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.
Obsessive-compulsive disorder (OCD) is a mental health condition that causes significant distress due to obsessive thoughts and compulsions. If you or someone close to you has OCD, you know the disorder’s daily impact on your life—including your work, school, and ability to maintain relationships.
While there are many OCD subtypes, one that is not understood well, even by those who suffer from it, is suicidal OCD. Suicidal OCD is linked to unwanted thoughts or impulses about ending your life. Paradoxically, these thoughts come from a desire to protect yourself.
In this article, we’ll delve deeper into what suicidal OCD is and how therapists diagnose it. We’ll also explore the most effective treatment and offer guidance on how to regain control of your life.
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 associated with harm OCD (HOCD) and is also known as harm OCD with suicidal obsessions.
Suicidal thoughts should always be taken seriously. However, 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 you might think that thoughts about suicide indicate wanting to act on that thought, the opposite is true. The real desire is to protect yourself from the risk of harm.
Rather than seeking out opportunities to hurt themselves, you may avoid places you know will trigger suicidal thoughts or stay away from scenarios where you have a chance to cause harm to yourself.
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, most people will think, “That was a weird thought!” and continue their day.
If you have suicidal OCD, however, you’ll know that thoughts like these are impossible to let go of. OCD latches on and assigns meaning to them. Suddenly, you’ll think, “I just had a thought I wanted to jump. That means I do. Otherwise, why did I just think that?”
These thoughts will spiral until they feel unbearable. You might think, “How could I do this to my friends and family? What would my parents think if they knew I had this thought?”
These thoughts will go on and on, often for hours or days, and won’t leave until the person has found temporary relief via their compulsions to dismiss these concerns.
Suicidal OCD thoughts, urges, and impulses: some examples
While this is not an exhaustive list, here are some examples of the thoughts and urges that people with suicidal OCD ruminate on and that lead to compulsions.
- 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
Thoughts like the ones listed above lead people with suicidal OCD to compulsions. Ask yourself if the thoughts you ruminate on lead to any of the following:
Reassurance seeking: If you have suicidal OCD may reach out to friends or family to seek reassurance about whether what you’re experiencing is normal. You may ask questions like, “This might be a weird question, but do you ever think about jumping in front of a train?” Similarly, you might ask, “Do you think worrying about falling from a balcony is normal?” These questions are meant to reassure someone with suicidal OCD they are not in danger of taking their own life.
Mental review: You may also engage in mental reviewing to convince and reassure yourself that you are not in danger of ending your life. You could review every time you have gone on the same hike and looked at the same view without anything happening as a way to prove to yourself that you are not suicidal. You 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?” You may spend hours researching these questions online.
Avoidance: If you have suicidal OCD, you may feel compelled to get rid of any object in your house that could be used to cause yourself harm, including ones you may need, like a kitchen knife or scissors. You may avoid places where your suicidal thoughts or images are more likely to be activated, like a balcony or a bridge.
Comparison: It’s common for someone with suicidal OCD to spend a lot of time researching cases of suicide and comparing themselves to the victim. You 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 list 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. A therapist trained in ERP will ensure that you’re gradually building towards reducing your compulsions rather than moving too quickly and overwhelming you with exposures.
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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 temporary relief your compulsions bring, you’re increasingly likely to use them in response to a trigger.
If, on the other hand, you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond. You 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 devise 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 you become more comfortable with them. As you become more familiar with these unwanted thoughts, the obsessions will begin to loosen their grip on your 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 can 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’s driven by a concern to protect oneself rather than harm oneself.
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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 Care 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 your treatment.