OCD, Self Injury and Suicidal Thoughts

Understanding Suicidal and Harm OCD

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Morgue Files

Harm obsessive-compulsive disorder (OCD) is a specific type of OCD in which the person fears causing harm to him/herself or others. There are many variations of harm OCD, including physical harm; aggression toward or killing oneself or another; and sexual harm, including ​harmful sexual behavior toward children. Fear of harming oneself when not depressed and/or wanting to die may be due to suicidal obsessions in OCD, or suicidal OCD.

This is different from suicidal thoughts due to depression or a desire to end one’s suffering because of physical illness or injury.

Important Note About Suicidal Obsessions

In this article, we will discuss the differences between suicidal obsessions in OCD, called suicidal OCD, non-suicidal self-injury and suicidal thoughts related to depression. However, any thoughts of suicide should be taken seriously and anyone who experiences these thoughts should be evaluated by a mental health professional to ensure safety. It is possible for someone with suicidal obsessions related to OCD to also become suicidal and want to die. The information in this article should not replace professional mental health evaluation or treatment.

Non-Suicidal Self-injury

The International Society for the Study of Self-injury (ISSS) defines non-suicidal self-injury, also known as non-suicidal self-harm and deliberate self-harm, as “the deliberate, self-inflicted destruction of body tissue without suicidal intent and for purposes not socially sanctioned” (ISSS, 2007).

This includes the most common behaviors, such as cutting, scratching, hitting, burning, head-banging, puncturing the skin and so on to relieve emotional distress. In these cases, there is no thought of wanting to die.

Self-injury is considered a maladaptive coping response to emotional distress or numbness.

This behavior often begins in adolescence. Although many teens who try self-injury do not continue to engage in the behavior, some continue it into adulthood. Self-injury may be associated with personality disorders, anxiety and/or depression

Suicidal Obsessions Related to OCD

Suicidal obsessions can be associated with harm OCD or suicidal OCD. In these cases, a person who does not want to die has unwanted, intrusive thoughts and/or images of dying or self-injury. Unlike those who are suicidal, the vast majority of people with suicidal OCD are afraid of dying by suicide. Many are morally opposed to suicide. If you have suicidal OCD, you likely live in fear that you might somehow lose control or go insane and commit an irreversible act of suicide.

Many who have suicidal obsessions believe they have what's known as Pure-O, meaning they have obsessions with no compulsions. However, it is now believed that most people with suicidal OCD engage in mental rituals or compulsions instead of physical ones in response to the suicidal obsessions.

This might include attempting to crowd out the suicidal thoughts with positive thoughts, praying, counting, seeking reassurance or other mental activities. Previously it was believed that exposure response prevention therapy (ERP) would not work for suicidal OCD, as it requires working to extinguish the compulsions. However, for those who perform mental acts to neutralize the suicidal thoughts, ERP is effective.  

Suicidal Thoughts Related to Depression

Suicidal thoughts are one of many symptoms of depression. However, not everyone who experiences depression will have suicidal thoughts or want to die. Also, not everyone who has suicidal thoughts actually comes up with a plan or makes an attempt, known as a suicidal gesture or suicide attempt.

The American Association for Suicidology (AAS) reports that at least half of all people who complete suicide are depressed. The American Foundation for Suicide Prevention (AFSP) cites the death by suicide rate was 12.93 out of every 100,000 people as of 2014 and that suicide is the tenth leading cause of death in the U.S. AAS reports the risk of suicide in people with untreated depression is 25 times greater than the general population. Untreated depression often results in other problems as well, such as substance abuse or dependence, which makes the risk even greater.

OCD and Depression

About 2/3 of people with OCD will experience at least one major depressive episode in their lifetimes. There are different schools of thought about why this happens. These two disorders are believed to involve the same neurotransmitters, which are brain chemicals, so there is a shared biological component. There is also a possibility that the depression is related to the feelings of hopelessness and helplessness that can result from the inability to control the symptoms of OCD. In either case, both the OCD and depression need to be treated. As noted above, left untreated, depression can result in suicide, and having more than one mental health condition increases the risk.

Treatment for Co-occurring Depression and OCD

Antidepressants are often used to treat OCD, as well as depression. For those who have both disorders, a combination of medications may be needed. Cognitive behavioral therapy (CBT) is effective in treating both disorders, as is mindfulness. Speak with a trained mental health professional immediately if you have any suicidal thoughts. Even those with suicidal obsessions may become suicidal without treatment.

Sources:

American Association of Suicidology Suicide Prevention is Everyone's Business. Suicide Fact Sheets. http://www.suicidology.org/resources/facts-statistics-current-research/fact-sheets

Definition of Non-Suicidal Self-Injury. ISSS. http://www.itriples.org/isss-aboutself-i.html

Facts and Figures. American Foundation for Suicide Prevention.http://www.afsp.org/understanding-suicide/facts-and-figures

Suicide in the U.S.: Statistics and Prevention. NIMH RSS. http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml

"Suicide Statistics." American Foundation for Suicide Prevention (2014).

"Depression and Suicide Risk." American Association of Suicidology (2014).

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