A Look Into Suicidal OCD

What is suicidal OCD?

These obsessions understandably cause extreme distress, fear, and anxiety for the individual. They will spend a great deal of time focusing on their obsessions. The high anxiety as a result of these obsessions will lead the individual to carry out compulsions to try to cope with their feelings. They may perform compulsions to try to lessen anxiety or to ‘prevent’ themselves from acting on their obsessions. However, just like with other forms of OCD, compulsions only ease anxiety in the short term: it comes back with vengeance and means you have to carry out increasing numbers of compulsions.

Suicidal OCD is sometimes referred to as S-OCD. It’s important to note that both suicidal OCD and S-OCD are ‘nicknames’ based on the type of obsessions experienced, rather than an official diagnosis. These phrases simply help professionals and individuals to identify their symptoms and seek appropriate help.

Suicidal OCD obsessions

Persistent thoughts about suicide

If you struggle with this type of obsession you will experience persistent intrusive thoughts about suicide which are very difficult to take your attention away from. You may focus on feelings that you have, particularly negative feelings, wondering if they mean you are feeling suicidal. You might think you feel suicidal and naturally find this very upsetting.

Suicidal images

You may also experience intrusive suicidal images such as, “images of stabbing, cutting, or causing life-threatening harm to oneself.” These can happen at any time. Sometimes they can be in reaction to something in your environment, for example if you’re cooking with a knife, and you have an intrusive image of stabbing yourself. Another example is walking down a pavement with cars passing by on the road, and having a sudden image of throwing yourself in front of a car. Alternatively, they can happen at any time of the day or night without a specific trigger. These images can be extremely vivid and realistic, which only makes them more distressing.

Fear of dying by suicide

It’s common to have a deep set fear of dying by suicide. You might fear that you are going to lose control of yourself and kill yourself. These fears are amplified as you will feel that this isn’t what you really want, and you are likely to worry that it’s going to happen before you have a chance to stop it. You may fear losing your life to these feelings and feel panicked at the thought of all you will miss out on. It’s also common to think about how your family and friends will feel if you die by suicide, and find this understandably distressing.

Thoughts of how you could kill yourself

You may find you have persistent thoughts and images surrounding the various ways you could kill yourself. These may plague you when you are going about your daily life with seemingly no ‘reason’. Alternatively, like the images we mentioned earlier, these images and thoughts could occur in reaction to something in your environment. For example, if you’re on a train you might picture jumping in front of a train, or if you’re driving a car, you may have a thought about driving it into a wall.

Fear of becoming mentally unstable

Some people with suicidal OCD fear getting another serious mental illness which could make them mentally unstable or psychotic. They might fear becoming deeply depressed or experiencing a mental breakdown. They will fear that this mental instability could lead to them dying by suicide.

Suicidal OCD compulsions

Just as with obsessions, compulsions can vary even within one type since we’re all individual and have different lives. We’ll cover some of the more common compulsions experienced in suicidal OCD.

Checking

Checking compulsions in suicidal OCD often involve repeatedly checking your surroundings for risk factors, such as being on the lookout for things that you might be able to use to harm yourself. Another common manifestation of checking compulsions is checking the internet for information about suicide and sucidial thoughts, to try to confirm that your thoughts don’t mean you are going to harm yourself.

You might look up stories of people who have who died by suicide and go over and over them. You might check for similarities in your own feelings and obsessions. You may also note differences. You might be fixated on reading them and checking them for ‘signs’ repeatedly.

If you struggle with these compulsions, you might find that you are checking other things in your environment which perhaps might seem unrelated to your compulsions. This might include repeatedly checking that the door is locked when you leave the house, or checking you’ve turned the oven off. You might feel that you need to check these things in a specific way in order to prevent yourself dying by suicide.

Mental review, checking, and reassurance

As well as physically checking, it’s common to experience mental review and checking. This entails mentally thinking about specific memories, events, or ideas. This is often in an effort to look for evidence that your obsessions won’t come true and that you aren’t really suicidal, or to seek evidence that they are true. For example, you might mentally go over past memories within which you were happy and use them as proof that your obsessions aren’t true. Conversely, you might think back to an event where you were unhappy and stressed, and worry that this is a sign that you are suicidal.

You might mentally go through the house and think about where there are items you could use to harm yourself. You might find that you have a checklist of things you need to mentally check in a specific order, in order to prevent yourself acting on your obsessions. You might try to reassure yourself mentally. You could do this by going over your mental illness history or by mentally listing reasons you wouldn’t act on your obsessions.

You might review facts, such as whether you’ve tried to harm yourself in the past and how often; whether you’ve made an actual suicide plan; or whether you have gathered any means to harm yourself. You might also regularly check to see whether you still feel the same way, or to see if you have any feelings you would describe as depression or suicidal ideation.

Reassurance seeking

As well as mentally seeking reassurance, it’s common to find that you are seeking reassurance from loved ones. You may repeatedly ask them to reassure you that you are ok or that you are mentally stable. You might ask them if your intrusive thoughts are normal. You may seek ‘evidence’ from them that you are not suicidal and that you are happy. You might ask them to assure you that you are not in danger of acting on your obsessions.

You may focus this reassurance seeking on family members, or you may ask a religious figure, a doctor, your therapist, or another mental health professional. In essence this reassurance seeking, both mental and psychical, is trying to get a certain answer that you are safe and not going to harm yourself. Of course, this certainty can not be found which only compounds the anxiety.

Rumination

Rumination is a mental compulsion which entails compulsively thinking about and going over an intrusive thought. You might focus on feelings, memories, and any events relating to your obsessions and find it hard to draw your attention away from them. You might go over and over every aspect of your obsession in your mind. A lot of the rumination in suicidal OCD focuses on trying to determine whether you will act on your thoughts, and attempting to figure out how you really feel.

Avoidance

It’s very common for anyone with OCD to avoid things which might trigger their obsessions. Someone with suicidal OCD might avoid anything that will trigger their intrusive thoughts, as well as anything which they could potentially harm themselves with.

For example, if someone has intrusive thoughts or images around stabbing themselves, they may hide or get rid of all the knives in the house. If you were to struggle with thoughts of stepping in front of a train, you might avoid train stations and use other methods of transport. If you struggle with thoughts of drowning yourself, you might avoid walking past rivers or going swimming for example, and so the list continues.

Counting

Someone with counting compulsions may need to count to specific numbers in their head or out loud repeatedly. They might need to carry out an action a specific number of times, to ‘prevent’ themselves from dying by suicide. These actions may seem related to their obsessions, or they may just be daily tasks which seem unrelated, such as how many times you wash your hands or walk through a door. When we say unrelated, it’s important to note that these actions seem unrelated to the individual’s obsessions from an outside perspective, but in their mind OCD has linked the obsession and the action intrinsically.

They might have lucky and unlucky numbers: they might fear that any inclusion of unlucky numbers in their life increases their chances of suicide, while lucky numbers help to fend it off. For example, if you walked past a house that had an unlucky number, you might suddenly have a deep fear that you are going to harm yourself. Likewise, if you went to a restaurant and were assigned an unlucky table number, you might fear it’s a sign that of your impending suicide.

Repeating

Repeating compulsions might involve needing to repeat an everyday task until it ‘feels right’ or until you feel it stops you from acting on your obsessions. This could be directly to suicidal obsessions, such as repeatedly checking there’s nothing in the home you could hurt yourself with. Alternatively, it could seem unrelated such as repeatedly washing your hands or tapping on a surface over and over again.

Arranging and symmetry

This compulsion involves arranging things in a specific order or symmetrically. This could apply to anything, from belongings like clothes, to items on your plate. You might feel that you need to arrange items until they feel ‘just right’ or ‘safe’. If you struggle with this compulsion it’s likely you will feel very distressed if this order is disturbed: you might feel that anything out of place means you are going to die by suicide.

Thought neutralization

Thought neutralization involves trying to replace a negative thought with a positive one, to ‘cancel out’ the negative. For example in suicidial OCD, when an intrusive thought about suicide crosses your mind you would actively think about something happy instead, such as a happy memory.

While this might seem harmless, just like other compulsions it actually feeds into the OCD cycle. By reacting to the intrusive thought, you’re reinforcing in your mind that it’s important and significant. This only gives the intrusive thought more power.

Prayers and mantras

This compulsion involves praying or repeating specific phrases in your mind or out loud to try to cope with obsessions. This might involve praying to God that you are not going to die and to keep you safe. It may involve repeating mantras such as, “I’m safe,” or “I’m not suicidal” to comfort yourself.

Wishing

If you experience wishing compulsions, you will repeatedly wish that your obsessions would go away. The act of wishing can be out loud or within your mind: it becomes repetitive and all consuming. Just like the other compulsions, this feeds into the OCD cycle.

Evaluating risk

Just as with other forms of OCD, the obsessions are so upsetting to an individual with suicidal OCD exactly because they don’t reflect their true feelings: they do not want to die. Their compulsions are focused around desperately trying to ensure that they do not act on their obsessions, precisely because they are frightened by their thoughts and want to stay alive.

This article explains aptly that the intrusive thoughts experienced by those with suicidal OCD are unwanted. In contrast, “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.”

The distinct difference is that those with suicidal ideation (meaning they are suicidal) are thinking about suicide of their own accord. Their thoughts are not external, they come from within the individual as a result of a deep emotional crisis. As a result of this mental health crisis, someone who is suicidal is likely feeling very drawn to act on their thoughts. Someone with suicidal OCD is not suicidal and their thoughts don’t align with their real feelings or beliefs: they are not drawn to act on their thoughts and in fact, are desperate not to.

What to do if you have symptoms of suicidal OCD

Talk to someone you trust

The first thing you should do is talk to somebody you trust, whether it’s a friend or family member. You’re going through a lot and you don’t have to go through it on your own. Rather than bottle things up, open up and allow those who love you to be there for you. They may just be there to listen, or they may be able to offer practical help such as attending appointments with you and helping you with therapy techniques.

Monitor your symptoms

Keeping a note of your symptoms is a really good step as it allows both yourself and medical professionals to get a clearer view of what you’re going through. It’s a great idea to write down when your symptoms occur; how severe they are; how they affect you; what they are in reaction to; and anything else you notice.

Seek treatment

It’s important to note that medical professionals may find it difficult to tell the difference between true suicidal intention and the risk of you ending your life, compared with suicide related obsessions. They want to keep you safe, and so may take steps to ensure you are not at risk.

However, it’s vital you don’t let this stop you from reaching out for help. Seeking help is how you can reclaim your life from your OCD and start your recovery journey. Remember that the more honest, open, and clear you are with professionals (even though it’s hard), the more likely they are to get a clearer picture of what you’re actually going through.

You can seek treatment through your doctor: if you do go to your doctor for help, ensure you advocate to be referred to a mental health professional. An OCD specialist is likely to understand your symptoms and be able to provide you the treatment you truly need. If you’re already under the care of a mental health professional, you could mention your symptoms to them. Alternatives for treatment include seeking treatment privately, or using an online OCD treatment programme.

Exposure and response prevention (ERP)

ERP is the first line of treatment for all forms of OCD. ERP is a form of cognitive behavioural therapy (CBT), which works to help you face your obsessions without reacting with compulsions. This is done very gradually, under guidance, so that you are able to cope. This article from the Anxiety and Depression Association of America states: “ERP entails flipping the typical OCD experience on its head by practicing bringing on intrusive, anxiety provoking thoughts while disengaging from any compulsions (both physical and mental) that have been utilized to obtain short-term anxiety relief.”

You’ll start with your least feared obsession and deliberately face it: you’ll experience the feelings which come along with that, without reacting with a compulsion. This actively breaks the OCD cycle. The mental health charity Made of Millions explains: “By repeatedly facing something you’re afraid of, you force your brain to recognize how irrational it is.” Over time, with hard work and consistency, you’ll find your anxiety reducing and you’ll feel more in control.

Mindfulness

Mindfulness focuses on achieving a deep sense of calm and relaxation by being present in the moment. You learn to let thoughts pass you by and experience them objectively, without attaching such meaning to them. This skill can help immensely in tackling intrusive thoughts and learning to experience them without reacting with compulsions.

Due to its usefulness in treating OCD, mindfulness is often used in conjunction with ERP and CBT to bring optimal results for OCD patients. You might also hear the term Mindfulness Based Cognitive Therapy which, “teaches people to identify, understand and change negative thinking patterns and behaviors.”

Mindfulness also helps to reduce anxiety and stress, as well as helping you to sleep more restfully. Mindfulness practices can involve meditation, breathing exercises, mindful movement, or guided visualization. Once you learn the skills of mindfulness, you can use them going forward in your life to help you deal with challenges in an effective, calm way.

Find support

Aside from seeking treatment, it’s also important that you have other forms of support in your life to help you on your recovery journey. As we’ve mentioned, this might be from family and friends. Alternatively, you might want to seek support from others with OCD who can really understand what you are going through. You may be able to find local support groups you can attend, or you could find support online through OCD forums, chat rooms, and even through social media.

How to help a loved one with suicidal OCD

Understand they aren’t a danger to themselves

One of the primary things you need to understand before you’re able to be there for your loved one, is that they are not a danger to themselves. Your loved one doesn’t actually feel suicidal: they don’t want to die. Their obsessions make them fixate on suicide, but they are actually very frigthened by the thought of suicide and their obsessions don’t reflect how they really feel. This article explains: “Family members and loved ones can take comfort in knowing that you’re actually obsessed with saving yourself, not harming yourself.”

Educate yourself

Take your time to read up on suicidal OCD and educate yourself about the disorder. You could read blogs, look up articles, or watch videos. The more informed you are, the better you can understand what your loved one is going through and the better placed you are to help them.

Be there to listen

One of the simplest but most effective ways you can be there for your loved one is by simply being there to listen when they want to talk. You don’t need to know the right answers or say anything profound: you just need to be there. It can truly make the world of difference.

Offer practical support

As well as being there emotionally, offering practical support can be extremely useful. You could offer to take them to appointments and to be there for moral support. You could offer to help with housework, shopping, or cooking: these things are likely to have been put on the back burner while your loved one is so occupied with their obsessions and compulsions.

Get involved in therapy

If your loved one is comfortable with it, getting involved in their therapy can be pivotal. This can allow you to gain a much clearer understanding of your loved one’s disorder, and learn how to help them break the OCD cycle. You may be able to attend some of their sessions or you might be able to talk to their therapist privately. You might also be able to get involved in the ‘homework’ they will likely be given between sessions.

Take care of yourself

It’s also absolutely vital that you take care of yourself. It’s impossible to be there for someone else in the way you want to be, if you are not looking after yourself too. Make sure you take breaks, talk to someone you trust, and practice self-care. Look after your own physical and mental health.

Lastly, it’s important you know that if you do find yourself feeling suicidal, whether you struggle with suicidal OCD or not, that you reach out for help. If you are in immediate danger, call the emergency services. If you are suicidal and need help, call your doctor, a mental health professional, a helpline, or even speak to a loved one. There is no shame in struggling with mental illness, and whether you or not you are suicidal: you are not alone.

References

Davida Vaughn, M.S., Ed.S., LPC, (2020), “Suicidal OCD: Thoughts, Obsessions & Treatment”. Nocd.

Debra Kissen, PhD, M.H.S.A., Paul Greene, PhD, (2019), “Suicidal Thinking vs. Harm OCD Intrusive Thoughts: How Are They Similar & How They Are Different”. Anxiety and Depression Association of America.

Made of Millions, (2020), “Living with Suicidal OCD”.