What to Read
Suicidal Thinking vs. Harm OCD Intrusive Thoughts
Self-Harm OCD is often experienced as a vicious cycle. The first step in this cycle involves a disturbing, scary, intrusive thought or image (this is the “O” or “obsession” part of OCD) about suicide. This is often followed by an exhausting and lengthy process of attempting to figure out if you are actually suicidal (this is the “C” or “compulsion” part of OCD) by mentally reviewing questions such as:
- “Do I want to harm myself?
- “Did I just move towards the window (or the knife or any other potentially dangerous object) because I want to harm myself? “What if I just lose it and hurt myself?”
- “Is this what it feels like to be suicidal?”
- “Is even thinking about this a sign that I am going crazy and could lose control and hurt myself?”
Certainty Seeking
At the heart of obsessive thoughts is the desperate need to know, with 100 percent certainty, that a feared outcome will not occur and that “everything is OK.” The neurological networks active in OCD are actually quite helpful in certain scenarios; humans would not have survived for very long without them. For example, it is helpful when you leave the house and forget to close your garage door to have the thought, “Oh no, I forgot to close the garage. I better head back home to close it, or someone is going to steal my new bike.” Unfortunately, some people are overly reliant on the certainty that comes from that sort of checking. You may be experiencing symptoms of OCD if you spend significant time engaging in mental gymnastics or physical compulsions to become 100% certain that a devastating outcome will not occur.
How can someone with Self-Harm OCD prove to themselves, beyond any doubt, that they won’t harm themselves? There are several often-used strategies. You can review the facts. You can remind yourself how many times you have actually tried to harm yourself. You can assess if you have been making a specific plan of how to harm yourself. You can assess if you have been gathering deadly means to harm yourself. But how can you PROVE to OCD that, with 100 percent certainty, that you won’t lose control and harm yourself? Ultimately none of us can have 100% certainty about what might or might not happen in the future.
The false promise of checking
And now we must give a brief apology. Perhaps you were lured into this article because you were hoping it would provide a handy way to help you differentiate between “true suicidal thinking” and obsessive / intrusive thoughts about suicide. Unfortunately that checklist not only does not exist but would be impossible to create.
Desperate google searches to find information that calms your anxiety and proves to you that you are “OK” are often just a certainty-seeking compulsion. The problem with engaging in any compulsion as a means to calm your anxiety is that it only “feeds the beast” of OCD, and strengthens the thinking patterns that brought on the initial thought. Inadvertently such compulsions increase the likelihood that, after a short period of relief, the intrusive thoughts will come back with a vengeance, demanding even more certainty that you are ok.
Adapted from Paule Green, Ph.D..
What to Watch
[VIDEO] [VIDEO]
What to Do
Create your ERP hierarchy following the example and instructions below.
- [ERP Instructions]
- [Suicidal ERP Hierarchy]
What to Measure