Obsessions of physically harming others are common in OCD. Current inventories largely do not include obsessions of emotionally injuring others, of diminishing another’s perceived value or worth. This may reflect a low prevalence rate or specific barriers to identification. Hypothesized barriers to clinical identification of emotional injury OCD include the atypically pleasant presentation of characteristic affirming compulsions. Patient self-identification is hypothesized to be diminished by the nature of overt and mental compulsions; for instance, agreeing with others and self-criticism. Recommendations are provided for differential diagnoses with social anxiety and codependency, as well as specific contraindications for common psychotherapeutic approaches. Hypothesized comorbid pathology are presented as opportunities for initial identification of cases. In establishing an a priori conceptual framework, this overlooked and misidentified OCD subtype can better be assessed, researched, and effectively treated.