Obsessions in OCD may have many themes. One of them is thoughts of suicide, but it doesn’t mean you want to act on them.
Content warning: This article contains explicit examples of suicidal thoughts that could be upsetting for some people.
Obsessions are symptoms of obsessive-compulsive disorder (OCD). They’re intrusive, unwanted thoughts that are difficult to get rid of or control.
OCD obsessions can include:
- flashing images
- ideas and thoughts
- urges and impulses
When these obsessions are mainly about attempting suicide, some people refer to them as “suicidal OCD.”
People with suicidal OCD don’t necessarily want to die. These thoughts and images about ending their life are unwanted and upsetting, and difficult to control without support.
OCD symptoms can be managed, though. Help is available right now.
Are you currently in crisis?
If you feel like you’re having a mental health emergency, you can:
- Call the National Suicide Prevention Lifeline at 800-273-8255 for English and 888-628-9454 for Spanish.
- Chat with professionals at Lifeline Chat.
- Text “HOME” to the Crisis Text Line at 741741.
- Check out Befrienders Worldwide or Suicide Stop if you’re not in the United States and need to find your country’s crisis hotline.
If you decide to call an emergency number like 911, ask the operator to send someone trained in mental health, like crisis intervention training (CIT) officers.
Most people have random intrusive thoughts every now and again. But, if you have OCD, these tend to be persistent. It might be hard to let go of them, too.
With OCD, you might be so disturbed by an intrusive thought that you keep thinking about it. Thoughts, images, and urges can become increasingly persistent and disturbing. Persistent, disturbing thoughts are considered obsessions.
With OCD, those obsessions can take on different “themes.” This means you tend to have the same or very similar obsessions.
Common OCD themes include:
- contamination OCD, which involves thoughts related to cleanliness
- scrupulosity or religious OCD, which is about ethical and religious “correctness”
- sexual orientation OCD, when you keep second-guessing your sexual preferences
- real event OCD, where you have obsessive thoughts about past events
- harm OCD, where you fear you’ll hurt yourself or others
Suicidal OCD can be considered a kind of harm OCD.
Someone who has obsessions about ending their life doesn’t necessarily want to act on those thoughts. In fact, suicidal thoughts become an obsession because the person finds these thoughts so distressing they can’t stop thinking about them.
It’s not always easy to distinguish between suicidal ideation and suicidal obsessions. Discussing these images and thoughts with a mental health professional can help you understand them better and come up with ways to manage them.
What is pure-O OCD?
Pure-O OCD, or pure obsessional OCD, involves both formal symptoms of OCD: obsessions and compulsions.
Compulsions are rituals or repetitive actions that people with OCD do to relieve some of the distress obsessions cause. Compulsions might involve mental rituals, mentally repeating mantras, or self-reassurance.
In pure-O OCD, however, compulsions tend to be less obvious or less frequent, while obsessions are dominant.
Obsessions about suicide can vary from person to person. They may include:
- feeling an urge to jump when you’re on a high building or cliff
- feeling an urge to jump in front of a moving car, truck, train, etc.
- feeling an urge to drive your car into oncoming traffic, off a cliff, etc.
- feeling an urge to hurt yourself when you see a sharp object
- intrusive, graphic mental images of you hurting yourself
- intrusive, graphic thoughts of suicide
- intrusive, graphic mental images of your funeral
Having intrusive thoughts about suicide doesn’t necessarily mean you have OCD.
It’s possible to experience random intrusive images of hurting yourself and then quickly dismiss the thought. But when these thoughts become upsetting or difficult to manage, it can be a good idea to seek the support of a professional therapist.
OCD compulsions can be directly linked to the obsession or seemingly random.
For example, if you have images of hurting yourself with a knife, your compulsion might be to avoid knives. You might also have a compulsion to say a specific mantra, pace a certain number of times, or do another seemingly unrelated ritual.
Suicidal compulsions can include:
- seeking reassurance by researching online or talking with loved ones to check whether your thoughts of suicide are common
- avoiding sharp objects, high buildings, or driving out of fear that you might hurt yourself
- repeating mantras or affirmations you feel will protect yourself from self-harm
- praying for protection or relief
- tapping your foot for a set number of times
- saying a specific word a number of times
Remember, compulsions can look different for different people, and they can be unique to you. The goal of a compulsion is to decrease your stress, so that’s why they can look different for everyone.
No. Obsessions and compulsions vary from person to person.
While some people have suicidal OCD, others might have obsessions and compulsions around cleanliness, inappropriate sexual behavior, health, or religion, to name a few examples.
Many people experience multiple OCD themes. It’s possible to have suicidal OCD and religious OCD at the same time, for example.
Yes. It’s possible to have both OCD and a mood disorder.
The International OCD Foundation estimates that 25 to 50% of people with OCD will also experience symptoms of depression.
While obsessive thoughts about suicide can occur in people who aren’t contemplating suicide, some people with OCD who live with depression do think of attempting suicide.
Further research from 2018 suggests people with OCD may be more likely to consider ending their lives if they also have depression.
Regardless of whether you have OCD, clinical depression, or both, you’re not alone. These symptoms can be managed and relief is possible. Consider reaching out for help.
Exposure and response prevention (ERP) therapy is one of the most effective treatments for OCD.
ERP therapy’s goal is to help you manage your obsessions without engaging in your compulsions. The idea is that you engage in compulsions because:
- you believe they’ll prevent the obsession from becoming real
- it brings you temporary relief from distress and anxiety
- it temporarily stops the obsessions
But engaging in the compulsion may not stop your obsessions in the long term.
ERP therapy asks you to engage in obsessions without carrying out those compulsions. This “teaches” your brain that you don’t need to engage in compulsions to stay safe from your thoughts.
In time, this can reduce the intensity of your intrusive thoughts and prevent compulsions from dominating your day.
Other helpful therapies for OCD include:
- cognitive behavioral therapy (CBT)
- acceptance and commitment therapy (ACT)
- imaginal exposure (IE)
You might also benefit from certain self-care strategies, including:
- joining support groups
- finding healthy ways to cope with stress
- maintaining healthy habits
- exercising or practicing meditation
- spending time with loved ones
Obsessive thoughts about dying by suicide can be disturbing and upsetting. Like all other forms of OCD, though, suicidal OCD can be treated.
Consider finding a therapist for support. You might also benefit from joining in-person support groups or online support groups.
Living with OCD can be challenging at times, but with the right treatment and support, it’s possible to manage your symptoms and live a healthy, happy life.