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What Are the Differences Between Suicidal Thoughts and Suicidal Obsessions?

Natalie Frank has a Ph.D. in clinical psychology and is Managing Editor for Novellas & Serials at LVP Publishers.

Suicidal ideation vs. intrusive thoughts: What's the difference?

Suicidal ideation vs. intrusive thoughts: What's the difference?

Suicidal Ideation vs. Intrusive Thoughts

Suicidal thoughts are a major health concern in the U.S. and many parts of the world today. Between 2015–2019 it was estimated that 4.3 percent of the U.S. population, or 10.6 million adults, experienced serious suicidal thoughts. As significant as this number is, it is believed to be a gross underestimate given that it’s based on self-reporting and many people are reluctant to report suicidal thoughts.

Caution in interpreting suicidal thought must be exercised as what sometimes appears to be suicidal thoughts or thought patterns can actually reflect a form of obsessive-compulsive disorder (OCD). In such instances, the suicidal thoughts are actually obsessive intrusive thoughts, which are often notably different from clinical suicidal ideation.

There are a number of factors that differentiate the two types of thoughts and there is also a high degree of overlap. Determining the parameters of each of the two conditions requires a comprehensive and careful assessment and regular evaluation by a specialized medical practitioner.

Suicidal Thoughts and Behavior

While many individuals believe suicidal thoughts only result from severe or chronic depression, such thoughts can result from a variety of other psychiatric illnesses, including anxiety disorder, bipolar disorder, schizophrenia, and substance use disorders, as well as physical illnesses and injury. Such thoughts may even occur in individuals who are entirely healthy.

The severity of suicidal thoughts can be difficult to determine as sometimes they may be short-lived and non-specific while other times they are accompanied by a specific plan for self-harm.

In many cases, people who are ready to die by suicide don't provide any indication of their plans and may deny even having thoughts of suicide. This is one of the most traumatic parts of suicide for survivors, who often belief that they should been able to prevent their loved one's death. This occurs despite assertions from professionals that there is usually no way to predict it beforehand. Even trained psychiatric doctors sometimes experience intense guilt in the aftermath of a patient's suicide and feel they should have been able to prevent it.

Many individuals with suicidal ideation may fluctuate for years between wanting to live and wanting to die. Others may not actually want to die but are experiencing such acute grief or trauma that they make an attempt that is serious enough to get the attention of others. Unfortunately, some of these people make miscalculations and what was meant to be a cry for help winds up being fatal. Thus, suicidal thoughts and behavior are complicated difficulties with a serious risk of death even when this is not the intended outcome.

Suicidal Obsessive Compulsive Disorder (S-OCD)

Suicidal obsessions, like other forms of obsessions found with OCD, are persistent cognitions, images or drives that invade a person's mind. While S-OCD is thought of as having only obsessions without the compulsive symptoms or a “Pure O” type, this is not entirely correct. In reality, the symptoms do include compulsions but these involve either rumination or different types of behaviors.

Suicide obsessions create a sense of anxiety just like other types of obsessions. This anxiety then results in the subsequent mental or behavioral acts that allow avoidance or escape from the thoughts and associated anxiety. The relief felt at not having the thoughts or anxiety reinforces the compulsions, which maintain the symptoms of the disorder.

Suicidal obsessions are defined as intrusive, repetitive, undesired thoughts of suicide that result in notable distress. They differ from suicidal thoughts in that they do not result from the genuine desire to kill oneself; actually people with these types of obsessions often feel exactly the opposite. They don’t want to commit suicide, are often against suicide morally or religiously and feel terrified by the possibility that their thoughts could unintentionally cause them to act in a manner that accidentally leads to their death.

Suicidal obsessions can occur at any time or any place, frequently seem to come out of nowhere, and can be triggered by either pleasant or unpleasant activities. The fear that they will re-occur creates what’s referred to as secondary anxiety, as well as attempts to identify possible triggers so they can avoid them. Over time, the rate of these thoughts increase until they occur throughout the day with much of their time taken up by the obsessions.

However, those who experience S-OCD often do not want to die—they are afraid of suicide and obsessively think about the different ways it could happen. This can lead to excessive reflecting, or rumination, about suicide as well as intensely researching the subject.

Some theorize that those with suicidal obsessions are actually suffering from true suicidal ideation on a subconscious level. They further posit that symptoms resembling OCD are actually an elaborate defense mechanism hiding unacceptable impulses. However, research has suggested that this is not accurate. There is significant evidence that a type of OCD involving suicidal obsession exists and that this form can be differentiated from clinical suicidal ideation.

Obsessions in S-OCD

Suicidal obsessions generally involve a person's fear of losing of control that results in suicide despite that person not wanting to die. Thus, the specific thoughts usually follow the form of “What if...and I end up killing myself before I can prevent it?" The “what if” part can be followed by a range of ideas and anxieties:

  • What if I have a nervous breakdown...?
  • What if I can’t recognize what I’m doing...?
  • What if I don’t notice my thoughts in time to prevent myself from following them...?
  • What if I impulsively jump off a high building or bridge...?
  • What if I become severely depressed without knowing it and...?
  • What if I’m harming myself (e.g. poisoning self) but don’t realize it...?
  • What if I intentionally put myself in danger without recognizing it...?
  • What if I can’t prevent myself from driving off a cliff...?
  • What if I become so focused on my thoughts that I can’t pay attention to what I’m doing and...?
  • What if I impulsively take too many pills...?
  • What if I black out and do something to hurt myself without being aware I’m doing it?

Compulsions in S-OCD

The compulsions that result from suicidal obsessions often involve the individual trying to assert control by gathering information or manipulating their environment. This often involves reality-testing to demonstrate that they don’t have the desire to pursue suicide as an option. These types of compulsions fall into four categories.

Checking

  • Mentally checking “actual” intentions to harm oneself, checking the way they act in front of others and what they say to others to ensure nothing indicates suicidal ideation; checking memories for instances they may have harmed themselves or attempted to harm themselves; checking their reasoning regarding why they wouldn’t want to follow through suicide and anything that indicates they might potentially do so.
  • Checking anything they have written to ensure nothing can be seen as a suicide note or the desire to attempt suicide.
  • Checking to ensure there is nothing lethal that is accessible at home, including poisons, dangerous tools, heavy objects, rope, sharp items, etc.
  • Checking themselves physically to ensure there isn’t any sign that they’ve harmed themselves without realizing it.

Avoidance

  • Avoidance of other people who have the tendency to make them feel bad about themselves or who trigger a bad mood or negative memories.
  • Avoidance of locations they associate with a potential intrusive and unwanted thought, such as bus station where they fear they won’t be able to resist jumping in front of the bus when the thought to do so occurs.
  • Avoidance of potentially deadly items in the homes of friends and family or in public locations.
  • Avoidance of being alone due to the belief they are unlikely to hurt themselves if they are around others; or if they do act on a thought to harm themselves, then the others who are present will prevent them from seriously harming themselves.
  • Avoidance of boredom or lack of something interesting to do such that they are always engaged in a variety of activities (sometimes to the point of exhaustion) in an effort to distract themselves from undesirable thoughts. Relaxation is also avoided for the same reason. This includes the refusal to go to sleep until it is impossible for them to stay awake any longer as they are afraid if they “let down their guard” this will permit the suicidal obsessions to occur.
  • Avoidance of horror movies involving violence in an attempt to prevent suicidal obsessions from being triggered, as well as the belief that the visual representation of violence or trauma, or even pleasant scenes, might trigger memories that evoke longing or sadness could prevent them from being able to resist thoughts of self harm.
  • Avoidance of reading the newspaper or watching the television news to prevent exposure to anticipated negative or violent coverage that might trigger suicidal obsessions.
  • Avoidance of instances of harming themselves by keeping their hands in their pockets or sitting on them.

Reassurance Seeking

  • Seeking confirmation that other people believe the individual would never kill themselves.
  • Seeking confirmation that other people know the individual has never harmed themselves on purpose.
  • Sharing unwanted thoughts with the hope that other people will respond that the individual shouldn’t feel guilty because such thoughts aren’t consistent with what they know about the individual.
  • Spending significant amounts of time on the internet and in other endeavors researching details about others who have died by suicide to prove that they have nothing in common with them.

Mental Rituals

  • Ruminating on the reasons why they would never engage in suicide.
  • Trying to replace suicidal obsessions with pleasant thoughts that are incompatible with suicide.
  • Purposely thinking about suicide to prove it disgusts and horrifies them.
  • Engaging in prayer or superstitions in response to suicidal obsessions, believing this will prevent them from acting out their thoughts.
  • Over-correcting by continuing to begin an activity over and over again until they complete the task without any undesirable thought intruding.

Understanding Suicidal Thoughts

In conclusion, suicidal thoughts and suicidal obsessions are different processes resulting from different internal and external factors. Similar to other obsessions found in OCD, suicidal obsessions are believed to be caused by a combination of neurobiological, genetic, physical, and environmental factors.

However, whereas suicidal thoughts often are consistent with a person's general mood and depressive thought patterns, suicidal obsessions are not. Usually, suicidal obsessions go against the person’s beliefs and preferences. As such, many of the compulsive behaviors they engage in are aimed at avoiding anything potentially dangerous and reassuring themselves that they are not in danger of harming themselves. This differs from those who have suicidal ideation because they are not intentionally developing plans to self-harm.

The follow-up article will discuss the reasons why the compulsions discussed here are not usually effective at preventing the suicidal obsessions from continuing to occur, how to differentiate between suicidal thoughts and suicidal obsessions and how suicidal thoughts may manifest in cases of OCD.

If you're experiencing suicidal ideation, please contact a suicide prevention center.

Further Reading

This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.

© 2017 Natalie Frank

Comments

Natalie Frank (author) from Chicago, IL on October 06, 2017:

How heart breaking. Thanks for sharing this story, Nadine. All the best.

Nadine May from Cape Town, Western Cape, South Africa on September 28, 2017:

Thanks for this very good article. Long ago I was a councilor for Lifeline and talked to many callers who have no real intention of dying but do make an attempt to get the attention by calling for help. I never thought to separate suicidal thoughts and the behavior patterns.

When I was in my twenties I saw a young boy of around 17 crying while sitting on the pavement in front of his townhouse home. I got out of my car asking him what happened. He said his mom died. I thought she must have been in a hospital, but when I found out that she was still inside the house, I got the chills but run inside. Apparently, he had found her in the bathtub and carried her to the bedroom and covered her up. I checked for myself but she was gone...the rest it to long to share, but that boy was heartbroken. I was involved with the rest of the family by moving out of my own townhouse with my children so they had a place to stay for a week while the Police sealed off the home.

I never knew the family or the mother, I often wondered why nobody else did in that same complex, but this family kept very much to themselves.

Natalie Frank (author) from Chicago, IL on September 26, 2017:

You're right Peggy - it is incredibly sad for everyone including the person whose life was ended prematurely. Thank your for your congratulations. It was truly a surprise, and a pleasant one! Best.

Natalie Frank (author) from Chicago, IL on September 26, 2017:

Congratulations on your award as well! That's really something - is if 5 years running now? That's an incredible achievement and indication of the writers respect for you. I voted for you and am thrilled you won again.

I am sorry you lost so many friends. I have know a couple of people though they weren't close friends but my brother did lose someone very close to him to suicide and I have had a couple of patients that made attempts but thank God were unsuccessful. I pray no one ever loses anyone to this terrible act again and no one feels driven to it - though I realize that would take a miracle I'm not beyond holding out for one. Take care and thanks for the comment.

Natalie Frank (author) from Chicago, IL on September 26, 2017:

Congratulations to you also. You deserve it! Unfortunately, miscalculations happen all the time. Sometimes they are positive in terms of someone who truly attempts suicide but is unsuccessful and can then get the help they need. But it happens on the other side too where someone who doesn't really want to die and just can't think of another way to get the attention they need to get help ends up really killing themselves. Thanks for the comment.

Peggy Woods from Houston, Texas on September 26, 2017:

I know some people who have committed suicide. It is so sad for the family members and friends. Congratulations on your award!

Bill Holland from Olympia, WA on September 26, 2017:

I've lost five friends to suicide. This article should be required reading for everyone....and congratulations on your award!

Dora Weithers from The Caribbean on September 25, 2017:

Congratulations on your "Hubber with Most Obscure Knowledge" Award! Articles like these are proof that you deserve it.

Thanks for all the valuable information you give here. This is certainly an eye opener that "some of these people, although not truly wanting to die, make a miscalculation and what was meant to be a cry for help winds up being fatal." Bomber!