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

Abstract

Obsessive-compulsive disorder is a common psychological illness characterized by recurrent intrusive thoughts, often accompanied by uncontrollable behavior. This disorder carries its own risk for suicide; however, suicidal thoughts can be a form of an obsession content of this illness. Distinguishing the difference between suicidal obsessions and accurate suicidal ideations may be under-recognized, which contribute to unnecessarily rigorous risk assessment, and subsequent interventions. This report presents one of the very few cases in literature that describes suicidal thoughts as the obsession content of obsessive-compulsive disorder patients. The present study can assist professionals evaluate a better risk assessment, and implement suitable treatment methods for patients suffering from this particular form of obsessive-compulsive disorder. Paroxetine is the choice medicine recommended for this cognitive, restructuring in the treatment of this and similar condition illnesses.

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].…”

“…OCD with ego-dystonic suicidal obsessions have rarely been reported in the literature (see Table 1). Each previously reported case of OCD with suicidal obsessions has been in patients with history of long standing OCD, treatment refractory OCD, or history of suicide attempt (Table 1) [13–15]. The case report by Al-Zaben [13] describes a patient with suicidal obsession in long standing OCD with comorbid depression.…”

“…Each previously reported case of OCD with suicidal obsessions has been in patients with history of long standing OCD, treatment refractory OCD, or history of suicide attempt (Table 1) [13–15]. 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).…”

“…Furthermore, violent obsessions have been reported to be positively correlated with suicidality in OCD [9, 12]. 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].…”

“…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).…”