How To Differentiate Self-Injury Versus A Self-Harm Obsession

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This post comes with a trigger warning.

Non-Suicidal Self-Injury (NSSI)

Currently, the general understanding is that people who engage in NSSI do so because they become emotionally overwhelmed with specific stressors. Because NSSI increases cognitive function, individuals feel a sense of calm in which for a little while, they are better able to self-regulate and reason things out on a more rational level.

Harm-intrusive thoughts in obsessive-compulsive disorder (HOCD)

When people have harm-intrusive thoughts, it differs from thinking consciously about NSSI. It’s because the harm obsession isn’t about self-injury in and of itself or to regulate emotions. And that’s despite the fact that someone might have hurt themself. Instead, hurting oneself is the corresponding ritual to relieve anxiety brought on by the intrusive thoughts. For example, Junior X has a symmetry obsession. He says, ‘The ritual of cutting myself with a sharp blade is similar to when I align objects in exact order.’ In other words, Junior X has a compulsive urge to make symmetrical cuts.

As a further example, Miss Z feels anxious about harm coming to others if she doesn’t cut herself, which equates to magical thinking. She says, “If I don’t do what OCD wants, it says my family will die.” She thus gives into the compulsive urge to keep her family safe. 


In NSSI, the logical understanding is that self-regulation is sought after through a negative emotional approach and thus becomes an automatic response. In contrast, compulsions seen in harm OCD show that anxiety relief is sought after through irrational attempts to feel right (symmetry) and to ward off perceived danger (magical thinking). 

  1. True or False: Harming rituals in HOCD do not increase cognitive function, but NSSI does.
  2. True or False: The logical understanding is that NSSI regulates one’s emotions and thus becomes an automatic negative response.
  3. True or False: Compulsions do not relieve anxiety brought on by harm-intrusive thoughts?
  4. True or False: OCD has logical value.
  5. True or False: Despite OCD’s having no validity, one still does compulsions because the end purpose is to feel right, to prevent danger and to relieve anxiety.
See answers below. 

A chapter of my book “Desire-Intrusive Thoughts: What to Do When Sexual, Religious, and Harm Obsessions Carry Unwanted Arousal” discusses harm-intrusive thoughts, NSSI and treatment options for both conditions.

Answers: 1. True 2. True. 3. False 4. False 5. True

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