The word obsession is commonly understood as an excessive, self-directed preoccupation with someone or something. In other words, an enduring focus on something we usually find pleasurable – gossip magazines, mountain biking, technology, etc.
An obsession in Obsessive Compulsive Disorder (OCD) takes on a far different – and sinister – meaning.
What is an Obsession as it relates to OCD?
Obsessions form the basis of the anxiety disorder known as OCD.
They appear as repetitive and distressing thoughts, images or urges often removed from reality. An example would be a thought of pushing a pedestrian into oncoming traffic or image of lunging off a building. Obsessions assume different forms and themes but ultimately elicit the same response – compulsive behavior.
In order to eliminate the anxiety obsessions generate, those with OCD perform compulsions or repetitive behaviors. Some examples include avoiding feared objects, asking friends/family for reassurance, or performing mental rituals. Compulsions strengthen obsessive thoughts by confirming their importance to the brain. Until this loop is terminated, OCD continues to run its course.
What are Suicidal Obsessions ?
As mentioned above, obsessions can span a wide range of themes: harm, sexual, religious, contamination and others. Among the “harm” cluster falls suicidal obsessions.
Suicidal obsessions are thoughts, images and/or impulses centered on taking one’s own life.
- Thoughts of swallowing a bottle of pills or consuming household chemicals
- Images of stabbing or hanging oneself
- Urges to veer a car off the road or jump off a building
These obsessions create such immense discomfort that a person resorts to compulsive (or repetitive) behavior:
- Seeking re-assurance from friends/family or researching suicide online
- Avoiding objects like knives, belts, medicine bottles
- Performing nonsensical rituals like touching/aligning objects or mentally reciting prayer
How are the above different from suicidal thoughts?
Suicidal obsessions appear identical to suicidal thoughts – but focusing on the content of the thoughts to the exclusion of the entire context is misguided.
While only a mental health professional can offer a proper diagnosis, there are some key distinguishing features that separate suicidal thoughts or ideation from suicidal obsessions:
- Anxious vs. ambivalent interpretation – Those with suicidal obsessions are consumed with anxiety over the content of the thoughts and feelings or doubts they ignite.[i] Suicidal individuals are often ambivalent towards the thoughts.
- Congruity to mood & self-image – Suicidal obsessions in OCD are ego-dystonic[ii]. This means they run counter to one’s self-image (attitudes, personality, beliefs) and mood state. [iii] [iv] For instance, a person with no symptoms of depression consumed in anxious anticipation over a recent promotion who suddenly gets “suicidal thoughts” is likely in the throes of OCD. Actual suicidal thoughts tend to be consistent with the person’s present self-image and mood as distorted by depression and/or other mental disorders (e.g. personality disorders). [v] [vi] [vii] [viii]
- Risk profile – Key risk factors for suicide are well established including depression, history of suicide attempts, substance abuse and detrimental life changes. [ix] A person with suicidal obsessions may not have a risk profile to suggest suicide.
- Behavioral response – Suicidal obsessions are always complemented by compulsive behavior designed to avoid the disastrous situations depicted in the thoughts. These behaviors can be overt like counting pills to ensure one hasn’t intentionally overdosed or using mental techniques to suppress the thoughts. Those with suicidal ideation may take comfort in the thoughts or otherwise be ambivalent towards them, creating no urgency for response.
Why do I have suicidal obsessions?
This is a perpetual question central to all themes of OCD. The thinking goes if I can answer WHY I have specific obsessions and in the process AVOID any remote possibility of them coming true they will go away.
Obsessions are a symptom, not a cause of OCD. We lose sight of this fact because they are the only tangible source of our anxiety and misery. Focusing on the content of the obsessions (compulsive behavior) is therefore the equivalent of taking ice to a sore tooth. We are temporarily drowning out a SYMPTOM of the disorder at the cost of allowing the problem to spiral out of control. We do this in large part out of fear. Fear of the dentist. Fear of uncovering a “hidden” part of our ourselves. Fear of UNCERTAINTY.
In order to answer why we have suicidal obsessions, we need to separate the phenomena of the obsessive thoughts from the content of the thoughts — cause from symptom. In other words, understand HOW and WHY otherwise normal thoughts morph into obsessions. Understand what drives the fundamental fear of uncertainty in OCD and the other factors mediate the disease.