When we think about Obsessive Compulsive Disorder (OCD), we often picture someone checking a stove multiple times before leaving the house, or hand washing to the point of raw skin. In the film, As Good as it Gets, Jack Nicholson’s character avoids stepping on sidewalk cracks, repeatedly turns all of his locks, and uses several bars of soap in scalding hot water when he washes his hands. While those behaviors constitute the compulsion half of OCD, the character’s obsessions, or intrusive thoughts are never revealed.
Obsessions are intrusive thoughts pacified through compulsions unique to each individual suffering from intrusive thoughts. Obsessive thoughts result in intense cognitive discomfort and shame, and often in isolation. Such is the case with Suicidal OCD, an OCD subtype I have recently encountered in both children and adults, and with which I previously had little familiarity.
Suicidal OCD is a form of harm OCD characterized by intrusive thoughts related to one’s own death, or the possibility of harming someone else. Unlike suicidal ideation, which is a person’s willful contemplation of suicide, thoughts related to Suicidal OCD are unwanted, and result in excessive reflection about whether of not the thoughts will be acted upon. To gain context, consider a person who while cutting her food with a steak knife visualizes stabbing herself in the chest, or slitting her own throat; or another person who while driving to work imagines driving his car into a building, or off a bridge. Eventually, these thoughts become so intense, the person experiencing them believes being alone increases the likelihood of acting on them. These thoughts are so vivid, they impede a person’s ability to focus on activities of daily living, leading to diminished quality of life.
People with Suicidal OCD begin avoiding situations in which ending their own lives is possible, which, if put in perspective, could relegate them to homebound isolation. So intense are the symptoms that one of my clients refers to “suicide” as “the S word” because saying the entire word might cause her to end her life. Anxiety disorders are characterized by false beliefs, and in this case, my client believes that having these thoughts makes her likely to act on them. This possibility could become real if a resulting act of self-harm causes accidental death, or if hopelessness creates a more willful contemplation of death, but in reality, these obsessive thoughts do not increase the likelihood of suicide.
Since Suicidal OCD is a subtype of OCD, there must be compulsions employed to appease intrusive obsessions. Sufferers of this subtype have no desire to end their own life, but in order to compromise with their thoughts, they often utilize self-harm to momentarily satiate them. Cutting, burning, or hair pulling are bargaining tools used to satisfy intrusive thoughts to some degree, even if the satisfaction doesn’t last long.
Anxiety disorders are often underrated causes of suicide, but they cause more people to end their own lives than most would think because people suffering from profound anxiety disorders have the motivation or energy often lacking in the severely depressed. Someone with agoraphobia might choose to end his own life to escape isolation and restriction. Similarly, someone with Suicidal OCD might eventually choose to end her own suffering once hopelessness of never finding relief descends.
As with any mental illness, the person experiencing the symptoms may feel ashamed enough to never share their thoughts and fears with others. Fear of stigma is often a first motivator toward isolation, which is why being forthcoming about symptoms is an initial step toward preservation of life. Close relationships are a strong first line of defense against mental illness hindering quality of life, but psychotherapy, or even medication could also be necessary. Thinking back to As Good As it Gets, Melvin Udall’s symptoms begin to abate when he finally connects with others in an intimate way.
Medications in the SSRI or benzodiazepine classes could provide symptom relief while root causes of symptoms are dug up in therapy, but before treatment is sought, anyone suffering from mental illness must understand there is no shame in divulging symptoms, or seeking help. Like any other medically diagnosed illness, mental illnesses are sickness that in no way suggest weakness or flaw.
If you, or anyone you know is experiencing this, or any other disorder, reach out, or encourage your loved one to do so. Only after connection is made can there be hope for healing.
