Self-Harm OCD

Self-harm OCD is similar to Harm OCD in that there's uncertainty, anxiety and distress around causing harm. However, with self-harm OCD, the fear is around causing harm to oneself. As with nearly all forms of OCD, the anxiety is fueled by the uncertainty of whether the scary thing will occur. In this case, the uncertainty is about whether someone will or want to cause harm to oneself. The usual responses are avoidance and limiting contact with objects that could case harm.

Obsessions

intrusive thoughts about causing harm to yourself
vivid images of causing violence to yourself
worries about having full control over your movements and actions
questioning your true intentions and whether you want to harm yourself

Compulsions

avoidance of places where harm is easily accessible (top of a building or on a steep hike)
reducing or eliminating contact with objects or substances that could cause harm
purposely testing what happens when around a dangerous object
seeking reassurance from others that you are not a danger to yourself
excessive time spent thinking about self-harm thoughts and intentions
internet research to resolve the uncertainty of whether you are truly suicidal

Additional Symptoms

extreme distress from intrusive thoughts
cyclic nature of intrusive thought followed by anxiety and then seeking certainty and relief
feeling uncertain in your ability to control your movements, actions and body
worries about harm to others with or without intent
terrified of impulsively harming oneself
guilt and shame

The Problem with Seeking Certainty

OCD comes with urges to engage in compulsions, either mental or behavioral. These compulsions are in pursuit of 100% certainty that the feared outcome will not happen. For example, keeping an excessive distance when near a balcony off ground level makes you feel more certain you won't spontaneously or impulsively jump off the edge. The way the cycle of OCD works is that the more restrictions you have to eliminate the possibility of harming yourself, the more you rely on these rules to keep you safe. But new triggers will continue to pop up and responding with only avoidance, limitations and false security puts your efforts in the wrong place.