Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What Is Suicidal OCD? Signs, Symptoms, and Treatment

Oct 25, 20237 minute read

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.

While there are many subtypes of obsessive-compulsive disorder (OCD), only a few are easily recognized by most people—themes focused on a fear of contamination or an intense need for order and symmetry are commonly associated with OCD, for example.

One theme of OCD that is not understood well, however—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 are very different from suicidal ideation, and actually come from a desire to protect oneself.

In this article, we’ll delve deeper into what suicidal OCD is and how specialized OCD therapists, like myself, are able to diagnose it and distinguish it from suicidal ideation. And if you think you may be suffering from suicidal OCD ourself, please have hope: this condition is highly treatable. I’ll 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 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 images: some examples

While this is not an exhaustive list, here are some examples of the thoughts and urges that people with suicidal OCD might experience, leading to intense distress and compulsive responses:

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 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?”

How Suicidal OCD is treated

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 supported by rigorous scientific research spanning decades.

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. 

Let’s use a specific example: A person experiences an intrusive and unwanted urge to jump in front of a train when they commute to work. When working with their therapist, they might start by just reading stories about people who died on train tracks, allowing themself to feel anxious as they read. With their therapist, they’ll will work to become more comfortable with these uncomfortable feelings—then, they can take their exercises to the train station itself.

They might start by just delaying leaving the platform—it may only be a couple of seconds at first. But over the weeks of treatment, it may extend to an entire minute. Eventually, they’ll find they can stay on the platform for five whole minutes. Soon, their anxiety subsides to the point where they can comfortably commute to work, at ease with the fact that they won’t act on intrusive impulses.

If you come away from this article with anything, let it be hope: effective care for suicidal OCD is accessible to you, and I can say from personal experience that you don’t have to feel this way forever.

Where to go for help

It’s an unfortunate reality that people with suicidal OCD are often misdiagnosed as experiencing suicidal ideation. Suicidal OCD is terrifying and painful, but it’s also fundamentally different from suicidal ideation: It’s actually driven by a concern to protect oneself rather than harm oneself. Sadly, many people who need treatment for OCD may hold back from seeking help, fearing that their symptoms will be misunderstood.

A mental health professional who specializes in OCD will be able to make an accurate diagnosis, so it’s crucial to find someone with the right specialized training and experience in OCD. Here at NOCD, all of our therapists specialize in OCD and receive intensive ERP-specific training. In fact, many of them have dealt with OCD themselves and understand how crucial ERP therapy is.

We specialize in treating Suicidal OCD

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