For most people, there will be times where we’ll get angry or upset and might have a fleeting image of hurting ourselves or hurting the person who caused that emotion. But for the majority of us, we see these thoughts as just that: thoughts. We recognize them as being fleeting and unrepresentative of our character, and we don’t have the urge to actually do the harm we imagine. For people with OCD, they worry that they might actually act on those thoughts.
These are called aggressive compulsions. They can present as you thinking about jumping in front of a subway train or out of a window, for example. Or, you might think about pushing someone else in front of that subway train or out of that window.
“One of the things that’s important to understand with OCD is it knows just what to exploit in the particular individual,” says Carrie Holl, PsyD, a Washington, DC-based clinical psychologist who specializes in OCD treatment. So for someone who’s normally gentle, OCD might present itself in aggressive thoughts, which causes incredible distress for that person.
“It’s like if you’re on a bike, if you start pedaling, it moves the bike along,” says Holl. “Compulsions are what keep the OCD moving along.”