Key Takeaways
- OCD and self-harm have a complex relationship. Around 7% of people with OCD engage in some type of self-harming behavior.
- People with OCD can also have obsessions around the ideas of self-harm and suicide* and worry that they’ll lose control and hurt themselves. This isn’t the same as actual self-harm or suicidal ideation.
- A mental health professional can help differentiate between the two and guide you toward the treatment that will be the most helpful.
Self-harm and obsessive-compulsive disorder (OCD) have a complex relationship. Self-harm isn’t a sign or symptom of OCD, but they commonly occur together, often due to overlapping conditions like anxiety or depression.
Research suggests that over 7% of people with OCD will engage in self-harm. People with OCD can also have distressing intrusive thoughts about losing control and harming themselves, even when they have no desire to act on them. Some may unintentionally harm themselves through compulsive behaviors, like excessive skin picking or hair pulling.
It’s scary to feel like you might hurt yourself — especially if it isn’t something you really want to do. A therapist can help you differentiate between OCD-related fears about self-harm and actual self-harm urges. They can also offer you evidence-based support to manage distress and build healthier coping strategies. You’re not alone, and help is available.
*The 988 Suicide and Crisis Lifeline offers 24/7 confidential support through trained crisis counselors. If you or someone you care about is experiencing emotional distress, self-harm, or a suicidal crisis, please call or text 988. For life-threatening emergencies or immediate assistance, call 911.
How OCD can cause self-harm
Self-harm — clinically referred to as nonsuicidal self-injury (NSSI) — is not a symptom of OCD, but the two can co-occur. People with OCD may worry that they’re going to self-harm without actually doing it. But many people with OCD actually do self-harm.
People with OCD can self-harm for different reasons, including:
- Finding relief from intense and painful distress associated with OCD
- Punishing themselves for something they think they did wrong, like hurting someone they love
- Believing that hurting or killing themselves will protect others from harm
- Distracting themselves from an OCD spiral
- Attempting to feel more grounded in their bodies
- Dealing with other mental health issues, like depression or trauma
Some people with OCD may also hurt themselves by accident through compulsive behaviors, which is different from self-harm but still serious. This can include:
- Picking at their skin or pulling out hair too much
- Washing their hands so much that their skin gets damaged
- Using harsh chemicals to “clean” themselves
Even if unintentional, these behaviors can cause real harm. If you’re struggling, reaching out for professional help can give you the tools to manage OCD symptoms and reduce self-injury.
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Unwanted thoughts about self-harm vs. suicidal ideation
Another important part of why the relationship between OCD and self-harm is so complex is that some people with OCD have obsessions about self-harm and suicide.
Obsessions are one of the hallmarks of OCD. They’re intrusive and unwanted thoughts, images, or sensations that cause intense feelings of disgust, fear, and/or shame. For example, a well-known type of obsession is a contamination obsession, in which the person with OCD worries about being dirty or spreading germs.
Obsessions can revolve around anything, including self-harm. If you live with these themes of obsessions, you might worry that you’re going to hurt yourself, despite not wanting to. You might have distressing and intrusive images come to mind about self-harming — especially when you’re around triggering objects (like knives or razors). These obsessions can cause intense fear, anxiety, and shame.
These obsessions are egodystonic, which means that they’re not in alignment with what you truly believe or value. That’s why they cause so much anxiety and fear. You don’t actually want to hurt yourself, but you’re afraid you might lose control and do it anyway.
To cope, you might engage in compulsions, such as avoiding sharp objects, seeking reassurance from others, or performing mental rituals to “neutralize” the thoughts. This is different from experiencing urges to self-harm due to emotional distress, which some people with OCD may also experience.
Example scenarios: Self-harm OCD vs. self-harm urges
To understand the differences between obsessions about the idea of self-harm and actual self-harm urges, consider the following scenarios:
- Self-harm OCD: You see a knife, and have the thought, “What if I lost control and stabbed myself with that?” You immediately feel anxious. You don’t want to hurt yourself — but you worry excessively that having the thought means you actually do want to hurt yourself and you’re in denial. You hide the knife, and try to banish the thought, but the worry keeps nagging at you. You repeatedly ask your friends to remind you that you’ve never expressed any self-harm or suicidal ideation before. This scenario describes OCD revolving around self-harm themes.
- Self-harm urges: You see a knife and have the thought, “What if I cut myself?” You feel relieved at the thought; you think cutting yourself would bring emotional release. You’ve often thought about hurting yourself or ending your life. It may be scary to think about actually acting on these impulses, but you believe that self-harm would help you feel better. You start thinking about the possibility more and more.
Overcoming self-harm and OCD with treatment
Whether you live with self-harm or OCD about self-harm (or both), you deserve support. Life doesn’t need to feel this way forever. Research shows that often, just getting the right diagnosis of OCD can be helpful in reducing the intense distress that can come along with self-harm urges.
Therapy can help you understand your OCD symptoms and learn more about how they could lead to self-harm. Rather than allowing obsessive thoughts to take over, you can learn to recognize them as what they are — just thoughts — and start to reconnect with the world around you.
A type of cognitive behavioral therapy called exposure and response prevention (ERP) is considered the first-choice treatment for OCD. ERP guides you to intentionally expose yourself, in a safe therapeutic setting, to obsessive fears. Then, your therapist will support you in tolerating the intense feelings that come from obsessions without engaging in compulsions.
Medication can also be helpful for managing OCD symptoms.
A common misconception is that people with OCD who experience intrusive thoughts about self-harm actually want to hurt themselves. In reality, these thoughts are unwanted and cause significant distress. With therapy, people can learn to manage their thoughts without acting on them.
Find care with Rula
OCD and self-harm urges can be confusing to navigate. Not only is it tricky to distinguish between OCD about self-harm and actual self-harm urges, but some people can experience both. With therapy, you can explore and process your internal experiences and get evidence-backed techniques to overcome both OCD and self-harm.
At Rula, we’re committed to delivering a comprehensive behavioral health experience that helps people feel seen and understood so they can get back to feeling their best.
Rula makes it easier to find a licensed therapist or psychiatric provider who accepts your insurance so you don’t have to choose between affordable care and excellent care. With a diverse network of more than 15,000 providers, 24/7 crisis support, and appointments available as soon as tomorrow, we’re here to help you make progress — wherever you are on your mental health journey.
About the author
Saya Des Marais
Saya graduated with her Master in Social Work (MSW) with a concentration in mental health from the University of Southern California in 2010. She formerly worked as a therapist and motivational interviewing trainer in community clinics, public schools, mental health startups, and more.
Her writing has been featured in FORTUNE, GoodRX, PsychCentral, and dozens of mental health apps and therapy websites. Through both her clinical work and her personal OCD diagnosis, she’s learned the importance of making empathetic and accurate mental health content available online.
She lives in Portland, Oregon but you can find her almost just as often in Mexico or in her birthplace, Tokyo.
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