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Could I really stab someone with a knife?

Obsessions involving violence are common among persons with obsessive-compulsive disorder (OCD). Sometimes these obsessions are referred to as “harm OCD.”  Often, these obsessions start innocently enough with a fleeting thought — e.g., “Hey, there’s a big steak knife on the kitchen table — it sure would be horrible if I were to stab someone with it…” For many people, this thought will come and go without creating any kind of emotional upset. However, for some OCD sufferers, this thought becomes a recurrent one that is hard to shake. For these unlucky individuals, the more unpleasant it feels, the more likely it is to return —  and the more terrifying it becomes. The thought is often accompanied by reasoning such as, “I know I don’t want to do it… but what if I did! I mean, what if I just lost control for 2 seconds!”  For persons coping with such deeply troubling thoughts, just being around knives or other sharp objects (especially around loved ones) can be nearly impossible.

Through exposure and response prevention (ERP) therapy, one learns different ways to process these thoughts. Typically, your therapist will guide you toward new patterns of thought and behavior that will require you to face some of your fear around knives. This change happens largely as a product of your doing exercises, called exposures, in which you might imagine being in a room with knife and a loved one for several minutes. When these exercises are conducted properly and under the guidance of a therapist using ERP, the fear gradually improves. Many who have used ERP successfully to cope with such obsessions say that as terrifying as these thoughts were initially, the relief they feel after ERP is as gratifying as the obsessions were upsetting.

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