OCD and Thoughts of Suicide

by david castillo dominici freedigitalphotos.net

by david castillo dominici freedigitalphotos.net

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.






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15 Responses to OCD and Thoughts of Suicide

  1. Hi Janet. Thank you so much for posting on this important topic. It can be really confusing and frightening for both the person with OCD and the family when thoughts of suicide enter the maze that is OCD. I’ve had this enter my office many times. Often it has been a teen or pre-teen who comes in being afraid that thoughts they have mean that they want to commit suicide. It’s usually, “I want to live; I don’t want to hurt myself, but these thoughts make me afraid that I do.” Of course, we have to tread very carefully and explore all options but the main difference I usually see is fear that thoughts mean one wants to hurt oneself vs. a stated wish or intention for life to be over. Thank you for educating people all the time about these issues!

    • Thanks for your expertise, Angie, and I love your explanation of how you differentiate between OCD and “real” thoughts of suicide. Your comment also serves as a good example of why we need therapists who truly understand OCD, so that people can be treated appropriately.

  2. flubadub says:

    Dear Janet
    Your articles and information are so important and valuable to OCD sufferers. I have battled obsessions since I was five years old. I am 68 yrs old now..

    I am enjoying relief now because I got rid of a couple obsessions related to apologizing to people by acting out. There is the terrible fear of my apologies being rejected or exacerabating whatever problems I had with people.
    I feel once again I have been lucky that things worked out in my encounters. So, I am feeling good. But, for all the wrong reasons,

    I went outside of myself instead of staying within myself for solutions.
    I’m rededicating myself to approaching my OCD thru both cognitive therapy and mindfulness.
    OCD is a never ending battle that non-.OCD sufferers. will never understand.

    Like compulsive gambling only other gamblers can understand the thought processes of an OCD victim.

    • Thank you for sharing and I am so glad to hear you are moving forward with CBT (specifically ERP therapy) to fight your OCD. I totally agree that those without OCD can never really understand what it is like to live with the disorder. But we can still support and care for our loved ones in appropriate ways. I wish you all the best as you move forward. Please keep me posted!

    • Laura says:


      Glad to hear that you rededicated yourself to treating OCD through cognitive therapy. It has definitely helped me out!

      You’re right that non-OCD sufferers will never fully understand, but it still helps to try and explain your thinking sometimes. My boyfriend, for example, has done a really great job trying to relate to me, even though he doesn’t have OCD.

      Best of luck to you as you continue this fight!


  3. keen08 says:

    Thanks for this post. I have OCD and used to have intrusive thoughts about suicide and it took me awhile to realize they were the OCD and not really suicidal thoughts returning (which I had had previously during a period of major depression) which I was scared about. OCD and mental illness in general can be complicated and confusing. You’re doing a great service helping untangle and explain it to people!

    • Thank you so much for your kind words, and I’m glad you have been able to differentiate between suicidal thoughts and OCD. I hope you’re doing well now and also hope you have the support of a good therapist. Thanks for sharing!

    • Laura says:

      I also had these intrusive thoughts about suicide when I was younger. It can be confusing and upsetting for sure, but it also can be overcome with therapy and/or medication.

      I’m always glad to see people blogging about OCD to raise awareness. That’s why I blog too! 🙂

  4. Thank you for an important post, an important blog. More and more, her therapists are beginning to think her mental illness is OCD, something I always associated with compulsive hand-washing or ducking under light switches. At some point, the thought of suicide entered her mind and, in recent weeks, she’s been unable to let it go. She’s in the hospital at the moment, and I’ve begun blogging about it in a desperate bid to understand what she – and I – are going through. I’ve got a lot of learning to do, clearly, and your blog is a great starting point.

    • I’m so sorry to hear your daughter has been suffering. She is lucky to have you for support and learning everything you can about OCD, as you are doing, is so important. I know you must feel overwhelmed right now, but with the right diagnosis and therapy, your daughter can regain her life. Just remember if she does indeed have OCD, then ERP therapy is a must. Good luck as you move forward and I hope to hear from you again.

  5. So scattered am I that I didn’t identify the “she” I just posted about. “She” is my 20-year-old daughter. Thank you again for a wonderful blog.

  6. Merlin says:

    This article has helped me, thank you for this.

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