What To Know About Harm OCD in Children

Pediatric Obsessive-Compulsive Disorder (OCD) is a complex neuropsychiatric condition, marked by the presence of obsessions— recurrent and unwanted intrusive thoughts, urges, or images that often cause significant distress. Compulsions are also a key feature of OCD— characterized by repetitive behaviors or mental acts that serve to mitigate the distress endured by the obsessions—however further strengthen and reinforce this loop. 

The prevalence of OCD in children has been reported to range between 1- 3%. The Yale-Brown Scale is a reliable and valid instrument for assessing OCD symptom severity.

What is Harm OCD?

Harm OCD is a subtype of OCD, characterized by intrusive thoughts or fears about causing harm to others or to oneself. These thoughts are often deeply distressing, as they conflict with the child’s sense of self. Harm OCD can lead to avoidance behaviors, recurrent compulsions, and excessive reassurance-seeking. While children with Harm OCD often do not act on these intrusive thoughts (obsessions), they experience significant emotional distress and often engage in behaviors (compulsions) aimed at neutralizing, or mitigating the anxiety associated with them. Compulsions reinforce the obsession and maintain the vicious cycle of OCD. The child may also experience significant distress when they cannot perform their compulsive rituals, leading to heightened feelings of anxiety and shame. 

Causes of Harm OCD

The etiology of Harm OCD is complex and multifaceted, involving an interplay of genetic, neurobiological, biochemical, as well as psychological and environmental factors.

Genetic Factors

Research demonstrates that genetics plays a significant role in the development of OCD, including Harm OCD. A family history of OCD or other anxiety disorders can increase the likelihood of a child developing OCD. Relatives of an individual with OCD are four times more likely to develop the condition compared to those in the general population. Several studies have identified specific genetic markers that may be associated with a heightened risk of OCD, including SLC1A1 and genetic variants influencing SLC1A1 expression. 

Neurobiological Alterations

Abnormalities in cortico-striato-thalamo-cortical (CSTC) circuitry have been found in OCD. This brain circuit plays a key role in modulating behavior and processing information related to obsessions and compulsions. Neurotransmitter imbalances in GABA and glutamate are also implicated in OCD. Modulatory neurotransmitters, including dopamine and serotonin, are further shown to be altered in OCD. These imbalances may contribute to the persistence of intrusive obsessive thoughts and compulsive rituals. 

Dysregulated Immune Function & Heightened Inflammation 

A growing body of research underscores the connection between the body and brain in terms of OCD. Autoimmune conditions, such as Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), may be involved in the onset or exacerbation of OCD symptoms in children. Studies have suggested that the immune system’s interaction with the nervous system may play a role in the onset of OCD symptoms, as heightened inflammatory responses can disrupt neurobiological functions.

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Signs of Harm OCD in Children

The signs of Harm OCD in children are similar to those of OCD in general, however, they are specific to the intrusive thoughts and compulsions relative to harm. 

Intrusive Thoughts

Children may experience frequent, distressing thoughts or images about causing harm to themselves or others. These thoughts or images are often unwanted, repetitive, and highly distressing. The child may become preoccupied, distressed and ashamed by these thoughts and may try to avoid situations that trigger them.

Compulsions

In response to these persistent obsessive thoughts, the child may engage in recurring, compulsive behaviors to neutralize the anxiety. Compulsions may include avoiding sharp objects, people (due to fears of harming them), or places, performing mental rituals (covert compulsions that occur in the mind, mental checking, reviewing, or rumination), or asking for constant reassurance that they would not harm themselves or someone else. Compulsions are not enjoyable for the child and take up much of their time and energy. However, they believe their distress will only intensify if they do not complete them, further perpetuating this vicious cycle. 

Is Self-Harm a Sign of OCD?

Self-harm is not a direct symptom of Harm OCD, but it can be a coping mechanism for some individuals with OCD. Children with Harm OCD may experience intense distress related to their intrusive thoughts and may engage in self-harm to temporarily alleviate their emotional pain. However, self-harm in these cases is typically not driven by a desire to cause injury, but rather as a way to manage overwhelming anxiety. 

Treatment for Harm OCD focuses on reducing the distress caused by these thoughts and preventing compulsive behaviors, including self-harm. 

Is Harm OCD Dangerous?

While Harm OCD itself does not typically lead to violent behavior, the distress it causes can be significant and disrupt daily functioning, while compromising health and well-being. Children may also experience comorbid health conditions (such as depression)  as a result of the chronic distress experienced in OCD. The child’s fear of acting on their intrusive thoughts can lead to feelings of heightened anxiety, isolation, guilt, and shame, which can further compound the condition. 

Treatment of Harm OCD in Children

Psychoeducation for Parents

Educating parents about the nature of OCD and how it manifests in their children is a critical first step in treatment. Understanding that OCD is not a reflection of the child’s character or desires can help parents support their child without reinforcing the OCD cycle through reassurance-seeking or avoidance behaviors.

Exposure and Response Prevention (ERP)

ERP is a form of therapy that involves gradually exposing the child to situations that trigger their obsessions while preventing them from engaging in compulsive behaviors. Over time, this process helps to reduce the anxiety associated with intrusive thoughts and enables the child to resist performing compulsions. For children with Harm OCD, ERP may involve exposing them to thoughts of harm without performing rituals, allowing them to realize that their thoughts are just thoughts and do not lead to action.

Mindfulness-Based Cognitive Behavioral Therapy (MBCT): 

MBCT is a form of cognitive therapy that incorporates mindfulness–present moment awareness, without judgment—-helping children to gain awareness and break free from their obsessions and compulsions. Mindfulness helps children observe their thoughts in neutral ways, without becoming overwhelmed by them, reducing their distressing impact. This form of therapy also teaches children coping strategies to manage anxiety.

MBCT modulates connectivity in the ventral default mode network (vDMN) and the frontostriatal network (FSN) in those with OCD.  This is further supported by a 2024 randomized controlled trial in adults. Mindfulness for parents of children with OCD is further implicated to have value. 

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Medication

Selective serotonin reuptake inhibitors (SSRIs) may be prescribed to help regulate the neurochemical imbalances associated with OCD. Using medications in conjunction with ERP and MBCT is often the gold standard for OCD treatment.

Will Harm OCD Go Away?

Harm OCD is a complex and distressing condition marked by intrusive thoughts of harm and compulsive behaviors aimed at reducing the anxiety associated with these obsessions. Early intervention, comprehensive treatment, and ongoing family support are pivotal in helping the child manage their OCD symptoms and break free of the vicious cycles of obsession and compulsion. With appropriate and consistent treatment, a child can learn to break the cycle of Harm OCD so that symptoms are no longer constricting their ability to engage in their lives