Suicidal OCD: What it Is, Causes, & Treatment

If You Need Immediate Help for Intrusive Suicidal Thoughts

People with suicidal OCD have intrusive thoughts about suicide but are usually not at high risk of acting on those thoughts. Still, someone with OCD should never ignore suicidal ideations or assume they’re not at risk for acting on them. Sometimes, suicidal OCD thoughts or urges are concerning or severe enough to warrant immediate help.

If you are having suicidal thoughts that are frequent, distressing, and debilitating, you should seek immediate help.

Here are some crisis and suicide prevention resources you can access for suicidal thoughts:

• Call the 24-hour Suicide Crisis Lifeline by dialing 988
• Get immediate help from EMS or police by calling 911
• Go to the nearest emergency room or psychiatric hospital

What Is Suicidal OCD?

Suicidal OCD is a subtype of obsessive compulsive disorder (OCD) that causes obsessions, which are intrusive thoughts, mental images, or urges, regarding suicide. These obsessions are deeply disturbing and trigger intense distress and self-doubt. While a diagnosis of OCD increases the likelihood of experiencing suicidal ideation, there is no research that suggests people with OCD are more likely to attempt suicide.^1,2

Similar to harm OCD, a lot of the distress related to suicidal OCD is caused by the fear that the person may one day act on their suicidal OCD thoughts. This lack of self-trust often causes time-consuming compulsions aimed at stopping their thoughts, feeling less afraid, and preventing an actual suicide attempt. Unfortunately, relying on compulsive behaviors to cope with suicidal OCD symptoms can backfire, making suicidal OCD thoughts more frequent and intense.^1,4.5

OCD Suicide Rates

Several studies have found that people with OCD are more likely to experience suicidal thoughts, but there is no strong evidence that people with OCD are more likely to attempt suicide.^1,2 In fact, some experts believe that people with OCD may be less likely to attempt suicide than people with other mental health conditions since many OCD compulsions are attempts to avoid harm and risk.⁶

Still, this does not mean that people with OCD should assume they’re not at risk for suicide, especially since OCD is one of the most distressing and debilitating disorders.^2,7 Also, as many as 80% of people with OCD are diagnosed with another mental health condition. Having severe OCD symptoms, another mental health diagnosis like depression, or a subtype of OCD that involves unacceptable thoughts are all believed to increase the risk for suicidality.²

Does OCD Always Involve Intrusive Suicidal Thoughts?

OCD involves random thoughts, images, or impulses that are persistent, time consuming, and hard to dismiss. While some individuals can experience intrusive suicidal thoughts, the specific obsessions and compulsions can vary between people. For instance, some OCD content may be related to health, cleanliness, inappropriate sexual acts, religion, and so forth. Conversely, someone can have multiple OCD themes like suicidal and contamination OCD concurrently.⁸

Suicidal OCD Symptoms

The main symptoms of suicidal OCD are intrusive thoughts of suicide that are disturbing. These obsessions involve thoughts and fears related to committing suicide and can manifest as words, mental images, or even fleeting urges to attempt suicide.^1,2,8 These may be followed by excessive worries about why the suicidal thoughts show up and whether or not they could lead to suicide.

To counteract these unwanted thoughts and feelings, people with suicidal OCD often rely on rigid behaviors (compulsions) aimed at stopping the thoughts or feeling safer.^4,8 Suicidal OCD compulsions can look different for each person, and for some, are mental compulsions that can’t be observed by other people. For example, mental compulsions can include mentally repeating mantras or prayers, reviewing past experiences, or mentally rehearsing a scenario. Often, compulsions provide temporary relief but make OCD symptoms worse in the long run.^1,4,5

Suicidal OCD Obsessions

Here are a few examples of common obsessions in suicidal OCD:⁵

• Having a random thought or urge to jump off a bridge when walking over it
• Having graphic mental images of killing yourself in specific ways
• Seeing a knife and thinking ‘what if I grabbed it and stabbed myself?’
• Repeatedly worrying that you’ll ‘lose it’ or ‘go crazy’ and end your life on an impulse
• Mentally rehearsing a specific type suicide attempt in your mind
• Imagining how loved ones would respond to the news if you ended your life

Suicidal OCD Compulsions

Here are a few examples of common compulsions in suicidal OCD:⁵

• Doing a ‘mental review’ of all of the times you’ve had a suicidal thought
• Needing to seek reassurance from a loved one that you’re not really suicidal
• Excessive research online about the warning signs of suicide
• Comparing yourself to other people who are depressed or suicidal
• Making consistent appointments for mental health evaluations to assess your risk for suicide
• Taking online quizzes or self-assessments to determine your risk for suicide
• Avoiding sharp objects, high places, or other situations that cause OCD suicidal thoughts
• Obsessively tracking your mood to check for suicidal or depressive symptoms

How Do I Know It’s OCD Vs. Suicidal Ideation?

Although people can experience unwelcomed thoughts, images, or impulses about suicide, that doesn’t necessarily mean that they have OCD. It is possible to have random intrusive suicidal thoughts and quickly shake them off. Nonetheless, when these are hard to manage, recurrent, time consuming, and causing significant distress, this could indicate the presence of a mental health condition such as OCD.^2,7,8

Some signs that could indicate suicidal OCD include:

• Being frequently consumed with unwanted thoughts or graphic images related to killing oneself
• The intrusive thoughts are persistent and hard to let go of
• Avoiding situations, places, or things that could trigger the thought of self-harm like getting rid of knives/scissors to ensure you don’t hurt yourself
• The suicidal thoughts stem from a chronic fear that you could potentially end your life
• Constantly seeking reassurance from yourself and/or others that you’re not endangering your life like asking yourself/someone else something like is it normal to think about jumping in front of traffic?

When to Be Concerned About Intrusive Suicidal Thoughts

Suicidal ideations are almost always deeply disturbing and frightening for people with OCD, who have a tendency to overreact to their thoughts and obsess over what they could mean. Because of this tendency, it can be difficult for someone with OCD and suicidal urges to know whether their suicidal thoughts are a symptom of their OCD or not, and when to worry about suicidal ideation.

While there are a variety of factors involved, research indicates that you’re at higher risk for suicide if you:^1,2,7

• Have more severe and debilitating OCD symptoms
• Have made a suicide attempt in the past
• Have a specific, detailed plan for committing suicide
• Experience frequent feelings of hopelessness and helplessness
• Have a mood disorder like depression or bipolar disorder
• Are naturally more impulsive
• Have a subtype of OCD that involves ‘unacceptable’ or taboo thoughts
• Have a family history of suicide
• Have high levels of toxic stress and low levels of social support

What Triggers Suicidal OCD Symptoms?

There is not one singular cause or trigger for suicidal OCD, and a variety of genetic, neurological, social, and environmental risks and triggers can contribute to the onset of symptoms. For many who develop suicidal OCD, stress is a contributing factor that worsens their symptoms and lessens their ability to cope in healthy ways, making them more prone to compulsive responses.^1,2,5

In a heightened state of stress, a random and fleeting thought of suicide is more likely to become obsessive for someone with OCD. Overreacting to these fleeting thoughts of suicide by ruminating on them, becoming overly distressed, or engaging in compulsions can worsen OCD suicidal thoughts. OCD obsessions are strengthened and intensified by any response or action that suggests the thoughts are true, important, or urgent.^4,5

Potential triggers for suicidal OCD symptoms include:

• Seeing suicide in a T.V. show or movie
• Hearing about someone who committed suicide
• Unexpectedly losing an acquaintance or friend to suicide
• Attending suicide prevention training for work
• Being asked by a doctor about whether you’ve had suicidal thoughts
• Knowing someone who is experiencing suicidal ideation
• Hearing on the news that suicide rates in young people are on the rise
• Hearing personal stories from people who missed warning signs of suicide in loved ones
• Reading an article about suicidal OCD or the heightened risk for suicide in OCD

Why Do I Have Suicidal Intrusive Thoughts?

A combination of environmental and biological factors is believed to contribute to OCD. Specific to suicidal OCD, people who have a subtype of OCD that involves taboo or unacceptable thoughts (i.e. scrupulosity OCD) are also more likely to report suicidality. Similarly, people with a comorbid mood disorder or high levels of impulsivity are believed to be more likely to develop suicidal ideation.

Potential causes of suicidal OCD include:^1,2,4,9

• Genetics: People who have a family history of OCD are more likely to develop the disorder, especially if the family member is a first-degree relative.
• Personality traits: People who have certain personality traits or tendencies like neuroticism, perfectionism, or a ‘type A’ personality may also be more likely to develop the disorder. People who are naturally more impulsive are also at higher risk for suicidal OCD.
• Abnormal brain structures: OCD may be partially caused by abnormalities in regions of the brain related to impulsivity, emotion regulation, and threat detection.
• Neurochemical imbalances: Neurochemical imbalances in the brain (i.e. GABA) may also contribute to the development of OCD.
• Childhood trauma: People who experience trauma in childhood are at higher risk for a number of mental health conditions, including OCD, suggesting this may be a causal factor.
• High levels of stress: Chronic stress is another risk factor that may contribute to the onset of OCD and suicidal thoughts, especially when the person also has low levels of social support.
• Coping styles: People with a predisposition to OCD may activate their symptoms by developing rigid routines, compulsions, or avoidance to cope with disturbing thoughts and feelings.
• Severe symptoms or co-occurring disorders: People with more severe symptoms of OCD or another mental health diagnosis are more likely to report suicidal ideation and are also at higher risk for suicide attempts.

Impacts of Suicidal OCD

The symptoms of OCD can be highly debilitating for people with the disorder, no matter what subtype of OCD they have. Although OCD only affects about 2% of adults living in the U.S., half of the people with the disorder report severe impairment from their symptoms, and nearly 35% report moderate symptoms.^8,9

Many people with suicidal OCD experience significant anxiety and distress about their suicidal thoughts and develop compulsive rituals to cope that are exhausting and time-consuming. The amount of time and energy it takes to manage OCD symptoms can lower their quality of life, impact their work, relationships, and ability to function normally and follow a normal routine.^2,3,4,7

How Is Suicidal OCD Diagnosed?

OCD is diagnosed by a licensed health provider. Normally, someone will get a diagnosis of OCD during an initial intake with a therapist, psychiatrist, or medical provider. Most of the time, OCD is diagnosed during a conversation about specific symptoms, but standardized assessment tools may also be used to confirm an OCD diagnosis.^4,8

It’s uncommon for brain scans, bloodwork, or other diagnostic tests to be used in the process of assessing someone for OCD. Unless there are other medical concerns or conditions to rule out, the diagnosis of OCD usually is made by licensed providers who gather information from patients about their symptoms.

Questions a medical professional may ask to help determine a diagnosis of OCD include:

• Do you ever have unwanted thoughts that you can’t stop thinking or worrying about?
• How often do these intrusive thoughts show up, and how long do they last?
• Are there specific themes to the kinds of thoughts you get ‘stuck’ thinking about?
• Do you have very specific methods or routines that you need to do to feel calm?
• If so, how much time do these routines take up on an average day?

Common Comorbidities With Suicidal OCD

Comorbidities associated with OCD can vary among individuals, and not everyone with OCD will experience the same ones. However, when it relates to suicidality, the research suggests that cooccurring disorders are probably the strongest link between OCD and suicidal ideation, with the most common diagnosis being major depressive disorder. Furthermore, it has been found that heighten severity of obsessions, feelings of hopelessness, and a history of suicide attempts can increase the likelihood of experiencing suicidal thoughts and worsening symptoms in those with OCD.^2,7

Treatment for Suicidal OCD

Like all types of OCD, suicidal OCD is often treatable with therapy, medication, or a combination of the two. Most of the time, people with OCD are recommended for specific OCD treatments like exposure and response prevention (ERP) or other specialized forms of cognitive behavioral therapy (CBT).^3,10 Sometimes, psychiatric medications are also recommended to help people get their OCD symptoms under control.

Effective treatment options for suicidal OCD include:^3,5,10

• Exposure response therapy (ERP): Using ERP for OCD can help people with suicidal OCD learn how to cope with triggering situations without relying on avoidance to cope. ERP can be highly effective at helping people with OCD break the cycle of obsessive thoughts and compulsive responses related to suicidal OCD.
• Cognitive behavioral therapy (CBT): CBT for OCD is a structured kind of therapy that helps people with suicidal OCD challenge irrational thoughts and fears related to suicide. In CBT treatment, people with suicidal OCD may also be encouraged to desensitize themselves to suicidal thoughts by talking about them more openly and facing suicidal fears and triggers they normally avoid.
• Acceptance and commitment therapy (ACT): ACT is a type of therapy that can teach people with suicidal OCD how to notice and observe suicidal ideations without needing to get overly involved in them. By using mindfulness, acceptance, and cognitive defusion techniques, ACT can help people with suicidal OCD learn not to attribute too much importance or urgency to OCD thoughts.
• Medications: People with more severe OCD symptoms or co-occurring mental illnesses may benefit from medications for OCD that can help to alleviate their intrusive thoughts and improve their mood and anxiety. For example, antidepressants are commonly used in the treatment of OCD, and antipsychotic medications can also help with obsessive thoughts.
• Neurostimulation: Neurostimulation refers to various techniques like electroconvulsive therapy (ECT) or transcranial magnetic stimulation (TMS) to modulate neural activity in the brain. While research in this area is still ongoing, neurostimulation may be effective for symptom reduction of therapy-resistant OCD, and decreasing suicidal thoughts particularly in those who have a co-existing mood disorder.²

How to Get Rid of Suicidal Intrusive Thoughts

People with OCD often struggle with debilitating symptoms on a daily basis. If you or a loved one is struggling with suicidal OCD, it’s important to seek professional treatment from a licensed counselor who specializes in OCD. In addition to regular therapy appointments, there may be some things you can do on your own to cope with your symptoms of OCD.

Here are five healthy tips for stopping suicidal intrusive thoughts:⁵

1. Don’t Overreact to Suicidal Thoughts

Unknowingly, many people with OCD make their symptoms worse by overreacting to disturbing thoughts that come into their minds. Ruminating, worrying, and analyzing your thoughts should be avoided in suicidal OCD, and so should compulsions like researching, mental reviews, checking, or reassurance seeking. Instead of overreacting to OCD thoughts about suicide, try to refocus your attention on something in the present moment (like your 5 senses, breath, or a task) to take your power back from suicidal OCD thoughts.

2. Start a Mindfulness or Meditation Routine

Starting a daily mindfulness or meditation for OCD routine is a great way to combat suicidal OCD in a healthy way. These practices can help you stay focused on the present moment rather than on the disturbing thoughts in your mind. Start by setting 15-20 minutes aside each day for mindfulness, and consider using a meditation app with guided meditations to start. Each time your mind wanders back to suicidal OCD thoughts, gently bring it back to the meditation. Over time, this practice can help you develop the skills to get less stuck in OCD thoughts when they arise.

3. Experience & Process Emotions in Your Body

By working on processing emotions in your body versus your mind, you can help retrain your mind to cope in healthier ways with distressing thoughts. Instead of ruminating, worrying, and overanalyzing your suicidal thoughts, try to experience them in your body. Pay attention to the sensations you feel when the OCD thoughts pop into your mind, and keep your focus on your body until the sensations you feel return to normal. This simple skill can help you work through upsetting OCD thoughts and anxieties more quickly without getting stuck in endless thought loops in your mind.

4. Maintain an Active & Social Routine

Because OCD suicidal thoughts are so distressing, a lot of people who have them end up avoiding certain people, places, and situations that may trigger them. While avoidance coping can bring you temporary relief, it usually ends up making your suicidal OCD symptoms worse in the long run. To prevent this worsening of symptoms, it’s a good idea to push yourself to maintain your normal routine, including allotting time for physical exercise and social activities, which both have positive effects on your mental well-being.

5. Face Your Fears to Rebuild Self-Trust

Facing your fears and suicidal OCD triggers is scary, but it is one of the fastest ways to overcome your OCD symptoms. By gradually facing your fears (starting with the smaller ones and working your way up to bigger fears), you will find that you experience less self-doubt and anxiety related to suicidal OCD thoughts. These exposures help you rebuild trust in yourself and in your ability to have difficult thoughts and urges without acting on them. Over time, this means your suicidal OCD symptoms will have less power over you, your life, and your choices.

When to Seek Professional Support for Suicidal OCD

If you have OCD and suicidal thoughts, it’s important to get professional help. Without treatment, OCD symptoms tend to worsen over time, becoming more debilitating, time-consuming, and distressing. You don’t need to wait until your suicidal OCD symptoms become unmanageable to get professional help. In fact, treating OCD in the early stages can help prevent the worsening of symptoms and may provide faster results.

Because OCD is one of the most misdiagnosed mental health disorders, it’s a good idea to spend time finding a therapist who specializes in OCD and is knowledgeable about different subtypes. This way, you are less likely to be misdiagnosed or mistaken for someone who is contemplating suicide. Many people begin their search online by using a therapist directory that allows them to narrow their search by their location, insurance type, and professional specialty. You can also use an online OCD resource, like NOCD, to get help from home.