Suicidal OCD and ERP: Can They Work Together To Treat You?

By Keara Valentine
4 min read
suicidal ocd and erp therapy

Content warning: This post discusses topics of suicide in relation to suicidal OCD and suicidal ideation. Any 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 number immediately. In the United States, you may also call the National Suicide Prevention Lifeline at 1-800-273-8255. 

What is Suicidal OCD? 

Suicide should never be taken lightly. That’s why, for many, the first signs and symptoms of suicidal OCD can be quite frightening and alarming. Suicidal OCD is a subtype of obsessive-compulsive disorder (OCD) that causes unwanted thoughts of suicide or fear of killing oneself, and it is closely tied to harm OCD. It is sometimes referred to as harm OCD with suicidal obsessions. These obsessions often focus around the possibility of harm coming to yourself or others close to you. With suicidal OCD, these thoughts focus around fears of intentional harm to yourself.

Suicidal obsessions vs. suicidal ideation

In understanding suicidal OCD, it’s important to recognize the differences between suicidal obsession and suicidal ideation. Suicidal obsession refers to unwanted or egodystonic thoughts about suicide. People with Suicidal OCD often experience thoughts about suicide that they don’t feel they can control and that don’t align with their values. They don’t want these thoughts — in fact, it’s quite the opposite. That’s actually a hallmark sign of OCD: unwanted thoughts. However, obsessions and anxieties bring these thoughts to the surface, and those with OCD have to work harder than most to push those thoughts out. 

Suicidal ideation, however, is different from suicidal obsession. Suicidal ideation refers to considering or planning to to commit suicide. Someone experiencing suicidal ideation is often voluntarily thinking about ending their life rather than having the unwanted idea of it pop into their head. These thoughts can be active — such as actively having a plan to carry it out — or passive, with a fleeting idea with no plans to carry it out. In either case, someone experiencing suicidal ideation is often brought peace by the idea of suicide rather than further distress. Because of this, their suicidal thoughts don’t feel intrusive or unwanted in the same way that they would in suicidal OCD.

Signs and symptoms of Suicidal OCD

Someone with suicidal OCD fixates on life-ending events and may make extreme attempts to avoid any thoughts around that. Some signs that someone is experiencing suicidal OCD may include: 

  • Persistent, unwanted suicidal thoughts
  • Intrusive images of self-harm 
  • Thoughts expressing a desire to kill oneself that cause fear or anxiety
  • Avoiding unwanted suicide by hiding or getting rid of all sharp objects or objects that are perceived as harmful, even items you use every day, like scissors or kitchen knives 
  • Repetitive behaviors to avoid or suppress suicidal thoughts
  • Constantly seeking reassurance from friends and family or constantly reassuring oneself that suicide will not occur

Experiencing one of these symptoms in passing may just be a fleeting, intrusive thought. However, if you or someone you know experiences one or more of these symptoms more regularly, it could be a sign of suicidal OCD. 

The good news is — like all forms of OCD — suicidal OCD is treatable. You don’t have to live with these fears alone, and you can gain more freedom from your obsessions and compulsions. All it takes is the right treatment provider and a desire to make a change. 

How is Suicidal OCD treated? 

If you’ve read about OCD before, you may have come across exposure and response prevention therapy, or ERP, the gold standard treatment for OCD. ERP is a type of cognitive behavioral therapy (CBT) that has been proven to effectively treat OCD of all kinds, including suicidal OCD. It works by exposing patients to potentially triggering situations or thoughts in order to provoke their obsessions, creating the opportunity to practice the prevention of compulsion responses in a safe and controlled environment. In someone with suicidal OCD, the goal is repeated exposure with response prevention to learn and tolerate distress and anxiety and force your brain to learn that your fears are unlikely to happen. 

If you’re worried that you or someone you know may be struggling with suicidal obsessions, working with a therapist specializing in OCD treatment can help. NOCD offers a nationwide network of licensed therapists specializing in ERP that you’re able to see from your computer or digital device, which means you can schedule a free call today with the NOCD clinical team to get more information and find a therapist that’s right for you. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. At NOCD, all therapists specialize in OCD and receive ERP-specific training.


If you or someone you know has expressed suicidal ideation or reported thoughts of self-harm or suicide, please call 911 or contact your local emergency number immediately. In the United States, you can call the National Suicide Prevention Lifeline at 1-800-273-8255.

If you are struggling with Suicidal OCD, there is hope! The first step is finding the right help by seeking out a provider trained in treating OCD with Exposure and Response Prevention (ERP) Therapy., Schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help. At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP.

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Keara Valentine
WRITTEN BYKeara Valentine