An overactive harm-alarm: Harm OCD

If you suffer from harm OCD or think you might, this post may be triggering for you - perhaps ask someone who understands your situation to read it first and recommend if its suitable for you or seek professional advice before you read.

What is harm OCD?

I'm going to quote things here that say it far better than I could. The OCD Centre of Los Angeles put it like this:

'Harm OCD is a manifestation of Obsessive Compulsive Disorder (OCD) in which an individual experiences intrusive, unwanted, distressing thoughts of causing harm. These harming thoughts are perceived as being ego-dystonic, which simply means that the thoughts are inconsistent with the individual’s values, beliefs and sense of self. Harming obsessions typically center around the belief that one must be absolutely certain that they are in control at all times in order to ensure that they are not responsible for a violent or otherwise fatal act.'

How do I experience this day to day?

I'll use the example of a walking group I used to lead. All we had to do was meet at our office and go on a half hour walk. What could possibly go wrong? And what could that possibly have to do with people drowning or dying? I hope you've lost me now and think.... huh? What have those horrible things got to do with anything? If I haven't lost you then you're one of my people!... We're the ones with overactive 'harm-alarms'.... we suffer from Harm OCD. 

I'll try to explain. When my husband or therapist, and I suppose people who don't have Harm OCD, think of taking out a group on a walk they think... 'I hope its a nice day' or 'I'm looking forward to being out by the river'. There may be some anxieties but these would hopefully not interfere with their normal life in the lead up to the day. Unfortunately my brain, along with other sufferers, doesn't process things like that. 

I become aware of my own voice telling me, 'I'm responsible for their safety, if anything happens to them it will be my fault, you don't want to be locked up do you? Better make sure you keep everyone safe then! You can't miss any risks, someone will die and you'll know it was because of you.' It's is like there's another me and it keeps tapping me on my shoulder and it's obsessed with preventing others from being hurt. It likes to show it to me on a big screen too, showing the imagined harm happening. This is really upsetting.

The thoughts and images are accompanied by safety behaviours or compulsions. In this case I had to count people almost constantly during the walk making it really difficult to have conversations and I had to ask people to stay away from the water every five minutes, much to their annoyance. I also thought of avoiding it all together, as I became so convinced someone was only moments away from harm. The week afterwards I had to find discrete ways to check if everyone was still alive, in case I'd accidentally allowed them to get lost on the walk and they hadn't returned home. That was really embarrassing. I had to also ask for constant reassurance from my husband that the walk would be ok, and living with my daily fear and distress in the days before was debilitating to us both. 

The OCD Centre of Los Angeles also say this:

'It is not fair to say that one form of OCD causes more pain than another. In our experience of treating individuals with OCD, those with compulsive hand washing appear to be in no less pain than those who live in fear of being sexual deviants or psychopaths. What sets Harm OCD apart is the way in which it attacks the things we love the most, and does so with such brutality and lack of mercy as to astound even the most creative minds. The moments that we most want to be highlighted by memories of peace and contentment suddenly become contaminated by mental imagery of horrific violence and feelings of relentless guilt.'


This is exactly it. I hope one day to become a mum, but I worry my baby will hurt itself and it will be my fault. This sort of worry is normal but in OCD its obsessive and relentless - its intrusive images and obsessive fear and its disordered because it prevents you from living a normal life. Instead of day dreaming about cuddles or baby's first steps, for Harm OCD sufferers its more likely to be baby's first trip, fall or choke. It's constantly obsessing over safety to make sure you don't inadvertently harm someone, and it attacks the things most important to you.

If you'd like to know more about the kinds of thoughts and obsessions that characterise Harm OCD then there's a really good questionnaire from the OCD Centre of Los Angeles to help you identify the extent of the illness and understand more about its nature http://ocdla.com/harm-ocd-test.

So how can we deal with this illness?

I don't know yet...sorry!.... well I don't have all the answers. I'm still in treatment, but, here's a few things that have helped me so far:

1. I identified the problem and told someone 

Part of the problem with Harm OCD is that its hard to tell anyone. You're so ill that you are sure you must be reckless or dangerous and you feel incredibly ashamed. The first step on a long recovery was telling my husband and my GP. I now go to an expert therapist, I've got a support group and I've found some people I can talk to about it (and I have my blog!). 

2. I temporarily stopped being in situations my anxiety was too high for

When I hit breaking point it had become so bad that I simply couldn't function on my University course anymore. It was tough to step back, I had no job or course and I started medication and therapy. But it was what I needed. You can get back to these things, but sometimes you have to stop life for a bit and get help. Just like any physical illness we go into hospital for, we need treatment for mental illness too. I'm now back at work and I lead a pretty normal life.... I just spend a lot of time in therapy, I run a support group for anxiety and OCD and I spend a lot of time learning self-help techniques, but I am getting better... slowly.

3. I went back to face triggering situations in a graded way with professional help and I volunteer a lot

When I was out of work I used voluntary work as a way of building up my confidence again and I still use it now. When I'm volunteering I'm helping others and myself, and that gives me a great self-esteem boost. There is also less pressure. I can face a triggering situation and its much less daunting to ask for help or step back than it is in the workplace.

4. Do more of the things your OCD doesn't attack

Running my support group isn't something that everyone would feel confident to do. When I've told people about it they've asked whether I worry about various things? And the truth is I don't. It's something I just don't have obsessional problems with. So I focus on this, on my skills and the confidence I have. I try to use CBT and Mindfulness to look at how I can challenge my OCD using this confidence.

5. Finding a support group, a therapist and self-help

I've been lucky enough to have had excellent treatment using Exposure Response Prevention (ERP), Cognitive Behavioural Therapy (CBT), Mindfulness-based CBT and psychodynamic techniques, and in the last 4 years I have had quite a lot of success in doing the things that trigger my OCD. I had to find private treatment because the NHS doesn't offer the kind of help I needed to get better. Therapy isn't for everyone, but I couldn't have recovered without it. So I would encourage you to explore whats out there, even if the NHS coverage is patchy, there are often private options at a range of prices. 

Support groups can be a really great place to share your experiences and can help you feel less isolated and alone. Again, not for everyone, but worth seeing whats around. With my group I totally respect if its not right for people and I'm more than comfortable for people to come along for just one session, and if its not for them, then no problem.

I'm trying this self-help book at the moment for my OCD The Mindfulness Workbook for OCD and I'm finding it really make sense to me. There are lots of online resources, books and audiobooks now that address OCD with a variety of physiological approaches. Again, its worth trying to see if any of them might appeal to you. Do a Google search now or pop along to your local Library... there might just be some answers there.

That's all for now!

Compassionista xxx

P.S. I must stress that these are my own personal tips and experiences. I am not a trained medical professional and these ideas wouldn't suit everyone. If you are concerned about any emotions, feelings or symptoms your experiencing, please seek the advice of a trained medical professional as soon as possible.

5 Practical Ways to Help Depression: from a sufferer

Depression is a unique, horrible and well hidden illness. But it is affecting more and more people, so I wanted to share some ideas on the things that have helped me get through it, past and present, that might help others. 

Depression can affect people in different ways, so I will try to explain how I experience it. This video puts it perfectly for me. If this sounds familiar, give these ideas a try if you can, they might help.... even a bit.

1. Find a charity that offer peer support

This is similar to my advice on the 'Find Your People post on anxiety.' Peer support, for me, is amazing. It can help so much to find a supportive environment and share experiences with others. It's not a quick fix, because there really isn't one. But when you are having a day when the depression is really bad and getting out of bed seems daunting and seemingly impossible, it can help to know that there are people out there who feel the same and who are rooting for you. 

Charities have a lot on offer now, from support groups and social groups, to advice and coaching services. To know that your support group members care for you and would really miss you if you weren't around or to know that there is a cup of tea with your name on it waiting for you can be enough to help you find the will to fight. I always think having depression makes you physically feel like you're walking through treacle and just having a shower can take me hours. But knowing I have people who care waiting for me helps so much. Or perhaps you're feeling anxious about filling out a form, there might well be a local advocate who can help you do that. 

Where do I find a charity? Google is a great place to start but there are also a lot of information lines that might be able to help provide the contacts of local charities e.g. Mind and Rethink but also your GP will hopefully have links with support that's local to you. 

2. Seek professional treatment

Depression is a mental illness, and mental illness is a serious and real as physical illness. You deserve support to get through this and going to see your GP is really critical to getting well. You're GP will be able to refer you for psychological therapies, prescribe medication if you would like, signpost you to support groups and charities, assess your safety and monitor your illness.

It can be very daunting to make that first visit, but it is very important. If you don't find one GP is very helpful, then you can always try visiting another one in your practice. More and more GP's are making connections with local support services and the profile of mental health is being raised, so it is well worth having a chat to them. See if you can ask a friend or relative to go with you if you think that would help.

I have found talking therapy and mindfulness training has helped me so much and my GP was able to recommend an excellent hospital for me to go to. If you have private medical cover its worth seeing if it covers talking therapies. Sometimes there can be long waiting lists on the NHS, much like many things, and private treatment can be expensive. Personally I've found the money myself and my family have spent on treatment for my mental illnesses is the best investment we've ever made. I recently came across this excellent article on ways to find affordable therapy and sometimes charities provide scalable therapy services, so tip #1 is a good one to follow.

You can access therapy in so many ways too now. Talk to your GP about online CBT, for example from IESO or see if your workplace has an Employee Assistance Program, you can often access free phone or email counselling this way.  

If you do decide to undertake talking therapy you need to set aside time outside of sessions to work with your thoughts and feelings. It is hard work. My house is full of CBT worksheets and I have so many notebooks I'm single-handedly keeping Paperchase going! I practice my mindfulness exercises everyday and I write in my journal to help recognise any unhelpful thinking patterns as soon as possible. So I guess I'm trying to say, it really is worth doing your homework. 

3. Self-care

When you have the flu its best to rest up and get well. Sometimes we're tempted to carry on with a load of cough and cold remedies, but actually rest and care is the most effective way to get well. It's no different with depression. You're body and mind are under attack from an illness. Care is what you need. 

Self-care is different for everyone but here are some ideas to start you off with. 

• See if a friend or loved one can help out with the chores or looking after the kids until you're well.
• See if you can take some time off work or talk to you manager about making adjustments whilst you're not well e.g. regular rest breaks or working a more flexible pattern (you're GP can help recommend this to your work place if you request an Occupational Health assessment). 
• Allow enough time for rest and sleep. If sleep is difficult see if you can create a helpful routine (I will make sure I post about mine in future).
• Set out daily time to do activities that comfort you. Perhaps watching you're favourite TV program, eating your favourite food or doing something you enjoy like going to the cinema. Pick things that are low anxiety and as enjoyable as anything can be right now, given how you're feeling.
• Curl up a lot - get a blanket, a cup of tea, put the TV on and tuck yourself up on the sofa as often as possible. This is what you do for a physical illness, mental illness needs the same care. Whenever you're feeling anxious or low, consider whether you need self-care. 

When I've been really depressed in the past and I felt suicidal, my husband would book cinema tickets regularly. I loved the cinema, we would pick quiet showings where no one was around. I would dress in my tracksuit, buy pick-a-mix and hot chocolate and literally curl up in the dark  cinema and get lost in the film. It was about the only thing I enjoyed at that time. I would call my husband to explain I was feeling suicidal and he would help me to promise I'd wait to see the film before I did anything. And week by week I kept making it to the cinema.... I'm still here 4 years later and I still love movies!

4. Self-help

Self-help books aren't for everyone. But, if you do like reading or you're willing to give it a try, there really is an amazing wealth of therapeutic material out there. When I was really unwell the first time, I was too ill to work. So I needed to create a structure for myself and I wanted to find out what I could do to help me recover. I find when I'm suffering a really bad bout of depression I cannot concentrate on reading a book, I often don't have the energy to even sit up! So I decided to try audiobooks. I would listen, sometimes fall asleep, sometimes cry too much to hear what was being said, but I'd try again the next day, and the next day, and the next day. I'd follow along with a copy of the book from the library. Until eventually I found the ideas were sinking in and I was ready to try some of the self-help techniques recommended.  Now, I have incorporated so many of the techniques I've learned into my life to improve my wellbeing and I use them in conjunction with my therapy.

Here are just a few of my favourites!

• CBT for Dummies by Rob Wilson and Rhena Branch (this helped me overcome my depression)
• Overcoming Perfectionism by Roz Shafran, Sarah Egan and Tracey Wade  (this helped me reduce the risk of relapse)
• Sane New World: Taming the Mind also by Ruby Wax (this helped me realise I wasn't alone and begun to teach me mindfulness to manage my illness)
• The Mindfulness Workbook by Thomas Roberts (as recommended to me by my therapist)
• A Mindfulness Guide for the Frazzled by Ruby Wax (this developed my mindfulness skills and made so much sense to me!)

I thank all you lovely authors for changing my life! I'm serious, these books have!

If all that isn't for you.... how about trying a wellbeing app or an online self-help course. I've never used it myself but the NHS recommend FearFighter, an online CBT based program for fear, panic and anxiety and I've had MoodGYM recommended to me in the past. I haven't tried these yet, so if anyone has, please share your experiences in the comments! Thank you!

And here is a link to some apps from the Mind website Apps for Wellbeing and Mental Health. As I've mentioned before, I use the Headspace app to learn mindfulness meditation. I'm currently working on the depression pack and for me its proving really helpful. It helps me to relate to my thoughts and feelings in a different way, and its comforting to know there are techniques out there to help me recover.

5. One post-it at a time

This was something my counsellor helped me to do. When I was completely broken down and struggling to function at all, she gave me post-its to help change my life. At the time I was living in pyjamas and making whale noises!

(My husband would come home at 5.30pm and run me a bath. I would manage to peel myself off the sofa, take my pyjamas off and get in the bath. Then I would soak until I was all shrivelled up like a pea.... he would try and talk to me, I would just moan. I call this pyjamas and whale noises. If I ever write a book.... that's the title!)

I was tasked with writing out 3 post-its at a time. They were simple things to begin to get me moving. I would stick them up on the wall and just work on one post it at a time. I remember one was to wash up a knife and fork, and that was it (you cannot wash up when you're really depressed, it is physically impossible, unless you're suffering obsession at the same time - then I scream if someone tries to peel me away from it...). That was a tough time. But I've realised now I have an illness. And that's just one thing that helped me to cope.

If you're currently functioning a little more than I was back then, try using post-its to manage your time, celebrate your achievements and pace yourself. Don't forget to include lots of self-care on there!

That's all from me now. I hope this is helpful to someone, its been helpful for me to share.

Take care everyone and take 'self-care',

Compassionista xxx

P.S. I must stress that these are my own personal tips and experiences. I am not a trained medical professional and these ideas wouldn't suit everyone. If you are concerned about any emotions, feelings or symptoms your experiencing, please seek the advice of a trained medical professional as soon as possible.