Differentiating Intrusive thoughts from SI

Hello, If anyone has experience with codiagnoses of MDD and OCD, how do you differentiate SI from an intrusive thought? How do you know when to engage with the thought (if it’s ocd) bs not (if it’s MDD) I added context of my situation below but no need to read it, you can also drop your experience or recommendations just addressing the question *** I haven’t been active here much since my OCD got significantly better after medical and ERP treatment few years back, but wanted to come on here for more specific help. About a year ago I started experiencing depressive symptoms which cumulated into an aborted attempt in April. Since early this year I’ve had a handful of minor crises (moments where I didn’t do anything but my god I really wanted to) and have been in the severe category for a few months. We’ve been approaching this as a separate entity (MDD as opposed to OCD) because of how different it is, but there are some similarities as well. I ironically years ago had a theme around suicide (except I was afraid that I was going to instead of genuinely wishing for it), so it’s a bit hard for me to tell. Part of the reason why this differentiation is important is because of how I should approach the thoughts. If it’s OCD, I need to expose myself to the idea of suicide, methods, mechanisms, locations, standing on an edge, etc.. If it’s MDD, then I technically shouldn’t engage in suicide related planning or actions because it allows an easy path during a crisis. Similarities: - the SI can appear in an intrusive-like manner of being seemingly out of nowhere - sometimes they are distressing, mainly because it’s annoying while I’m trying to pay attention to class and have a semblance of a good day - I want to do a certain action to make me feel better about said thoughts, which is looking up and establishing methods, planning letters, dates, etc., and resisting the urge to finalize my methods is both difficult and distressing. Differences - It’s MUCH more egosyntonic. And not in a “I’m worried that I want to commit suicide” way, in a literal I’m exhausted and I want out. If there was a bottle of pills that deleted me from existence to where no one would remember me, I’d take them in a heartbeat. I don’t have an inherent will to stay here, I’m only here because of my family and cats. Also ideal methods are kinda hard to access. - Sometimes I find comfort in the thoughts, like it’s always an available emergency way out. When I get distressed from them, it’s usually less because of the thought and more because I don’t have an established plan so I feel trapped to live. - Additional symptoms that appear with MDD and not always OCD (anhedonia, physical slowing, emotional blunting, hopelessness, weight fluctuations, random unexplainable bouts of tears, hypersomnia), like textbook MDD symptoms. - sometimes when the SI is bad it tends to “cancel out” typical blips of ocd I have. For example, I sometimes still have thoughts about contamination and getting in a car accident, except when the thoughts appear they don’t bother me in the slightest, and if anything I avoid compulsions and embrace the possibility of them happening because it’s a good excuse to hit the road. Feels like a bit of a catch 22 because if I engage in suicidal thinking/planning/rehersas, it either 1) could worsen my mental health if it’s from MDD, or 2) could help my mental health if it’s from OCD

Anonymous

Date posted: Yesterday

Im not sure if this is helpful, but just in case: After getting diagnosed with OCD I starting seeing my SI in general (experienced at different points over a decade before diagnosis) as an OCD mental compulsion, whether I was worried about actually committing it or not. I started seeing it this way because a compulsion was described to me as a repetitive way to avoid sitting in distress. SI was the most extreme way I did this. I started understanding rumminations as a cycle of thoughts providing very brief moments of relief by imagining certainty before seconds/minutes later creating doubt. I realized that my SI was apart of this. It would briefly present an imagined reality where all my pain goes away. After I realized this, it clicked that that the "certainty" of that imagined reality was false, a rouse to help me cope with not feeling safe to feel despair. I have no idea what happens after death. I could experience less pain or more. Who knows. Once I starting seeing it this way and prioritized sitting in distress my SI intensity plummeted. I bawl way more, feel less in control and much more helpless. But I think I move on faster cause im not trying to avoid it or fix it. SI still pops up very briefly sometimes, but are much less sticky and is met with uncertainty forcing me back into siting in distress. Im not sure if this fits in with MDD though. Best wishes 💫

sydthefrog

Date posted: 23h

I also have MDD and OCD with suicidal/harm obsessions. It’s SO HARD to tell them apart. I was hospitalized about a year ago, and I still don’t know whether it was suicidal ideation or suicidal obsessions. It’s one of the most difficult things I’ve ever experienced. I’m so sorry to hear you’re going through it. Here’s what helped me: I stopped trying to figure it out. That was so hard to do. But the more I tried to figure it out, the more I obsessed and the more depressed I became. I still did exposures, but I had to stop figuring out which thoughts were obsessions and which were ideation. It also really helped to have a good psychiatrist and ERP therapist who understood MDD and OCD and knew how to treat both. My therapy has been a mix of CBT for depression and ERP for OCD, and I take medication for both. I could never figure out how to handle it on my own though. I hope you have access to healthcare, and if not, I’m still rooting for you and believe you can make it through this. I’m glad you have your family and your cats… it always helps to remind myself why I choose to live, no matter how small the reason.

Leo_Massie

Date posted: 25w

Constant intrusive thoughts about ending it (TW)

Starting in high school, I became very suicidal, and it became my “safety net” of all went wrong. I know it’s dark, but I was in a really bad head space and I saw suicide as my escape if I couldn’t fix my life. It got to the point where I was constantly thinking about suicide (literally every day, multiple times a day). Over the last year, I’ve gotten better and I think about it less. But then my OCD grabbed hold of it…. Now, if I do something wrong or embarrassing or if I struggle in a social situation (which is often 😅), my mind says “kys”, “jump off a bridge”, and so on. It’s like an automatic response with my OCD and it makes me so uncomfortable… I’m trying to get better. I don’t want to die. Sure, I still get pretty low, but I always push the thoughts away now instead of welcoming them like I used to. But with the intrusive thoughts being nearly constant now, it’s kind of scary. I dont know what to do to make them stop since the intrusive thoughts are just so automatic at the slightest feeling of discomfort. I have a therapist, but I dont know how to bring this up with her. I’m too nervous to even admit to suicidal thoughts, not to mention the intrusive thoughts they’ve turned into. It kind of feels like it’ll never go away.

rokenna

Date posted: 24w

New to diagnosis, and wanting advice

Hello, I’m in undergrad and recently was diagnosed with OCD. Its a very new diagnosis and it’s both been stressful and relieving to receive it. Looking back at my past I’ve been able to explain a lot of behavioral issues that I thought were simply attributed to me being “crazy”. It’s comforting to know it’s something that others struggle with and that there are set coping mechanisms and treatments for it. There are a number of thing of which I obsessively think about, and it’s been getting really hard to deal with all of them. The most troubling are my thoughts toward suicide. I can’t stop thinking about it. There’s not really any intent, it’s just like my brain has tuned into a frequency that plays in the background at all times. Usually though this leads to more dangerous behaviors, and so I always try to do any preventative work to keep myself safe. As for the asking for advice portion of this post, what do you all do to combat unending loops of thought? Because I’m so new to my diagnosis, my therapist and I haven’t found good strategies for me yet, outside of just labeling those thoughts as OCD in an attempt to delegitimize them.

smolstitch

Date posted: 9w

TW: Suicidal OCD question

Hey y’all. I have suicidal OCD and I feel that it manifests in a strange way. I feel like my brain often encourages me to kill myself. Like my most dominant thought isn’t ’what if you kill yourself’, it’s ’you should kill yourself.’ It tends to amp up every time I make some mistake, even if it’s small. And it definitely gets worse during times of stress. I don’t want to kill myself and I wouldn’t consider myself depressed. But if these thoughts are OCD, and are my brain trying to keep me safe from killing myself, why would it tell me to? I’d appreciate any insight.

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Differentiating Intrusive thoughts from SI

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