Suicidal Ideation Versus Suicidal Obsession: A Case Report

Abstract

This case report illustrates the relationship between stress and obsessive-compulsive disorder (OCD) by describing an unusual case of OCD sequelae following a suicide attempt. The patient is a 29-year-old married woman who suffered a major depressive episode without OCD and tried to commit suicide by drinking household cleaner. Following the attempt, violent obsessive thoughts of harming herself and others emerged along with avoidance behavior. After exposure therapy, there was a decrease in her obsessive thoughts, less anxiety, and no avoidance behavior. This report highlights not only the existence of “posttraumatic obsession” but also the importance of accurate interpretation of suicidal preoccupation, leading to the diagnosis of OCD rather then suicidal ideation secondary to depression.

Clinical Handbook of Obsessive-Compulsive and Related Disorders

“…Based on the results found in this case study and limited previous research (Wetzler et al 2007), CBT approaches, such as ERP, are effective treatments for this type of OCD presentation, which is consistent with previous studies that have shown that ERP can be effective for reducing OCD symptom severity within the unacceptable thoughts subtype (e.g., Williams et al 2013).…”

Suicidal Obsessions in a Patient with Obsessive Compulsive Disorder: A Case Report

“…A similar case was reported in Wetzler et al [10] , where the patient's depressive symptoms were accompanied by suicidal thoughts initiated from obsessive symptoms of OCD rather than a true wish to die. The patient expressed suicidal thoughts of drinking detergent.…”

Obsessive-Compulsive Disorder with Suicide Obsessions in a First Responder without Previous Diagnosis of OCD or History of Suicide Attempts

“…(DSM-5), defines suicidal ideation as “thoughts about self-harm, with deliberate consideration or planning of possible techniques of causing one's own death.” Rumination of suicidal ideation in mood disorders is generally mood-congruent and not necessarily experienced as intrusive, distressing, or linked to compulsions [1]. Suicidal obsession on the other hand is characterized by recurrent, persistent, intrusive, and unwanted thoughts about suicide that cause marked anxiety or distress [1, 13, 14]. Factors suggesting OCD related thoughts include ego-dystonicity, absence of past behavior consistent with the thought, presence of avoidance behavior (i.e., avoidance of any tools of suicide), frequent thoughts, high degree of distress, and fair-good insight with strong motivation to seek help [17].…”

“…The case report by Al-Zaben [13] describes a patient with suicidal obsession in long standing OCD with comorbid depression. A case report by Wetzler et al [14] described a patient with long standing MDD who developed obsessive thoughts of harming herself following a failed suicide attempt (posttraumatic obsession). In addition, a case report by Watterneck et al [15] described suicidal obsession in a patient with chronic treatment-resistant OCD with comorbid depression who was successfully treated with methodology described by Foa et al [18], an evidence-based treatment for OCD.…”

“…However, OCD with ego-dystonic suicidal obsessions have rarely been reported [13–15]. Al-Zaben described a patient with long history of both MDD and OCD who developed suicidal obsessions [13] while Wetzler et al described the development of OCD with suicidal obsessions in a patient with MDD, following a suicide attempt [14]. Furthermore, Wetterneck et al described OCD with suicidal obsession in a patient with treatment-resistant OCD [15] (see Table 1).…”