Differentiating Self-Harm OCD from Suicidal Ideation

Differentiating Self-Harm OCD from Suicidal Ideation

Emma Kelley-Bell

Emma Kelley-Bell is an Associate Clinical Social Worker (ASW) in California, trained and supervised by Tejal Jakatdar. Her passion is in providing client-centered care to children and adolescents living with Obsessive Compulsive Disorder (OCD) and related disorders.  Emma completed her Bachelor’s in Science in Child and Family Studies from Louisiana State University. She went on to earn her master’s degree in Social Work with a concentration in Direct Practice from the University of Pittsburgh. During graduate school, Emma interned at an intensive outpatient clinic for pediatric OCD. There, she discovered her passion for providing evidence-based therapy to children and teens. 

Emma has been with Willow since 2021. She has experience incorporating Cognitive Behavior Therapy (CBT), Exposure and Response Prevention (ERP), and Acceptance and Commitment Therapy (ACT) to teach her clients the skills to defy OCD in their everyday life. Emma is also trained in Supportive Parenting for Anxious Childhood Emotions (SPACE). Emma is skilled at drawing upon clients strengths to make therapy fun and engaging while also productive. In addition to guiding families through treatment, Emma also aims to create a safe space for clients to be themselves. Emma is LGBTQIA+ affirming and practices from a perspective of cultural humility with clients from diverse backgrounds. She approaches each session with enthusiasm, positivity, and compassion. Emma enjoys spending her free time around people who bring out her inner child, creating arts and crafts projects, and relaxing with her pets.

Boost Search Results
Off

Differentiating Self-Harm OCD from Suicidal Ideation

Share
No
Differentiating Self-Harm OCD from Suicidal Ideation

How do I know if I have self-harm OCD or if I actually want to kill myself? This is a significant differentiation to make because it can have treatment-impacting and even life-threatening consequences. In this post, we will explore the main differences between suicidal ideation (SI) and self-harm obsessive-compulsive disorder (OCD). 

SI occurs when an individual has thoughts and wishes related to death and suicide. To break it down even more, active SI is when an individual has thoughts about suicide and a plan to follow through with those thoughts. On the other hand, passive SI is a wish to die, but no definitive plan to follow through. Often, passive SI is the first step in reaching active SI.  

Self-harm OCD is when an individual has unwanted thoughts about harming themselves and then feels anxious that they will hurt themself. It can be seen in the form of questions such as: 

  •  “What if I want to hurt myself?” 
  •  “What if I hurt myself with this?”
  •  “What if I lose control and hurt myself?” 
  •  “Does having these thoughts mean that I want to hurt myself?” 

Difference between ego-dystonic and ego-syntonic 

  • Ego-dystonic thoughts are intrusive and go against your values (things that are important to you). 
    • Examples: 
    • You want your child to win their championship game and have the thought, “I really hope they lose”.  
    • You do not wish to die and have the thought, “What if I used this object to hurt myself?”.  
  • Ego-syntonic thoughts are thoughts that are in line with your values.  
    • You want your child to win their championship game and have the thought, “I hope they win”.  
    • You are feeling depressed and hopeless and have the thought, “I don’t want to be here anymore”.  

To be clear, everybody has both ego-dystonic and ego-syntonic thoughts. That is just how our brains are wired; we cannot control what thoughts pop into our minds. It is what you do with these thoughts that is important. Self-harm OCD is ego-dystonic while SI is ego-syntonic. Here are some examples (please note that these are just examples, not what everyone might experience): 

  • Self-harm OCD: You see a knife in the kitchen and think, “What if I stab myself with that?”. You then feel anxious, avoid looking at the knife, and leave the kitchen. You might tell yourself that you would never do that. You avoid anything that might trigger similar thoughts. However, you continue to experience these thoughts and maintain a cycle of avoidance/reassurance.  
  • SI: You see a knife in the kitchen and think, “What if I stab myself with that?”. You might feel relief and engage with the thought. These thoughts may be scary, but they get you to think about it. The initial thought transforms into other thoughts, “That would fix things; I wouldn’t have to feel this way anymore…”. You engage in the act of thinking and come up with a plan.  

To differentiate the two, it is important to break it down by thoughts, feelings, and behavior: 

  • What thoughts/images/urges are popping into your head? 
  • How do you feel? 
  • What do you do (behaviorally- mentally or physically) after that thought? 

All this being said, a person can have both self-harm OCD and SI. If you have concluded that you have self-harm OCD, please find an experienced Exposure and Response Prevention (ERP) provider. If you have concluded that you have suicidal ideation, please find an experienced Dialectical Behavior Therapist (DBT). 


This post is presented in collaboration with ADAA's OCD and Related Disorders SIG. Learn more about the SIG.

Emma Kelley-Bell

Emma Kelley-Bell is an Associate Clinical Social Worker (ASW) in California, trained and supervised by Tejal Jakatdar. Her passion is in providing client-centered care to children and adolescents living with Obsessive Compulsive Disorder (OCD) and related disorders.  Emma completed her Bachelor’s in Science in Child and Family Studies from Louisiana State University. She went on to earn her master’s degree in Social Work with a concentration in Direct Practice from the University of Pittsburgh. During graduate school, Emma interned at an intensive outpatient clinic for pediatric OCD. There, she discovered her passion for providing evidence-based therapy to children and teens. 

Emma has been with Willow since 2021. She has experience incorporating Cognitive Behavior Therapy (CBT), Exposure and Response Prevention (ERP), and Acceptance and Commitment Therapy (ACT) to teach her clients the skills to defy OCD in their everyday life. Emma is also trained in Supportive Parenting for Anxious Childhood Emotions (SPACE). Emma is skilled at drawing upon clients strengths to make therapy fun and engaging while also productive. In addition to guiding families through treatment, Emma also aims to create a safe space for clients to be themselves. Emma is LGBTQIA+ affirming and practices from a perspective of cultural humility with clients from diverse backgrounds. She approaches each session with enthusiasm, positivity, and compassion. Emma enjoys spending her free time around people who bring out her inner child, creating arts and crafts projects, and relaxing with her pets.

Use of Website Blog Commenting

ADAA Blog Content and Blog Comments Policy

ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors – or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees. Any comments or opinions expressed are those of their respective contributors only. Please remember that the open and real-time nature of the comments posted to these venues makes it is impossible for ADAA to confirm the validity of any content posted, and though we reserve the right to review and edit or delete any such comment, we do not guarantee that we will monitor or review it. As such, we are not responsible for any messages posted or the consequences of following any advice offered within such posts. If you find any posts in these posts/comments to be offensive, inaccurate or objectionable, please contact us via email at [email protected] and reference the relevant content. If we determine that removal of a post or posts is necessary, we will make reasonable efforts to do so in a timely manner.

ADAA expressly disclaims responsibility for and liabilities resulting from, any information or communications from and between users of ADAA’s blog post commenting features. Users acknowledge and agree that they may be individually liable for anything they communicate using ADAA’s blogs, including but not limited to defamatory, discriminatory, false or unauthorized information. Users are cautioned that they are responsible for complying with the requirements of applicable copyright and trademark laws and regulations. By submitting a response, comment or content, you agree that such submission is non-confidential for all purposes. Any submission to this Website will be deemed and remain the property of ADAA.

The ADAA blogs are forums for individuals to share their opinions, experiences and thoughts related to mental illness. ADAA wants to ensure the integrity of this service and therefore, use of this service is limited to participants who agree to adhere to the following guidelines:

1. Refrain from transmitting any message, information, data, or text that is unlawful, threatening, abusive, harassing, defamatory, vulgar, obscene, that may be invasive of another 's privacy, hateful, or bashing communications - especially those aimed at gender, race, color, sexual orientation, national origin, religious views or disability.

Please note that there is a review process whereby all comments posted to blog posts and webinars are reviewed by ADAA staff to determine appropriateness before comments are posted. ADAA reserves the right to remove or edit a post containing offensive material as defined by ADAA.

ADAA reserves the right to remove or edit posts that contain explicit, obscene, offensive, or vulgar language. Similarly, posts that contain any graphic files will be removed immediately upon notice.

2. Refrain from posting or transmitting any unsolicited, promotional materials, "junk mail," "spam," "chain mail," "pyramid schemes" or any other form of solicitation. ADAA reserves the right to delete these posts immediately upon notice.

3. ADAA invites and encourages a healthy exchange of opinions. If you disagree with a participant 's post or opinion and wish to challenge it, do so with respect. The real objective of the ADAA blog post commenting function is to promote discussion and understanding, not to convince others that your opinion is "right." Name calling, insults, and personal attacks are not appropriate and will not be tolerated. ADAA will remove these posts immediately upon notice.

4. ADAA promotes privacy and encourages participants to keep personal information such as address and telephone number from being posted. Similarly, do not ask for personal information from other participants. Any comments that ask for telephone, address, e-mail, surveys and research studies will not be approved for posting.

5. Participants should be aware that the opinions, beliefs and statements on blog posts do not necessarily represent the opinions and beliefs of ADAA. Participants also agree that ADAA is not to be held liable for any loss or injury caused, in whole or in part, by sponsorship of blog post commenting. Participants also agree that ADAA reserves the right to report any suspicions of harm to self or others as evidenced by participant posts.

RESOURCES AND NEWS
Evidence-based Tips & Strategies from our Member Experts
RELATED ARTICLES
Block reference