Suicidal OCD: Thoughts, Obsessions & Treatment

Davida Vaughn, M.S., Ed.S., LPC

Davida Vaughn, M.S., Ed.S., LPC

September 8, 2020

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. This line is available to you all day, every day.

What is Suicidal OCD?

Suicidal OCD is a subtype of OCD in which people fear they will lose control and kill themselves. It is closely tied to Harm OCD and is otherwise known as Harm OCD with Suicidal Obsessions. 

People with Harm OCD experience obsessions about the potential of harm coming to themselves or to others, either accidentally or intentionally. Suicidal OCD occurs when these obsessional fears center on intentional harm to oneself.

Signs and Symptoms of Suicidal OCD

Suicidal OCD involves thoughts that are fixated on life-ending actions or risks, and extreme attempts to avoid them. Signs someone might be experiencing Suicidal OCD include:

  • Intrusive images of stabbing, cutting, or causing life-threatening harm to oneself;
  • Thoughts that express a desire to kill oneself that cause fear or anxiety;
  • Attempts to avoid unwanted suicide (i.e., locking away or throwing away all sharp objects even if they are useful items, like kitchen knives);
  • Suicidal thoughts that are unwanted and persistent;
  • Repetitive behaviors aimed at suppressing suicidal thoughts;
  • Constantly seeking reassurance from friends and family; 
  • Constantly reassuring oneself that suicide will not occur;

Suicidal Obsessions vs. Suicidal Ideation: What is the difference?

As with many other OCD themes, it can be difficult for people with Suicidal OCD to differentiate between a thought about an action (obsession) and a genuine intention to commit the action (ideation). 

Suicidal Obsessions – Unwanted Thoughts About Suicide: 

People with Suicidal OCD experience suicidal thoughts that feel outside of their control. These thoughts are intrusive, persistent, unwanted, and feel repugnant. People with Suicidal OCD do not truly want to die and their obsessive thoughts cause them significant distress.

In response to that distress, people with Suicidal OCD perform compulsions that provide short term relief. These compulsions are aimed at avoiding suicidal thoughts and reducing the risk of self-harm.

Suicidal Ideations – Deliberate Intentions to Commit Suicide: 

On the other hand, suicidal ideations are deliberate thoughts about ending one’s own life. People with suicidal ideations think of suicide voluntarily, without feeling the need to avoid or suppress the thought.

For people with suicidal ideations, thoughts of suicide can produce a sense of relief and can be seen as a solution. They have an actual wish to die, and therefore suicidal thoughts do not feel intrusive or unwanted. 

These thoughts can be active (i.e., having a plan to carry it out) or passive (i.e., fleeting, with no plans to carry it out). In either case, they are connected to a wish to die.

People with genuine suicidal ideations do not see their suicidal thoughts as an external threat. These thoughts are compatible with who they are and what they value or believe.

That said, the key difference between suicidal obsessions and suicidal ideations is a true wish to die. People with genuine suicidal ideations actually do want to die, whereas people with Suicidal OCD do not. OCD obsessions are, by definition, unwanted and do not align with personal values or beliefs. A person with suicidal obsessions will try to avoid suicide by any means necessary – often to the point dysfunction or impairment in their life.  

If I Have Suicidal OCD, am I in Danger of Killing Myself?

People with Suicidal OCD are no more likely to take their own lives than people with any other OCD theme. 

That said, people with OCD, regardless of theme, are at an increased risk for attempted and completed suicide. Suicidal ideations occur in 20 – 46% of individuals who have OCD.

These ideations in people with OCD can be related to other psychiatric conditions, most commonly Major Depressive Disorder (MDD). Co-occurring disorders can also cause suicidal thoughts, which can make diagnosis and treatment an involved process.

In all cases, a person with suicidal thoughts should seek professional help. Whether it is a case of Suicidal OCD, another disorder, or multiple disorders at the same time, treatment is available. 

Woman sitting on top of mountain

How is Suicidal OCD Treated?

Exposure and Response Prevention, the gold-standard treatment for OCD, has been found to effectively treat suicidal OCD. Exposure and Response prevention is an approach to treatment that uses methods of cognitive-behavioral therapy to prevent fear-avoidance and compulsive responses to obsessive fears, making coping with intense feelings more manageable. 

If you are concerned about whether you are struggling with suicidal obsessions, a therapist trained in OCD can help. You can schedule a free call with the NOCD clinical team to learn more about working with one of our licensed therapists, and how they can help you get better.

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