I Have Thoughts of Hurting People — What’s Wrong With Me?

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Reader’s Question

I have thoughts and sometimes images of killing people I know, and thoughts that I’ve hurt a child, although I have no intention of doing anything like that. So I will check them over and over again.

I always find myself checking things over and over for fear something bad will happen, and I like things in their place and in a certain order until it feels right. What is wrong with me?

Psychologist’s Reply

I imagine that your thoughts of killing or harming someone are extremely upsetting because it sounds as though harming someone, especially a child, is the last thing you would want to do.

These unwanted thoughts and images that are coming into your mind over and over again are called obsessions. People can have obsessions about various things, including contamination, aggression (e.g. hurting someone), and the need to have things just right. Obsessions can also be religious or sexual in nature. One thing all obsessions have in common is that they cause great distress.

You also mentioned that you are so afraid of hurting someone that you are checking things over and over to make sure that you do not accidentally cause harm (or some other bad thing). This is called a compulsion. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines a compulsion as a repetitive behavior or mental act that one feels driven to perform in order to prevent or reduce distress, or to prevent some dreaded situation. Some common compulsions are hand-washing, touching something, checking (e.g. to see if something is closed or off), counting, or repeating words silently.

Obsessions and compulsions usually go hand in hand. For example, if someone obsesses about contamination, he might compulsively wash his hands after touching anything — up to hundreds of times per day. Washing reduces the perceived likelihood of contamination, and therefore relieves anxiety (temporarily). In your case, checking is the compulsion that you perform to deal with the fear of harming someone.

You did not mention how often the obsessions and compulsions occur or how long they last. If the presence of the obsessions or compulsions themselves causes distress, takes more than one hour per day, or significantly disrupts your daily routine, you may have an anxiety disorder called Obsessive-Compulsive Disorder (OCD). The good news is that OCD is a highly treatable disorder, with both therapy and medication.

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If you would like to seek professional help, it would probably be best to find a therapist who specializes in treating OCD. A particular type of cognitive behavioral therapy that a specialist would likely provide is called exposure and response prevention (ERP). With this treatment, you would learn to cope with the anxiety triggered by the thoughts that you have harmed someone (exposure) without engaging in the checking compulsion (response prevention). This will take some practice and persistence on your part, but it may help to know that many have successfully learned to manage their symptoms of OCD.

Another treatment option is psychotropic medication. Ask your medical provider for a referral to a psychiatrist who can talk to you about what you are experiencing, and then find the right medication for you.

You can begin with therapy or medication or do both together.

If you would like more information about OCD, check out the International OCD Foundation, where you can find referrals for therapists, recommendations for self-help books, and information about whether there are support groups in your area.

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