The Fear of Losing Control and Harming Others With OCD

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Obsessive-compulsive disorder (OCD) is a psychiatric disorder, which involves both obsessions—recurrent, persistent, intrusive thoughts, images, or urges that cause anxiety or distress—and compulsions—repetitive behaviors or acts that are meant to reduce or neutralize anxiety and fears. 

Obsessions such as contamination concerns and those involving perfectionism are common obsessional themes of OCD that can manifest as cleaning, washing, checking, and arranging. However, some cases of OCD are misunderstood, misdiagnosed, and ineffectively treated, such as those involving the fear of losing control.

Fear of Harming or Killing Yourself

If you find yourself asking the question: "How do I know I'm not going to hurt or kill myself?", it is important to distinguish between actual suicidal ideation and thoughts of wanting to die versus unwanted, intrusive thoughts of fearing the loss of self-control that could potentially result in harming or killing yourself.

If you have OCD, you may fear losing control to the point where it results in your own demise. This does not mean you want to kill yourself. Rather your compulsions are likely carried out in a way that ensures you are safe.

Compulsions to keep you safe may include:

  • Avoidance of knives or sharp objects
  • Avoidance of songs, movies, or readings, which involve death or injury
  • Avoidance of belts, ropes, medicine bottles, and cabinets, or other objects that may be associated with suicide
  • Avoidance of being alone

Fear of Deliberately Harming Someone Else

Many people with OCD fear that harm will come to their loved ones. If you are afraid you will harm someone close to you, it is important to distinguish between actual homicidal ideation versus unwanted, intrusive thoughts of having the potential to lose control and kill a loved one.

If you have OCD, your fear of losing control may manifest in a way that appears neglectful or avoidant. Similar obsessions may involve assault, rape, incest, or other personal aggression or violation. Compulsions of this nature are carried out to ensure loved ones are safe.

Compulsions to keep another person safe from you include:

  • Avoiding knives or sharp objects
  • Avoiding songs, movies, or readings, which involve murder, death, or injury
  • Avoiding touching or caring for a loved one who has been the subject of the unwanted thoughts
  • Avoiding being alone with the loved one

You may carry out these compulsions as a means of reassuring yourself that you won't hurt or kill your loved one, even if you lose control.

Fear of Unknowingly Harming Someone Else

It is important to distinguish violent, antisocial behavior from unwanted, intrusive thoughts of uncertainty. If you have OCD, you might find uncertainty extremely distressing, thus increasing any obsessive thoughts you may experience. In these cases, compulsions are carried out as a way of trying to gain certainty.

Compulsions may include seeking reassurances from others, checking behavior (locks, windows, schedules), and mental rituals that involve trying to seek clarification.

A Word From Verywell

If you have any of these thoughts, it is important to speak with your doctor or therapist. Current evidence-based symptom treatments for OCD and the fear of losing control include cognitive behavioral therapy (exposure and response prevention [ERP/ExRP]) and medication (selective serotonin reuptake inhibitors for OCD). If you have treatment-resistant OCD, your doctor may try a procedure like deep brain stimulation (DBS) or transcranial magnetic stimulation (TMS). 

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Article Sources

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  • Himle M, Franklin, M. The More You Do It, the Easier It Gets Exposure and Response Prevention for OCD. Cognitive and Behavioral Practice. 2009;16:29-39. 

  • Hudak, R. & Wisner, K. Diagnosis, and Treatment of Postpartum Obsessions and Compulsions That Involve Infant Harm. Am J Psychiatry 169: 360-363, 2012.