CBT for Harm and Checking OCD - Cognitive Behavioural Therapy in London, Kent and Online by Video Session

Repetitive checking and time consuming routines for locks, switches, appliances, instructions, messages, emails and car journeys, are compulsive behaviours normally associated with a clinically recognised OCD subtype known as harm and checking Obsessive Compulsive Disorder. This can also include intrusive thoughts, images and worries about acting aggressively, losing control or causing harm to others.

If you need help with harm / checking OCD, you can organise a free initial call with an OCD specialist. We provide expert treatment for Harm and checking OCD, together with other related OCD problems. Email This email address is being protected from spambots. You need JavaScript enabled to view it. or complete our contact form for a direct response from a member of our therapy team.

What is Harm and Checking OCD?

Harm and Checking Obsessive Compulsive Disorder is a clinically recognised OCD subtype. Whilst harm obsessions and checking behaviours are normally clustered together from a diagnostic perspective, this classification can sometimes feel arbitrary and may overlap with other OCD themes including Pure “O” and Magical Thinking OCD.

This demonstrates that in spite of the established diagnostic classifications, OCD is frequently experienced on an idiosyncratic, subjective and individualised basis. From an OCD treatment perspective, it also emphasises the importance of seeing OCD as a common four-part process, in spite of significant differences in the content of the obsessions and compulsions themselves. You can read more about our four-part Unified OCD formulation here.

Mindful of the arbitrary nature of different OCD subtypes and themes, we have drawn the distinction between repetitive and ritualised checking behaviours, normally performed to prevent harm or loss, and aggressive, violent and repugnant harm obsessions, linked to feeling unsafe or losing control.

Checking OCD

Repetitive or ritualised checking behaviours can involve highly time-consuming and disruptive checking routines, including gas and electrical appliances, light switches, door and window locks, dashcams, emails, online transactions, account balances and bills. The checking compulsions are frequently rooted in an attempt to prevent, avoid or protect against responsibility for danger, loss or harm to self or others.

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Over time, checking behaviours can become so engrained and automatic, that the individual sufferer no longer explicitly identifies with the original loss or harm obsessions. Like other forms of OCD, Checking OCD can overlap with other forms of OCD including comparing one’s partner in Relationship OCD , ritualising in Magical Thinking OCD and mental checking in Pure “O”.

Typical checking OCD obsessions can include:

Being responsible or to blame for fire, theft or flooding at home.
Causing accidents or failing to prevent danger.
Violating rules, laws or standards.
Completing work tasks incompetently or inaccurately.
Causing financial or material loss to self or others.
Being blamed for something that others have done. Failing to protect others from random or fatalistic events.

Typical checking OCD compulsions can include:

Repeatedly checking door or window locks.
Checking gas and electrical switches and appliances.
Looking closely, repeatedly examining and taking pictures as evidence.
Googling and checking internet references in an attempt to resolve worry.
Mentally replaying, memory checking or seeking reassurance from others.
Avoiding or passing security or safety related responsibilities to others, such as locking up, turning things off and driving.

Compulsions provide short-term temporary relief from obsessional worry and distress, however they also reinforce the association between the checking trigger, safety or security doubts and the need to perform the compulsion. This trade-off between short-term relief and long-term reinforcement, causes checking OCD to increase in frequency and intensity.

Harm OCD

Harm OCD involves intrusive doubts, obsessions and images of causing harm to one’s self or other people. This is a predominantly internal and obsessional problem leading to mental or physical avoidance. Individuals struggling with disturbing, violent or aggressive thoughts and images, attempt to use mental suppression or avoidance as a means of neutralising, avoiding or seeking reassurance about causing harm or danger.

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This can involve vivid and intrusive thoughts, images, mental scenarios or worries about acting on or being vulnerable to dangerous impulses. Aggressive or violent harm obsessions can also overlap with POCD and Pure “O” OCD presentations, again demonstrating the subjective nature of different OCD subtypes and classifications.

Aggressive or violent OCD obsessions can include:

Saying something hurtful, discriminatory, offensive or harmful.
Intrusive thoughts and worry about stabbing, strangling, smothering or drowning vulnerable family members or other people.
Pushing people in front of trains or traffic.
Loosing control and attacking other people.
Jumping from platforms, crashing when driving or seriously harming one’s self with knives or other objects.
Poisoning, overdosing or electrocuting self or others.

Aggressive and violent OCD compulsions can include:

Attempting to mentally neutralise, deflect or suppress aggressive thoughts and worries.
Hiding or removing knives and other potentially dangerous objects.
Avoiding or withdrawing from family members, children or vulnerable people.
Disengaging from parental responsibilities such as bathing or checking children.
Avoiding driving, busy places or crowded platforms.
Seeking reassurance from close family members regarding own safety and sanity.
Avoiding social events and alcohol and attempting to discretely check that friends or colleagues were not upset or offended by comments or behaviour.

Compulsions provide short-term temporary relief from obsessional worry and distress, however they also reinforce the association between the harm trigger, safety doubts and the need to perform the compulsion.

How is Harm and Checking OCD Maintained

Like all other OCD subtypes, Harm OCD involves a three-part inter-related process. Intrusive doubts lead to harm obsessions and high levels of fear, anxiety and depression. Avoidance and reassurance seeking behaviours are performed in an attempt to escape or supress the obsessions and anxiety. Whilst this provides temporary relief, it also reinforces the vicious cycle of Harm OCD.

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Harm and Checking OCD is a learnt behavioural pattern, in which the individual attempts to resolve safety or security doubts, obsessional worry and fear by performing compuslive safety, checking and avoidance behaviours. You can learn more about the predispositions and causes of OCD here . There are three parts to the Harm and Checking OCD cycle:

Firstly hypervigilance and selective attention to cues that imply potential danger, loss of control, responsibility or blame. This creates a vicious cycle that reinforces and maintains the OCD.

Secondly, obsessional worry, over-analysis, rumination, magical thinking and catastrophising about preventing or being responsible for harm or loss.

Thirdly, safety / security compulsions, involving repetitive and ritualistic checking behaviours avoidance and routines.

This creates a three-step vicious cycle, in which the individual’s checking or avoidance behaviours provide temporary relief from harm or loss obsessions, whilst inadvertently reinforcing the underlying association between the initial checking trigger and the need to perform the checking compulsion.

Checking and reassurance seeking behaviour, also paradoxically reinforces the individual’s need to check, by preventing the disconfirmation of the perceived threat and implying that harm was avoided because of the act of checking itself. This trade off between short-term relief from the obsessional worry and long-term reinforcement of the need to check or avoid when triggered, becomes deeply engrained and almost addictive over time.

Checking and Harm OCD frequently increases in frequency and intensity as the individual’s confidence in their checking behaviours deteriorates over time. Checking once becomes checking again and then checking that the check was completed properly. Individuals struggling with Harm and Checking OCD become consumed by the need to prevent, control, avoid and shift responsibility for potential danger or loss.

This can also involve high levels of control and restrictions placed on family, friends and colleagues. Harm and Checking OCD frequently leads to profound disruption to work and personal commitments and can contribute to significant relationship difficulties.

If you are struggling with Harm and Checking OCD, you can organise an informal and confidential call with a member of our team by completing the contact form or emailing This email address is being protected from spambots. You need JavaScript enabled to view it.

How is Harm and Checking OCD Treated?

The gold standard psychological treatment for Harm and Checking OCD is Cognitive Behavioural Psychotherapy, including ERP. In particular, a combination of cognitive, meta-cognitive and behavioural strategies drawn from mainstream CBT, Acceptance and Commitment Therapy (ACT) and Inference Based Therapy (IBT), have been found to be highly effective in the treatment of Harm and Checking OCD.

Exposure and Response Prevention (ERP), should always be incorporated into the behavioural part of the CBT treatment process. Whilst some therapy providers recommend ERP as a stand-alone treatment for Harm and Checking OCD, this provides limited access to other evidence based cognitive change and defusion strategies. UK best practice therefore involves integrating ERP into the wider CBT process.

Other forms of talking therapy including interpersonal, psychodynamic and psychoanalytic therapy, has been shown to be less effective in the treatment of Obsessive Compulsive Disorder. Clients should always follow the published clinical evidence when engaging in OCD therapy.

Sometimes the term “Refractory” OCD is used to describe particularly complex or treatment resistant forms of OCD. At GoodCBT.com we therefore incorporate Schema based CBT, where an underlying or unresolved attachment problem, trauma or maladaptive belief maintains the individual’s vulnerability to OCD.

How Many CBT sessions are Required to Effectively Treat Harm and Checking OCD?

Whilst it's difficult to state precisely how many sessions of Cognitive Behavioural Therapy will be required to address Harm and Checking OCD, the process typically involves as few as eight sessions and can involve up to twenty. The number of therapy sessions will always follow a full psychological assessment of the problem and the production of a therapy plan.

At GoodCBT.com we always write to our clients following the first session, with a full psychological assessment and treatment plan. Every session is followed by detailed session notes, summarising the key learning points and the agreed actions. All sessions are 60 minutes long, rather than the 50 minutes or less offered by most other private providers. This means that our clients can spend more time engaging in the therapy process, without being distracted by time constraints or detailed note taking. Sessions may also be recorded for future reference where the client wishes. To talk to us about specialist Cognitive Behavioural Psychotherapy for Harm and Checking OCD, complete our contact form or email This email address is being protected from spambots. You need JavaScript enabled to view it.