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Harm inducing types of thoughts, images and urges are typically referred to as Harm OCD and they can cause significant distress and anxiety in sufferers.

The ability to be ourselves with clients makes it so much easier to connect, to be real about how challenging treatment is, and enlist their help to ensure that whatever the exposure is, its something they can tolerate, trust in, and most importantly, begin to experience relief from their intrusive thoughts and the compulsions that may dominate their lives. 

The most common rituals for this form of OCD is confessing thoughts to parents and seeking reassurance.  While this is the most distressing part for parents, the good news is that if the parents are involved, they can help their children.