Harm OCD Part Three: Son of Harm OCD

When my first child was born, my second thought was, “I am so blessed to have this amazing thing happen and I will love this child more than anyone has ever loved anything.”  It was a sublime moment.  My first thought was, “Don’t think nothin’ stupid.”  Before she made it out of the womb and onto the table, I had already pictured her falling to the floor.  Then they handed me a pair of scissors to cut the umbilical cord.  Stand there over the newborn with a pair scissors… and don’t think nothin’ stupid. 

The thing about living with OCD is, you are still able to achieve whatever it is you want in life, so long as you are willing to accept that OCD will want a piece of it.  This is not accepting defeat, or being second-in-command of your destiny.  This is about understanding how to master this disorder to keep it from taking away everything you love.  If you want a family, you can have a family, but you may need to be prepared for the thoughts that come with it.  Nowhere is this more painfully obvious than in the relationship between an OCD sufferer and his/her children.

Common obsessive thoughts in Harm OCD focused on children:

  • I will kill or physically harm my child by:
    • Stabbing
    • Strangulation/smothering
    • Drowning
    • Disposing of them in the trash
  • because I will:
    • snap and go crazy
    • respond uncontrollably to an unwanted impulse
    • secretly want to
    • be negligent
  • or I will sexually molest my child by:
    • Changing diapers inappropriately
    • Bathing them inappropriately
    • Allowing my child to inadvertently come in contact with my genitals while holding them
    • Allowing myself to become sexually attracted to them by allowing sexual thoughts or sensations to occur in their presence
  • I will always be burdened by intrusive thoughts/images of my child being harmed and therefore will:
    • Never enjoy being a parent
    • Resent them for making me unhappy

Common compulsions associated with Harm OCD focused on children:

  • Avoidance of:
    • Being alone with children
    • Bathing, dressing, changing, etc.
    • Triggering imagery associated with children
    • Schools, parks, and other places children may be present
    • Household items that could be used harmfully (knives, etc)
    • Triggering media (news articles about child harm, movies with related themes, etc.)
  • Mental review of:
    • Did I touch my child in an inappropriate way?
    • Did I expose my child to something inappropriate?
    • Did I feel an urge to hit or otherwise act aggressively toward my child?
    • Was that feeling of love really a feeling of love or a feeling of sexual attraction?
    • Groinal responses around children
  • Reassurance seeking and confessing
    • Reporting to significant other that you “may have touched” somewhere or done something inappropriate
    • Reporting to significant other that “bad thoughts” occurred
    • Asking others if triggering behaviors, thoughts, or events are “ok” or normal
    • Researching stories of people who have caused harm to children to ensure there are no similarities
    • Excessive researching laws and regulations about child safety
    • Self-reassurance (i.e. “I would never harm my child because…”)

It’s Not Fair

It’s totally unfair.  With everything it takes to get to the place in life where you can call yourself a mom or a dad, and then right at the moment you start to truly appreciate how amazing that is, OCD swoops in for the kill (as it were).  It may not come as a surprise.  If you’ve been living with the disorder for some time, you’ve likely seen it go after your relationships, your sexual orientation, your health anxieties, your sense of safety around germs, chemicals, or people in general.  If you have post-partum OCD or late onset OCD, this may have appeared to come out of nowhere.

Though these symptoms of OCD are very common, sufferers frequently fail to get treatment for several reasons, including:

  • Shame associated with acknowledging the presence of the thoughts
  • Fear that vocalizing the thoughts will make them more likely to come true (magical thinking symptoms associated with OCD)
  • Legitimate concern that their treatment provider may not understand OCD and will make a mandated report
  • Fear that the treatment for the OCD will be more painful than tolerating the symptoms

Each of these issues can be addressed by specifically seeking treatment from an OCD specialist familiar with the disorder and its treatment with cognitive behavioral therapy.

The Real Danger

The real danger here is not that you will act on your thoughts.  Though there are no failsafes against extraterrestrial possession, simply not wanting to hurt your children is actually enough to control your behaviors.  Further, doubt about what you do or don’t want to do is still enough to just not do anything.  The real danger is actually the harm you cause your family by obeying the OCD.  This often gets overlooked by the Harm OCD sufferer who is spending every waking moment believing they are protecting their loved ones from their closet sociopathy.  But what of the harm they are causing with compulsions?

  • Lack of physical affection due to fear of contact
  • Lack of physical presence due to avoidance
  • Lack of mental presence due to being “in your head” all the time
  • Conflict between caregivers due to anxiety and an imbalance in parental involvement
  • Lack of healthy bond between parent and child due to association of child with mental anguish

Mindfulness and Harm OCD Focused on Children

The first thing to remember about this form of OCD is that the horrible and disgusting “abnormal” thoughts are indeed totally normal.  The problem has to do with how the thoughts are presented and how they are responded to, not with their existence or absence.  The OCD mind is a wide open mind, highlighting extreme potentials in any given context.  To cherish something (like a child) is to also be aware of the horror of losing something that you cherish.  The OCD sufferer can’t not think that.  The problem is in the mistaken belief that the awareness of this thought has an intrinsic meaning, instead of simply being a mental event that comes with having an OCD mind.  Therefore mindfulness, the skill of observing mental events without judgment or analysis, is an essential aspect of mastering the disorder.

The brain records actions much more clearly than thoughts, feelings, or intentions.  What this means is the parent who changes the child’s diaper while having intrusive thoughts about committing some vile act in the process is actually recording more helpful information than the parent who is avoiding changing the diaper and the intrusive thoughts.  The person who allows the thoughts, but not the avoidance is actually programming the brain to calculate the thoughts as irrelevant and the value of the interaction as the most important element.  The avoidant person is establishing only that diaper-changing is a threat.

CBT and Harm OCD Focused on Children

Cognitive therapy can help bolster this concept by challenging distortions, such as emotional reasoning (thinking something is dangerous only because it feels that way when there is no other supporting evidence).  Challenging distorted thinking can be an important tool in committing to non-avoidant behavior.  Working with an OCD specialist may be especially important in this regard, however, as challenging a thought process can quickly be turned into challenging thoughts themselves, leading to compulsive self-reassurance.

Mindfulness and cognitive restructuring matter, but as with any form of obsessive compulsive disorder, the fight for freedom is staged on the battlefield of exposure with response prevention (ERP).  The tendency for people who suffer from this form of OCD is to fear ERP as much as they fear their thoughts and feelings.  It seems like experimenting on your children, putting them at unnecessary risk – even by allowing yourself to “go there” and think those thoughts, it seems like you are playing with fire.  This is an illusion.  No ERP protocol prescribed by an OCD specialist actually puts anyone in harm’s way.  Most ERP for this form of Harm OCD involves either imaginal exposure (writing about the fears coming true), exposure to triggering media (films or news articles about the triggering theme), or the daily completion of normal child care PLUS allowing the unwanted thoughts and feelings to be present.

Examples of ERP for Harm OCD Focused on Children:

  • Imaginal exposures
    • Writing a story in which you describe acting on your unwanted thoughts, including what events would take place, what the consequences would be, and how it would affect the rest of your life story.
    • Writing a narrative in which you describe the consequences of merely accepting uncertainty about the meaning of the thoughts and never being able to know 100% that you will not act on your thoughts.
  • Media exposures
    • Watching films that involve stories about pedophilia or familicide (The Woodsman, Happiness, The Lovely Bones, Little Children to name a few…) and sit with the uncomfortable feelings while resisting self-reassurance.  This can also be done with documentaries or news segments about Andrea Yates, Susan Smith, etc.
    • Put triggering words into google news and read the articles that come up (e.g. killed his family, molested by mother, convicted pedophile, etc).  Be careful not to use the articles as a form of reassurance, but as a strategy for triggering unwanted thoughts and resisting compulsions!  For some, resisting reading these articles may be a better exposure (to not having fully investigated one’s own potential of being harmful).
  • In vivo exposures
    • Volunteering for diaper duty and bath time and allow the thoughts to be present
    • Preparing meals for your children with knives
    • Engaging in arts and crafts with the use of scissors or other items that trigger unwanted thoughts
    • Spending time alone with your child or taking them out, to a park for example, and let the unwanted thoughts join you
    • Resisting confessing or seeking reassurance from your partner (or others) about the thoughts and purposefully telling yourself that you are hiding something dangerous
    • Allowing children to be unattended when appropriate and accepting thoughts of harm that may befall them

It’s Worth It

Being a parent is hard.  It’s way harder than any person assumes it will be before it happens to them.  It causes stress, over-stimulation, sleep deprivation, and worst of all the sense that more people are watching to see how good you are at it and how good a person you are in general.  It may seem as if people care about you more, focus on you more, now that you are responsible for children.  And children will press your buttons and try to make you frustrated because making you anything is fascinating to them.  But what they can’t understand yet is that if you have OCD and you’re stressed, exhausted, frustrated and over-stimulated, your disorder flares up.  And when your disorder flares up, it targets everything you care about the most and tries to bind it to a living nightmare.

All this being said, if you fight for what you really want and see that between you and loving being a mom or dad is just discomfort, you can learn to master this thing.  You let go of resistance to thoughts and feelings and create pathways in the mind that allow the worst of the worst to pass through relatively unnoticed.  Then you get the good stuff.  The giggles, the hugs, the I-love-yous… and even the unpleasant stuff becomes ok too.  You get the freedom back to be angry without debating in your head what that means, to want to be alone without feeling guilty, to wake up in the middle of the night to whining and demands and think to yourself, “Man, I’m gonna kill that kid” without it having to mean something.  This freedom is ultimately what allows you to be present with your child.  To play games, soothe them when they’re hurt, cuddle on the couch.  It’s these moments, still-frames of bliss that we fight for.

Most people say “I’d do anything for my child” but the Harm OCD sufferer has to do more than just show up for the job.  They have to show up to this amazing beautiful thing knowing that it aggravates their disorder.  They have to do exposure to the darkest, most terrifying corners of the mind.  They have to cope with extreme love often reminding them of extreme fear.  They have to tolerate the uncertainty that their child may have a short or painful life in order to maximize the possibility that they have a happy one.

Worth it.

Click here for Harm OCD: Part One

Click here for Harm OCD: Part Two

Click here for Harm OCD: Part Four

Jon Hershfield, MFT is a psychotherapist in private practice licensed in Maryland and California, specializing in the treatment of OCD.  Follow him on Twitter and Facebook