OCD can sometimes involve distressing, intrusive thoughts about suicide, typically distinct from genuine suicidal ideation. Treatment like exposure therapy can help individuals heal from harmful thought patterns and lead fulfilling lives.

Those with obsessive-compulsive disorder (OCD) may experience fearful thoughts of suicide, despite also feeling that they don’t really want to end their life. If you have immediate thoughts of harming yourself, you’re not alone. Many people with OCD experience obsessions or compulsions regarding self-harm, including suicide.

While these thoughts may understandably feel very upsetting, regardless of your situation, help is available. There are ways to acknowledge and change harmful thought patterns, including a form of cognitive behavioral therapy (CBT) called exposure and response prevention (ERP).

Suicidal OCD is not a clinically recognized subtype of OCD. However, advocacy organizations and people with OCD use this term frequently as shorthand. With support from loved ones, therapy, and new habits, it’s always possible to lead a happier and more fulfilling life. Here’s what to know about the condition, including how to treat it.

You’re not alone

If you’re experiencing thoughts of suicide, there’s someone ready to support you immediately through the following services:

Some advocacy organizations and people with OCD use the term Suicidal OCD as a shorthand way to describe their symptoms. But, it is not a clinical subtype of OCD. It can involve intrusive, undesired thoughts about suicide. These thoughts are typically not aligned with the person’s values and do not come from a true desire to end one’s life. These thoughts or impulses may occur during any emotional state and are not tied to depression or sadness.

Keep in mind that those with OCD (like many mental health conditions) have a higher risk of suicide overall. A 2017 research study involving more than 37,000 Swedish participants with OCD found that they were 10 times more likely to die by suicide than the general population. Those with the highest risk also have a condition existing simultaneously, such as major depressive disorder, bipolar disorder, or substance use disorder.

It’s important to keep in mind that these statistics have varied widely over the years, and it doesn’t mean it will happen to you. But it isa good reason to seek support.

So, while suicidal OCD doesn’t typically involve genuine intent to follow through with suicide, if you or someone you know is experiencing this condition, seeking therapeutic support or even talking with a trusted loved one about your issue is strongly encouraged. When you reach out, you’re one step closer to attaining peace of mind and leading a life you love.

Suicidal ideation, in clinical terms, is used to indicate that there’s a risk the individual genuinely wants to or will attempt to take their own life. Suicidal ideation may have a higher degree of planning or seem inevitable to the person going through it. Common warning signs of suicidal ideation include:

  • feeling a growing sense of hopelessness
  • talking about or researching death or suicide
  • feeling increased depression
  • changing behavior patterns
  • engaging in self-harm
  • making end-of-life plans
  • giving away possessions or pets
  • making plans to follow through with suicide
  • having a sense of relief when the decision is made

However, intrusive suicidal thoughts in OCD may conflict with the individual’s true values and desires. These intrusive thoughts are likely to be distressing for the person going through them, as they may feel out of their control or dangerous.

If you feel relief at the thought of not committing suicide, then you’re more likely to be experiencing suicidal OCD. But if you feel relief at the idea of ending your life, then you are likely experiencing genuine suicidal ideation. Remember that there’s support available and you can turn your life around today.

Keep in mind that it’s possible to have both suicidal OCD and genuine suicidal ideation or to experience these conditions at different points in life. Regardless of your situation, you deserve support.

Suicidal OCD typically begins with an unwanted, disturbing thought or image about suicide. This is the obsessive component of the condition.

Those with OCD will typically attempt to discern if they really want to harm themselves or if the pervasive thoughts will somehow cause them to die by suicide.

Those with suicidal OCD may experience thoughts such as:

  • Do I really want to hurt myself?
  • Is this what it feels like to be suicidal?
  • Did I just move toward the knife, ledge, etc. because I wanted to hurt myself?
  • What if I just lose it and hurt myself?
  • What if my religion/God will punish me for these thoughts or for committing suicide?

Like most forms of OCD, suicidal OCD typically involves a deep desire to know that everything is totally okay. In this case, you actually won’t self-harm.

Compulsions in response to the suicidal obsessions may include:

  • praying excessively, repeating mantras, performing rituals, etc., to prevent suicide or thoughts of suicide
  • seeking constant reassurance from others
  • avoiding potentially triggering situations, such as standing by a sky-rise window

The pervasive thoughts and/or images associated with suicidal OCD may understandably feel very stressful or traumatic. Without treatment, they may significantly alter your day-to-day quality of life.

However, there are ways to quiet these intrusive thoughts and live with greater peace of mind. Two core treatments include:

  • Exposure response prevention (ERP) therapy: It is a form of CBT that involves exposure to your fear until it no longer holds power over you.
    • Under supervision, your therapist will speak with you. They acknowledge and confront your thoughts and feelings. They will gradually expose you to the concept of suicide in safe ways. Eventually, with practice, you will gain the confidence and experience to fully trust yourself and realize these thoughts needn’t control your life.
  • Selective serotonin reuptake inhibitors (SSRIs): They are a form of antidepressant that healthcare professionals commonly prescribe to treat OCD. They have the best results when used in combination with therapy like ERP or CBT.
    • Keep in mind that SSRIs may actually increase suicidal thoughts in some individuals, especially teenagers. So, they may not be the best option for someone with suicidal OCD. It’s important to discuss these risk factors with a mental health professional.

Other effective forms of treatment suicidal OCD and overall mental health may include:

No matter the cause of their suicidal thoughts, it’s important to support a loved one going through this in a thoughtful and respectful way. In this article, we talk about ways to listen without judgment, help them make a safety plan, and other resources.

It’s also important to keep in mind that even if the person doesn’t have genuine suicidal intent, these thoughts and mental images likely may feel very frightening, and they may have a strong fear that it will actually happen.

To support them during this time, try to:

  • Empathize without minimizing their experience, for example:
    • “That sounds challenging. I’m here to listen and support you.”
    • Avoid saying, “This just sounds like OCD,” or “You don’t really want to end your life.”
  • Ask them how you can best support them, for example:
    • “What can I do to help? Would you like to do a fun and/or relaxing activity together now?”
    • “Would you like me to help you find a therapist?”
  • Encourage professional help; you can learn more about helping a loved one get a psychiatric evaluation in this article.

With proper diagnosis, therapy, and support, those with suicidal OCD can learn to manage their intrusive thoughts and lead happier, fulfilling lives.

If you or someone you know is experiencing suicidal OCD, reaching out to a mental health professional for guidance and support is a great first step in healing.