linking the person with OCD to crime or danger. People who come from extremely mild homes and who have never experienced or perpetrated violence are capable of being diagnosed with harm OCD, as are those who have experienced or perpetrated violence.

Harm OCD may also involve sexual thoughts or compulsions that are highly frightening or disturbing, precluding someone from seeking help. These thoughts may drive an onslaught of compulsions to thoroughly convince the person with OCD that they are safe and sane and simultaneously increase feelings of isolation and fear.

Can OCD Be Dangerous?

Although Obsessive Compulsive Disorder is not inherently dangerous, there are aspects of the disorder that can encourage the development of thoughts or behaviors that have the potential to lead to self-harm and psychosis. This form of OCD may be referred to as "harm OCD." Harm OCD feels real to individuals who are experiencing violent thoughts or impulses and can be extremely distressing. The prospect of harming others or oneself can prevent people with the disorder from seeking help. They may develop increasing numbers of compulsions to cope with the fear, anxiety, and discomfort brought about by violent thoughts, images, or impulses.

Treatment for harm OCD is roughly the same as treatment for other forms of OCD. It will often involve exposure therapy to create healthy coping mechanisms when violent thoughts or impulses arise. Because harm OCD can mimic suicidal ideation, in that it can focus on self-harm and suicide, it is different from desiring suicide in that OCD follows a pattern of obsession (a thought, idea, or image) and compulsion ("proving" your thoughts are incorrect or correct, self-soothing, and more). Self-harm OCD can prompt thoughts about suicide and even involve some degree of compulsive self-harm, but the two conditions are considered different conditions and require different treatment plans.

Obsessive-Compulsive Disorder is a painful and frustrating disorder without treatment. It can show up in many ways, some of them involving violence, and some of them involving practically everything else. Harm OCD is the term used to describe a violence-bent OCD diagnosis. Still, it does not indicate that OCD is an outwardly dangerous disorder, nor does it suggest that people with Obsessive Compulsive Disorder are in any way unsafe to be around or unable to function well in society. Instead, it means that people with a particular form of OCD experience disordered thinking with a specific trigger or predilection and those symptoms must be managed carefully and effectively to minimize the self-doubt, fear, and isolation that harm OCD can bring.