Suicidal OCD: A Complete Guide
Suicidal obsessive-compulsive disorder is categorized by the terrifying and unwanted fears about killing oneself.
Closely linked to Harm OCD, this subtype is sometimes called harm OCD with suicidal obsessions. Although the fears of potentially harming oneself feel very real, suicidal OCD is actually driven by the desire to protect oneself from harm.
Those with this subtype are no more likely to die by suicide than any other OCD subtype.
However, those thoughts, images, and urges are petrifying because – in classic OCD fashion – they cause the sufferer to question why they would experience them in the first place.
People with suicidal OCD wonder why they would imagine ending their life and apply meaning to those obsessions believing that it is a sign of an underlying desire to commit the act.
This isn’t true.
Those thoughts and feelings are not an indication that you want to act on them.
OCD obsessions are egodystonic, meaning that the person has these thoughts repetitively but they do not line up with their values and cause an immense amount of uncertainty.
This is why compulsions are done to eliminate the perceived risk of losing control; the sufferer does not want this outcome for themselves.
NOTE: If you are having thoughts of suicide that are egosyntonic (an actual wish to harm oneself), please contact your nearest emergency room immediately.
What is Suicidal OCD?
Suicidal OCD is a mental health condition defined by fears of losing control and killing oneself. These fears are followed by repetitive and ritualistic behaviors to remove the uncertainty and regain a sense of control, in a bid to avoid that outcome.
It’s important to understand that people with suicidal OCD do not want to die.
In fact, people with this subtype are paralyzed by the idea of killing themselves, which is what prompts the obsessive thoughts.
Everyone experiences intrusive thoughts of this nature, whether they have OCD or not. The difference is that for those without OCD, these thoughts are fleeting. Someone might suddenly experience a flashing image of throwing themselves in front of an oncoming bus and think, “Oh wow! That was weird!” But then carry on with their day as normal.
For someone with suicidal OCD, those intrusive thoughts, images, and urges are incredibly disturbing. They trigger immense uncertainty and anxiety, and the sufferer is left questioning why they would think or feel this way and what might happen if they lose control.
Physical and mental compulsions are then performed in a desperate attempt to reduce all possible risks.
With this subtype, along with many others, such as harm OCD or pedophilia OCD, the stakes feel high.
The potential consequences of not addressing those obsessions and not doing whatever we can to make sure you don’t harm yourself are frightening.
This is how sufferers find themselves trapped in the OCD cycle, as with every obsession and compulsion we engage with, the cycle continues. But for someone with this subtype, it feels dangerous to leave those obsessions alone and carry on without stopping the thoughts or preventing them from happening.
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Suicidal OCD vs Suicidal Ideation
A tremendous struggle for those with OCD, particularly those with subtypes related to harming themselves or others, is differentiating between a thought about an action (obsession) and a genuine intent to commit the action (ideation).
The difference between suicidal OCD and suicidal ideation may seem subtle, but it matters.
Suicidal OCD = Unwanted and disturbing thoughts about suicide.
Suicidal Ideation = Thoughts fuelled by the intention to die by suicide or harm oneself.
It may be difficult to hear, but if you are terrified by the thought of losing control and bringing life-ending harm to yourself, then you likely fall into the category of suicidal OCD.
And the good news here is that there is a treatment that can help you, and you don’t have to keep suffering the way you are.
Those with suicidal ideation often feel a sense of relief as they ruminate on thoughts of suicide, as it is seen as a solution. There is a desire to end their life, which means suicidal thoughts are not unwanted or intrusive – they are welcomed without fear.
Those with suicidal OCD are plagued with intrusive suicidal thoughts that are perceived as a threat. They wish they didn’t have these thoughts, and they hope with every ounce of their being that the outcome never comes to fruition.
Signs and Symptoms of Suicidal OCD
The two core components of OCD across all subtypes are obsessions and compulsions.
In suicidal OCD, obsessions include thoughts, images, urges, feelings, or sensations that fixate on life-ending actions.
These are followed by ritualistic behaviors called compulsions, which are done in an attempt to avoid those fears becoming a reality at all costs.
Suicidal OCD obsessions
- Persistent thoughts about suicide
Someone may experience intrusive thoughts about ways in which they might kill themselves.
They may fear regular driving routes in case they drive their car off a bridge.
They may think about cutting themselves while chopping vegetables for dinner.
They could think about their medicine cabinet and what would happen if they took too many tablets.
- Suicidal Images
Flashes of suicidal images come into their mind.
They may imagine vivid scenarios of cutting themselves, jumping in front of a train, hanging themselves from a tree in their back garden, or walking into oncoming traffic, for example.
- Fear of losing control
They may experience extreme fears about what will happen if they lose control and act on these obsessions.
These often arise as what if thoughts.
They might sound like, what if I lose control and cut my wrists? What if I lose control and drive into that lamppost? What if I lose control and give in to my ‘desires’?
Suicidal OCD compulsions
- Reassurance
People with suicidal OCD may seek reassurance from friends or loved ones to check whether or not these thoughts and urges or suicide are common.
They may ruminate on their thoughts, trying to find the reason why they would think these things.
Hours can be lost trying to ‘solve’ for these obsessions and understand what they must mean about them as a person and how to avoid having those obsessions at all costs.
- Avoidance
Someone with this subtype is likely to avoid people, places, or things that might trigger their obsessions.
For example, they might avoid driving their car for fear of losing control and indulging the urge to drive into oncoming traffic.
They may avoid using all sharp knives in their kitchen for fear of losing control and cutting or stabbing themselves.
They may avoid going to the top of tall buildings for fear that they may lose control and jump off the balcony or throw themselves down the stairs.
- Mental Review
They may also engage in mental review to try and reassure themselves that they are not in danger of committing suicide.
They may try to search through their experiences to prove to themselves that they are safe and that they are not suicidal.
They could also try to mentally answer questions like, “Do other people think this way too?” and “What are the chances I will act on these thoughts?”
Are you in danger of killing yourself if you have Suicidal OCD?
Those with suicidal OCD are no more likely to die by suicide than people with any other OCD theme.
The fears feel very real because it’s a real process that happens inside our minds.
Those thoughts, images, and urges are perceived as a source of threat that triggers our anxious response. Our brain is trying to do its best by protecting us from this perceived danger, but in the case of these obsessions, it misfires.
Our body then experiences the physiological effects of anxiety.
Increased heart rate, feeling on edge, hypervigilance, etc.
Our brains are figuratively screaming, “Something is wrong here! Don’t ignore it!” even though the reality is, there is no real danger.
So those obsessions do feel very real, and you are not crazy if you fear that you might lose control.
However, it’s important to know that having suicidal OCD does not mean you are in greater danger of killing yourself.
No matter which subtype, this is a severe mental health condition that can greatly diminish the quality of life. And so while this again falls into the category of suicidal ideation rather than suicidal OCD, it’s important to be aware that co-occurring disorders such as major depressive disorder can cause suicidal thoughts.
Major depression is a common co-morbid condition that worsens the levels of suicidality in OCD.
Many people with OCD do experience some suicidal ideation and if that is the case, please speak to a medical professional.
IMPORTANT: This is why you must speak to a medical professional and seek support if you notice any signs of suicidal thoughts. Whether it is suicidal OCD, suicidal ideation, or OCD with suicidal thoughts… there is help available for all.
Treatment for Suicidal OCD
Exposure response prevention (ERP) therapy and cognitive behavioral therapy (CBT) are considered the gold standard treatment for suicidal OCD, and all OCD subtypes.
Our clients follow a bespoke treatment plan using these modalities alongside ACT (Acceptance and Commitment Therapy), self-compassion, and mindfulness. This treatment has proven to show incredible results, with our success rates typically surpassing those of recent studies, showing ERP to be 80% effective.
We first begin treatment by educating our clients on OCD and giving them told to help manage the anxiety and uncertainty that they are feeling.
In ERP, you will create a hierarchy of exposures together with your therapist.
You will have the opportunity to practice engaging in situations that trigger those obsessions so you can change your relationship and response to them (giving them less validity and therefore less control) whilst also resisting the urge to do compulsions.
This is so your brain can learn that you are capable of managing uncertainty and anxiety without the use of those safety rituals that overrun your life.
When you continually engage in those compulsive behaviors, you only strengthen OCD’s hold and maintain the OCD cycle. We want to help you break the cycle once and for all.
Our goal is to help you live a life that is fully functioning.
Exposures for suicidal OCD may look like this:
- Standing on a train platform, noticing the anxiety as you experience the urge to jump, and resisting the desire to leave the platform.
- Hold a sharp knife and chop some vegetables for dinner. Notice the anxiety as you experience the urge to cut or stab yourself while resisting the urge to put the knife down.
- Driving your regular route to work, noticing the anxiety, and you experience the urge to drive the car off the bridge while resisting the urge to stop the car or turn around.
The exposures are always gradual, and you will never be asked to do an exposure you don’t feel like you can manage.
You work with your therapist to challenge yourself with exposures that you feel are achievable, and you are always met where you’re at.
1:1 therapy
When clients come to us, they’re often in a state of desperation where fear of ending their life is stopping them from living their life.
When you decide to work with us, you’ll be met by a team of highly qualified mental health professionals and OCD specialists who understand how you feel.
But there is always a sense of hesitation when it comes to starting their recovery. We understand this. You’ve read enough online to know that it’s not plain sailing. It can be tough going.
Having a skilled and understanding therapist to support you will make this journey easier.
A well-trained specialist will not judge you for having those thoughts.
A compassionate ERP therapist will understand that having self-harm thoughts does not mean that you want to harm yourself.
We know that you do not want to harm yourself.
You’ll be welcomed with compassion and empathy. Our clients may hesitate to begin their treatment but they never regret starting, they only wish they’d started sooner.
Recovery isn’t linear, but when you can have your own personal cheerleader and guide in your corner, it makes it easy to make it through the tough times so you can finally live and find joy in the present moment without OCD stealing your focus with thoughts of suicide.
If you are based in California or Arizona and are seeking 1:1 therapy, please submit an initial intake form here.
Our team is eager to help you take back control from OCD.
Online program
If private therapy is not an option for you, ERP SCHOOL is an online self-paced program that is affordable and accessible for all.
You will be given the exact tools and techniques to stop intrusive thoughts from ruining your life and resist the urge to do compulsions.
You can do all of the things that OCD is currently stopping you from doing. You can live each moment without being paralyzed by fears of losing control.
You will be taught how to apply proven ERP and CBT techniques to your specific fears and obsessions so that you can begin your recovery journey today.
