Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What Are Suicidal OCD Exposures? Explanation and Examples

May 13, 20214 minute read

Reviewed byPatrick McGrath, PhD

What are some exposures for suicidal OCD

There is a type of OCD known as harm OCD, where people are focused on potentially causing harm to others or themselves. One form of harm OCD, called suicidal OCD, or suicidal ideation, causes an individual to obsess over the potential of taking of their own life. 

One way to distinguish between the suicidal OCD subtype and actual suicidal intent is that in suicidal OCD the person fears wishes surrounding, thinking about, or imagines taking their own life. They do not wish to actually end their life. They fear having that wish and they fear they will somehow lose control of their mind and go ahead with whatever plan would result in death. 

It’s actually common for people who don’t have OCD to have an errant thought such as, “What if I was to drive my car off this bridge?” or, “What if I was to throw myself through the window?” These thoughts happen, and most people don’t dwell on them. But where OCD has taken hold of someone’s psyche, the person will worry and obsess over these thoughts, images or urges, fearing that they might actually be suicidal and that they may act on these urges. As a result, they can go to extreme lengths with behavioral and mental compulsions to avoid their feared outcomes just to release the anxiety they’re feeling due to their obsessions.


Like any other OCD type or subtype, suicidal OCD is best treated with exposure and response prevention (ERP) therapy. In ERP, we expose a person to the fears their obsessions have attached to, while discouraging the use of any mental or behavioral compulsions. By doing this, the person learns that there is no risk to start with, and therefore doing compulsions is an exercise in futility. They also learn that either their distress will reduce on its own without doing the compulsions, or, alternatively, that they are able to tolerate the distress at any level without actually having to undertake any rituals or compulsions.                                                                                                                                                                    

For suicidal OCD, there are many ERP practices and exposures that can be helpful. I will start with the example mentioned above, where a person is on a bridge and suddenly gets a thought or an urge to drive or walk off it. Obsessing over these thoughts or urges causes distress, so they may decide to change their route to avoid crossing the bridge. Avoidance is a behavioral compulsion. If the person has no other alternative to crossing the bridge, they might do it while engaging in other compulsions, such as praying or counting. 


In an imaginal exposure, we would have this person imagine being on the bridge while driving or walking, without counting or praying. The person thus sits with their anxiety and discomfort, without engaging in any compulsions. 

In an in-vivo exposure, the person would drive across the bridge without doing THEIR   rituals or compulsions. When they safely cross the bridge, they learn that the ritual or compulsion was not actually necessary. They will also learn that they can tolerate their anxiety without using compulsions.

Here’s another example: Let’s say a person obsesses over the thought they will lose control, grab a knife, and fatally injure themselves. They may use avoidance as a compulsion, staying away from knives or other sharp objects. If they have to use a sharp object, they make sure they are never alone, which itself becomes another compulsion. In ERP, we would have this person practice chopping vegetables with a knife while alone at home. Again, by resisting the compulsion and practicing the trigger, they see that they are able to survive the distressing thoughts, and those thoughts may even lessen over time.

Yet another example would be someone who worries they will feel so sad, sick, and tired that they will lose control and overdose on a bottle of pills. This person might add extra safety measures to administering medications, such as keeping their pill bottles in a locked safe or locking the medicine cabinet. They might even make sure that they have no personal access to medicines, instead asking a family member if they need to take a pill. An exposure in this case would be to leave a pill in an unlocked medicine cabinet easily accessed by them. The person sits with the anxiety of knowing this, without using any compulsions such as reassurance seeking from the therapist or a family member that they won’t overdose on the pill. Over time they can leave more pills in the bottle as an ERP exercise. With time and practice, they learn to live with the discomfort of the obsession, and it loses its power over them.

As these examples made clear, suicidal OCD is not a death wish. Quite to the contrary, it is the fear of having such a wish. Suicidal OCD is treatable with ERP. At NOCD, you can get connected to a licensed therapist, specializing in OCD, who will guide you through ERP exercises to recover from this disorder. 

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