What Is Suicidal OCD?

All thoughts of suicide or self-harm should be taken seriously. If you or someone you know has reported thoughts of self-harm, please call 911 or contact your local emergency room number immediately. In the United States, you may also call the National Suicide Prevention Lifeline at 1-800-273-8255 or text at https://www.crisistextline.org/. This line is available to you all day, every day.

Suicidal OCD symptoms

Suicidal obsessive-compulsive disorder (OCD) is an OCD subtype that includes unwanted thoughts, images, or impulses related to killing oneself. It is closely related to harm OCD (HOCD) and is also known as harm OCD with suicidal obsessions. Suicidal thoughts should always be taken seriously, which can make symptoms of suicidal OCD especially frightening and alarming. But people with suicidal OCD are not more likely to commit suicide than people with other OCD subtypes. In fact, suicidal OCD is driven by the need to protect oneself from potential self-harm. While an individual with suicidal OCD often views their intrusive and unwanted thoughts as an indication of desire to act, their compulsions are often aimed at protecting themselves from the risk of harm. Rather than seeking out opportunities to hurt themselves, they may avoid places they know will trigger suicidal thoughts or stay away from scenarios where they have a chance to cause harm to themselves.

Intrusive thoughts about suicide are relatively common even for people who don’t have OCD, but these thoughts generally only last a few seconds at most. For example, it’s not unusual to wonder, “What happens if I jump?” when leaning off a balcony. When this happens, people will generally think, “That was a weird thought,” and forget about it. 

However, most people with suicidal OCD find thoughts like these are impossible to let go of. When someone with suicidal OCD catches themselves with a thought like this, their OCD latches on and assigns meaning to it. Suddenly, the person will think, “I just had a thought that I wanted to jump. That means I do. Otherwise, why did I just think that?” These thoughts will spiral until they feel unbearable. A person might start thinking, “How could I do this to my friends and family? What will my parents think if they knew I had this thought?”

Suicidal OCD thoughts, urges and impulses: some examples

• Intrusive and graphic images of hurting oneself in specific ways
• Experiencing an urge to jump when looking below from a mountain, skyscraper or balcony
• Experiencing an urge to drive one’s car off of a cliff or bridge or into oncoming traffic
• Wondering what it would feel like to jump from a balcony
• Experiencing an image of hurting oneself with a household object
• Leaning on the railing of a boat and experiencing an urge to jump into the water 
• Imagining jumping in front of the train when standing on a train platform

Suicidal OCD compulsions: some examples

• Reassurance seeking: A person with suicidal OCD may reach out to friends or family to seek reassurance about whether what they are experiencing is normal. They may ask questions like, “This might be a weird question, but do you ever think about jumping in front of a train?” They might ask, “Do you think it’s normal to worry about falling from a balcony?” These questions are meant to reassure the sufferer that they are not in danger of committing suicide. 
• Mental review: They may also engage in mental reviewing to convince and reassure themselves that they are not in danger of committing suicide. They may review every time they have gone on the same hike and looked at the same view without anything happening as a way to prove to themselves that they are not suicidal. They may mentally try and answer questions like, “How likely is it that I will act on these thoughts?” or, “Do other people experience these thoughts, too?” They may spend hours researching these questions online. 
• Avoidance: An individual may get rid of any object in their house that could be used to cause them harm, including ones they may need, like a kitchen knife or scissors. They may avoid places where their suicidal thoughts or images are more likely to be activated, like a balcony or a bridge.
• Comparison: A person may spend a lot of time researching cases of actual suicide and comparing themselves to the victim. They may think, “This person was 27, and I am 27. Does this mean I’m in danger?” or, “This person was an only child, and I’m an only child. Is there any significance to this?”

Suicidal OCD ERP therapy

The best course of treatment for suicidal OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. ERP is considered the gold standard for OCD treatment and has been found 80% effective. The majority of patients experience results within 12-25 sessions. As part of ERP therapy, you’ll track your obsessions and compulsions and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

The idea behind ERP therapy is that exposure to these thoughts is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety. 

ERP takes a targeted approach to address your obsessions and compulsions for suicidal OCD. An ERP-trained therapist will help by reviewing which thoughts or scenarios are causing you the most anxiety and then work with you to come up with a specialized treatment plan to alleviate them through gradual, controlled exposure. 

Examples of suicidal OCD ERP exposures 

Rather than trying to make intrusive thoughts, images and urges about suicide go away with compulsive behavior, ERP therapy works to help a person become more comfortable with them. As a patient becomes more familiar with these unwanted thoughts, the obsessions will begin to loosen their grip on their mind. 

Let’s use a specific example: A person may experience an intrusive and unwanted urge to jump in front of a train every time they stand on a platform. Each time this happens, the fear that they will act impulsively and actually jump is so overwhelming, the person leaves the platform immediately. When working with an ERP-trained therapist, this patient might practice standing on a train platform and noticing the anxiety that comes up when they experience an urge to jump. 

With a therapist, the person will work to become comfortable with these urges. At first, staying on the platform may feel unbearable in the face of the patient’s fear and anxiety. The patient may start their treatment by working with the therapist to extend the time between the moment they experience an intrusive urge to jump and when they leave the platform. That may only be a couple of seconds at first. But over the weeks of treatment, it may extend to an entire minute. Eventually, the patient may find they are able to stay on the platform for five whole minutes, and, in time, their anxiety subsides to the point where they no longer need to leave the platform. 

How to get help

It’s an unfortunate reality that people with suicidal OCD are often misdiagnosed as experiencing suicidal ideation. The condition of suicidal OCD is terrifying and painful, but it’s also fundamentally different from suicidal ideation: It is driven by a concern to protect oneself, rather than harm oneself.
 

A mental health professional who specializes in OCD will be able to make an accurate diagnosis. If you have or think you might have suicidal OCD, you can schedule a free call with the NOCD clinical team to find out how ERP therapy can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live face-to-face video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment.

Learn more about suicidal OCD

• Suicidal OCD: Thoughts, Obsessions & Treatment
• Suicidal OCD and ERP: Can They Work Together To Treat You?
• My Story: Overcoming Several Forms of OCD