Not All Harm Is Risk: Differential Assessment of Harm OCD, Suicidal Ideation, and NSSI

Not all thoughts of harm signal risk—and not all risk presents as intrusive thoughts. This talk will examine the clinical distinctions between harm-related obsessive–compulsive disorder (Harm OCD) and genuine suicidal ideation (SI) and non-suicidal self-injury (NSSI) urges, with emphasis on accurate assessment and differential formulation. We will review key phenomenological markers that differentiate ego-dystonic intrusive thoughts from intent-driven risk states and outline how misclassification can lead to inappropriate or ineffective intervention. The presentation will compare evidence-based treatment approaches for each presentation and highlight common pitfalls in clinical decision-making. Presenters will underscore the critical role of structured collaboration between mental health, medical, and risk-management providers to support safety with diagnostic and treatment precision.

Learning Objectives:

By the end of this presentation, participants will be able to:

1.     Describe key features that differentiate harm-related obsessive–compulsive disorder (harm-OCD) from suicidal ideation (SI) and non-suicidal self-injury (NSSI) urges.

2.    Compare and analyze…