What Happens When Self-Harm Is Your OCD Compulsion

As someone whose primary diagnosis is bipolar disorder, that’s usually what I’m focused on stabilizing– and I’m really good at it. I recognize my early warning signs, reach out to my treatment team for help and am extremely honest about my symptoms. However, being so focused on one disorder and thinking the others are “cured” or won’t be problematic again due to being in remission for so long can lead me to trouble.

The instance I’m talking about this time refers to how obsessive compulsive disorder, or OCD, snuck up on me. I thought I was just going through a bipolar depressive episode for an extended duration of time. No medication changes were helping, but I thought maybe it was situational as I was also under a lot of stress. In hindsight, my OCD symptoms were there in plain sight, but I was somehow able to justify them as being under control and non-bothersome.

Until they were and I was calling off of work due to intrusive thoughts and being unable to stay safe. Still, I justified it as, “Maybe I’m experiencing psychosis and these are command hallucinations.” I thought it had to be bipolar disorder. That’s just my primary diagnosis. It’s what I struggle with the most. So, when my therapist suggested I needed inpatient and the thoughts may be related to OCD, I was thrown off guard, to say the least.

When I was admitted to the hospital, it was a different story. I explained my symptoms and they asked me questions to clarify if it was indeed psychosis or OCD. It didn’t take long to determine it was OCD. Even more surprising, though, was the conclusion that my self-harm was a compulsion.

At first, that seemed like a cop-out. I didn’t want to admit it because I’ve self-harmed on and off for fourteen years. However, when it was explained to me, it made sense. This wasn’t a habit I just couldn’t kick. It was deeply ingrained in my brain as a way to prevent me from engaging in the things my intrusive thoughts convince me I might do.

For reference, I have harm OCD, which is a subset of OCD where you get intrusive thoughts about harming others and obsess on them to the point of distress. For me, this mainly comes out with intrusive thoughts about hurting my loved ones, which is extremely terrifying. I’m constantly afraid that I may go into a black rage and hurt or kill those I care deeply about, including my husband and two dogs. For me, this means that when I feel intense emotions or a loss of control, it feels like I may slip into a black rage and my intrusive thoughts will come true. So, in response, I self-harm.

In my mind, self-harm is a preventative measure. Although it sounds irrational, I genuinely believe that if I hurt myself, I won’t hurt other people or slip into that black rage I’m so fearful of.

And, for the record, when I’m calm I know that doesn’t make much sense to others. But to me, it does. “As long as I hurt myself in some way, I won’t hurt others,” has become a comforting thought and a way to make sure my intrusive thoughts won’t come true.

So, yes, in a way, self-harming is still just an unhealthy coping mechanism, but it’s also a harder cycle to break because if I don’t self-harm I truly believe the alternative is severely hurting someone I love. For me, it’s to the point where if I don’t self-harm, I become suicidal due to the immense anxiety and panic it causes because I don’t want to be a bad person. I don’t want to hurt anyone else. But if I get intrusive thoughts or feel intense emotions and/or a loss of control, I will hurt them if I don’t self-harm.

Right now, I’m in the midst of a partial hospitalization program (PHP) where I do exposures for hours each day to combat these fears and it’s hard. It’s really hard, in fact. Most days, I don’t want to show up because the exposures are pretty excruciating to sit through. But I show up anyway. I’m trying. I want to get better, and I know I can’t go another 14 years with self-harming as a compulsion. I can’t keep calling off of work due to intrusive thoughts. I need to combat this somehow. I just started the program, so at the moment, combatting my OCD still feels impossible, but I’m trying to keep an open mind. I want to get better, I just don’t know how.

I’m determined to figure it out eventually, though. And when I do, maybe I’ll come back to this article and reminisce on how far I’ve come. I’m not there yet, but one day I will be. Right?

I’d like to hope so.