Harm OCD Therapy in San Antonio and Across Texas
Harm OCD is OCD that focuses on fears of causing harm.
Harm OCD centers on unwanted thoughts, images, or urges about hurting yourself or someone else. Most people shrug these thoughts off. With OCD, the thought feels dangerous and meaningful, so you fight it, check it, and avoid anything that might trigger it. The fact that these thoughts terrify you is the point: OCD targets what you care about most.
A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.
How we treat harm OCD: the two leading OCD treatments, at a pace you agree to.
Exposure and Response Prevention (ERP) helps you gradually face the thoughts and situations you've been avoiding, without the checking and reassurance [3, 4]. Inference-Based CBT (I-CBT) helps you see how OCD builds a case for danger out of possibility, so you can trust your actual values again [5].
- Exposures are planned together, and nothing is forced. No exercise ever involves doing anything dangerous.
- Examples include holding a kitchen knife near a loved one or writing out a feared thought, always at a step you've agreed to.
- If ERP isn't the right fit, you can switch to I-CBT without leaving the practice.
A free 15-minute call. No forms, no commitment. Just a conversation about what you're facing.
Common signs of harm OCD
| Obsessions (the thoughts) | Compulsions (what you do to feel safe) |
|---|---|
| Images of stabbing or hitting a loved one | Hiding knives or avoiding the kitchen |
| Fear of snapping or losing control | Avoiding being alone with children, partners, or pets |
| Urges to swerve into traffic or push someone | Replaying the day to make sure nothing happened |
| Worry you hit someone while driving | Driving back to check, or checking the news |
| Fear you might secretly want to hurt someone | Searching online, asking for reassurance, confessing |
| Fear of harming yourself without wanting to | Mentally arguing with the thought or praying it away |
Learn more about our approaches: ERP therapy and I-CBT. Harm fears often overlap with scrupulosity and unwanted sexual or taboo thoughts.
Related types of OCD
Back to OCD therapy at Integratus.
Frequently asked questions
Do I have to tell you my thoughts in detail?
Only when you're ready. It often brings relief to say them out loud to someone who isn't alarmed. We've heard it before.
Will you think I'm dangerous or report me?
No. Unwanted intrusive thoughts are a recognized OCD symptom, not a sign of risk [2]. We'll talk through confidentiality and its limits at your first session so you know exactly where you stand.
Is harm OCD the same as postpartum OCD?
They overlap. Many new parents have intrusive thoughts about their baby being harmed. See our page on perinatal and postpartum OCD.
How long does treatment take?
It varies with your symptoms and goals. We review your progress together regularly and adjust the plan as you go.
Do you offer harm OCD treatment virtually?
Yes. We see clients in person in San Antonio and by secure telehealth anywhere in Texas. You need to be physically in Texas during each session.
How much does it cost?
Individual sessions are $150 for 50 minutes. We're a private-pay practice, and clients working with Luke Mayeux, LPC, can request a superbill for possible out-of-network reimbursement.
References
- Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., et al. (2014). Part 1—You can run but you can't hide: Intrusive thoughts on six continents. Journal of Obsessive-Compulsive and Related Disorders, 3(3), 269–279. https://doi.org/10.1016/j.jocrd.2013.09.002
- Veale, D., Freeston, M., Krebs, G., Heyman, I., & Salkovskis, P. M. (2009). Risk assessment and management in obsessive-compulsive disorder. Advances in Psychiatric Treatment, 15(5), 332–343. https://doi.org/10.1192/apt.bp.107.004705
- Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder: A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. https://doi.org/10.1016/j.cpr.2015.06.003
- Wang, Y., Miguel, C., Ciharova, M., et al. (2024). The effectiveness of psychological treatments for obsessive-compulsive disorders: A meta-analysis of randomized controlled trials published over last 30 years. Psychological Medicine. https://doi.org/10.1017/S0033291724001375
- Aardema, F., Bouchard, S., Koszycki, D., Lavoie, M. E., Audet, J.-S., & O'Connor, K. (2022). Evaluation of inference-based cognitive-behavioral therapy for obsessive-compulsive disorder: A multicenter randomized controlled trial with three treatment modalities. Psychotherapy and Psychosomatics, 91(5), 348–359. https://doi.org/10.1159/000524425
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