Living with Self-Harm OCD can be an incredibly painful experience, both physically and emotionally. It’s one of the most misunderstood subtypes of OCD because the thoughts that accompany it can make you feel like you’re losing control of yourself. If you’ve been living with these thoughts about harming yourself, I want to acknowledge how hard that can be. It feels like a constant battle between fear and anxiety, with the overwhelming sensation that if you don’t act on the thoughts, something terrible will happen.

What I want to share with you is that Self-Harm OCD is not about actually wanting to harm yourself—it’s about the fear of doing so. The thoughts are distressing, and they trigger a profound sense of shame, guilt, and confusion. But these thoughts don’t define you, and they are not who you are. There is a way to break free from this cycle, and I want to guide you through understanding the underlying mechanisms and the tools you can use to reclaim your peace.

What Is Self-Harm OCD?

Self-Harm OCD (SHOCD) is characterized by thoughts that involve the fear of self-harm. These thoughts feel like a direct threat to your integrity or your mental state, leading to a deep sense of anxiety and helplessness. Many people with this subtype fear that they will lose control, act on the thoughts, or be trapped in an endless cycle of harm. These thoughts can appear without warning, making daily life feel uncertain and unsafe.

I had a client in our OCD Coaching Program who struggled with these very fears. He’s a male client, and he often experienced terrifying thoughts that he might hurt himself—though, in reality, he didn’t want to. He would experience these thoughts and immediately feel an overwhelming urge to check his emotions, his environment, and even his body to make sure he wasn’t about to act on them. The fear of these thoughts being true led him to constantly seek reassurance, perform rituals, and avoid any situation where he might be alone and could potentially hurt himself.

Examples of Thoughts People with Self-Harm OCD Experience:“What if I lose control and hurt myself in the future?”“What if I accidentally do something to harm myself, even though I don’t want to?”“I feel like I might act on these thoughts—what if I’m dangerous to myself?”“If I don’t check or reassure myself, I might hurt myself.”“What if these thoughts are a sign that I really want to harm myself?”Common Compulsions with Self-Harm OCD

Self-Harm OCD is often accompanied by various compulsive behaviors that reinforce the cycle of fear. These compulsions provide short-term relief but ultimately keep the thoughts and anxiety in place. Here are some common compulsions associated with SHOCD:

Mental Checking: Constantly checking in with yourself to see if you are still “safe” or in control, sometimes leading to mentally scanning your emotions or thoughts for signs that you might be at risk.Avoidance: Avoiding situations where you might be alone with objects that you associate with harming yourself, like avoiding sharp objects, or even avoiding being around certain people who might trigger your fears.Seeking Reassurance: Asking others for constant reassurance that you would never harm yourself or that the thoughts are just that—thoughts—and not actions you would take.Ritualistic Actions: Performing actions, like repeatedly checking your body or your surroundings, to make sure you’re not in a place where harm could occur. You might also engage in rituals to “prevent” the thoughts from becoming reality.The Cycle of Doubt and Anxiety

The cycle of doubt and anxiety with SHOCD is grueling. When my client in our coaching program experienced these fears, he felt that by checking or avoiding certain triggers, he could “control” the possibility of self-harm. However, this only reinforced the cycle, keeping the anxiety present. The more he checked, reassured himself, or avoided, the more the fears and thoughts came back stronger, leading to more compulsions.

What my client learned—and what I want to share with you—is that trying to solve the doubt or find the answer is exactly what feeds the OCD. The more you try to confirm whether the fear is real or not, the deeper the cycle becomes. The key is not in finding the answer, but in learning how to accept the uncertainty that comes with these thoughts and sitting with the discomfort without acting on them.

The Importance of Exposure and Response Prevention (ERP)

Exposure and Response Prevention (ERP) is the gold standard for treating OCD, including Self-Harm OCD. In my coaching program, we conducted ERP to expose my client to the very thoughts he feared and allowed him to sit with them without performing any compulsive behaviors. For example, when he experienced thoughts about self-harm, we didn’t try to avoid them or reassure him. Instead, we focused on allowing the thoughts to be present without engaging in mental checking or avoidance. Over time, this reduced the power these thoughts had over him, and he began to regain control.

Learning to Let Go

In addition to ERP, another technique that helped my client tremendously was Letting Go. Letting go is about allowing the thoughts to come and go without engaging with them or giving them any meaning. It’s not about forcing the thoughts away or suppressing them. Rather, it’s about accepting that they are there and giving yourself permission to let them exist without fear. By practicing letting go, my client was able to break the cycle of fear and not feel compelled to react to the intrusive thoughts.

You’re Not Alone

If you are struggling with Self-Harm OCD, it’s important to remember that these thoughts are just that—thoughts, not actions. You are not defined by them. You can learn to live with uncertainty and regain control over your life. The intrusive thoughts you’re experiencing are a symptom of OCD, not a reflection of who you are.

Recovery takes time and effort, but it is absolutely possible. If you’re ready to take the next step in breaking free from Self-Harm OCD, I invite you to apply for our hands-on OCD coaching program. This program offers personalized support to help you overcome the compulsions and fears that are keeping you stuck, and empowers you to live a life filled with peace and clarity.

Click here to apply now and start your journey to freedom from OCD.

Take care,

Zach W.

Founder, OCD Coaching Services