Suicide. It’s a word that invokes paralyzing fear in those who love someone with a brain disorder. And well it should. Thoughts of suicide should always be taken seriously and help should be sought immediately.
But when you have OCD and are dealing with thoughts of suicide, it can get complicated, to say the least.
We already know that those with OCD often attach more meaning to their thoughts than those without the disorder. While most of us can acknowledge our thoughts and just let them float by, those with OCD obsess about them. Will I become contaminated? Will I hurt someone I love? Will I commit suicide?
In some cases, thoughts of committing suicide become an obsession for those with OCD. They do not want to commit suicide, just as they do not want to harm others, or offend God, or carry out any other undesirable act their OCD is focusing on.
So how do we know when to worry? When we should take thoughts of suicide seriously in those with OCD?
I can’t stress enough, even if thoughts of suicide appear to be “just OCD thoughts,” how important it is to seek professional help (preferably an OCD specialist) to evaluate the situation. Sadly, there are those with severe OCD who have indeed committed suicide, so the topic should never be taken lightly or ignored. Even if your loved one with OCD doesn’t seem “that bad off,” don’t dismiss their thoughts. Those with OCD can be masters at hiding their pain.
That being said, it is not uncommon for the idea of suicide to become an obsession for those with OCD. Remember that OCD latches on to what we care about the most, and if we value our lives and want to live, having even innocuous thoughts of suicide can be fodder for OCD. And since we can’t be 100% certain of anything (how do I know I won’t kill myself?) the vicious OCD cycle begins.
So how is this type of OCD treated? Exposure and response prevention (ERP) therapy, as we know, is the front line psychological treatment for OCD. But we are not going to expose the person with OCD to suicide! Imaginal exposures, based on imagining something as opposed to actually carrying it out, can be extremely helpful.
I don’t think a discussion about OCD and suicide can be complete without at least mentioning the possibility that medications might contribute to suicidal thoughts. In my book, I talk about how my son Dan’s suicidal thoughts were related to being improperly medicated. And a co-morbid diagnosis of depression might also be a cause for concern.
When dealing with only OCD, the content of the thoughts really doesn’t matter. But when the content of the thoughts involves suicide, where the stakes are so high, it is better to be safe than sorry, and it is important to confirm that there really is no intent involved. Once that is established, the person with OCD can move forward with ERP therapy.