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.
When to use it
- New parents with intrusive thoughts of harming their infant (postpartum OCD).
- Clients avoiding knives, stairs, balconies, driving, or being alone with loved ones.
- Any harm-content intrusions with associated horror, avoidance, and mental checking.
- Not for use before a violence risk assessment — screen for history, intent, plan, and means first.
How to use it
- 1
Name the content plainly
The specific thought, in the client's own words. Naming it in the room reduces shame quickly.
- 2
Catalogue avoidance and mental compulsions
Every safety behavior — hidden knives, refusing to hold the baby alone, mental checking. This is what will be dropped.
- 3
Pick avoidance to approach
Approach, not avoid. Holding the knife. Being alone with the baby. Small, graded, with response prevention.
- 4
Practice the target response
'Maybe, maybe not — moving on.' Do not argue with the thought. Do not seek certainty. Move on with life.
- 5
Track the wave
SUDS at 0, 20, and 60 minutes after refusing the compulsion. The empirical drop is the treatment mechanism.
Frequently asked questions
What is harm OCD?+
A subtype of OCD in which intrusive thoughts, images, or urges of harming others (or oneself, without suicidal intent) trigger compulsive avoidance, mental checking, and reassurance-seeking. The person is horrified by the thought and does not want to act on it.
Am I dangerous if I have harm OCD?+
No. The presence of distress is diagnostic of OCD, not risk. A person with genuine intent to harm does not experience the thought as unwanted and does not build elaborate avoidance to prevent it. Clinicians conduct a brief risk assessment to confirm and then proceed to ERP.
Should I tell my partner about my harm intrusions?+
Once, in a calm conversation, so they understand the diagnosis. Not repeatedly, as reassurance-seeking. Repeated confession becomes a compulsion.
What does ERP look like for harm OCD?+
Deliberately approaching the avoided situation — holding the knife, being alone with the child, watching violent content — while not performing the mental checking or reassurance-seeking. The distress rises, peaks, and falls.
Is this worksheet free?+
Yes. Free printable PDF. Sign in to send as a secure client link.
Worksheet — Harm OCD Worksheet — provided by TherapistAssist for clinical use. Not a substitute for assessment or treatment.
