Harm OCD Worksheet

About this worksheet

Harm OCD is the subtype in which the intrusive thoughts are of hurting someone the client loves — often a child, partner, or family member. The horror is diagnostic. Someone with genuine intent to harm does not lie awake terrified they might. Clients with harm OCD often present after months or years of silent suffering, having avoided sharp objects, refused to be alone with their child, and developed elaborate mental checking rituals ('do I really want to…?'). This worksheet names the intrusive content, catalogs the avoidance and mental compulsions that maintain the loop, and rehearses the target response — 'maybe, maybe not — moving on' — which drops both the compulsion and the argument. The distress-wave tracker at the bottom captures the empirical fact clients need to experience: the wave rises, peaks, and falls on its own when the ritual is not performed. It is important to distinguish harm OCD from genuine violence risk. A brief risk assessment — history of violence, current intent, plan, means — should precede ERP. In the absence of any of those, treatment is straightforward exposure and response prevention.