There has been an increase in discussion about suicide in the past several weeks after the suicides of fashion designer Kate Spade and chef Anthony Bourdain. The Centers for Disease Control also released a report earlier this month that reported a 30% rise in suicide rates since 1999. I feel it’s important to address the topic of Suicidal OCD given how confusing it can be to both those who have it and those who have loved ones with it.

Suicidal OCD is not about wanting to die. On a very general level, those who end up dying by suicide feel that this is their only way of dealing with painful thoughts, feelings, or circumstances.  Suicidal OCD is the fear that one may act upon intrusive images or thoughts they have about harming themselves. As Dr. Steven Phillipson explains in this video OCD is about seeking safety. People with Suicidal OCD generally want to be absolutely 100% sure they will never act on these images of harming themselves. 

Please watch this important video from Dr. Phillipson:

 I love this video created by Russ Harris explaining how our primitive brains respond to the modern world.

Too often we verbally beat ourselves up for how our brains initially react to situations it perceives as threatening. As the video shows, we often come by these automatic responses naturally. The primitive brain can receive signals from the environment in milliseconds. 

For those of us hyper-sensitized to anxiety, it’s as if our internal fire alarms are getting set off by shower steam rather than by actual smoke. This is helpful to remind ourselves when we feel ourselves feeling fear in the absence of a clear and present danger.

This has been an especially active hurricane season for those of us living on the Gulf Coast or the Southeastern part of the country. I can’t speak for all of those people but I know for myself the worry about a hurricane starts once it’s named and could be heading my way. It jumps about 10 notches once where I live is inside the dreaded, but appropriately named, “Cone of Uncertainty”.

At that point, my worry takes two distinct forms. The first is what I call “Action Mode”: I start gathering supplies, gassing up the car, sorting through insurance policies and family pictures to take with me if we evacuate, and preparing the house. The second form is “Fretting Mode”. This causes me to check the weather every 30 minutes, watch all the videos that make the rounds about what hurricane winds can do to your house, and compulsive read Facebook. I tell myself “I’m just gathering information so I’m prepared” but the effect it has on me is just the opposite. It fuels the catastrophic thoughts much like the warm water fuels the hurricane – these thoughts just get bigger and stronger. I get trapped in my head with thought thoughts that often start with “What if” as in “What if where we evacuate gets it worse? What if we get stuck on the road? What if we stay and our tree falls on the house and we get trapped”

Many people, including myself, experience these modes of worry in situations other than approaching hurricanes. These can be problems at work, in school, in social situations, in relationships. When they occur, it’s important to start noticing and naming the type of mode we are in and what is the best way to deal with it.

  1.  Action Mode = this is a productive type of worry. It propels us to develop a specific plan of action for an immediate situation. It prompted me to get gas for the car and locate the insurance policies. It has a tangible result and increases our sense of productivity as we are able to do something for ourselves. The best way to handle this is to take the action or make a plan as to when it would be appropriate to take the action.
  2. Fretting Mode = this is an unproductive type of worry. It’s unproductive because it is more future-oriented and it is less likely that we can take any action on it at the moment. It also does not give us a sense of power. In fact, it often makes us feel even more powerless. “Feeding the fret” by checking the weather every 30 minutes or coming up with every catastrophic possibility does not answer any questions for me. In fact, it ends up agitating more and paralyzing me from taking any kind of useful action. The best way to handle this one is to recognize your mind is trying to solve a problem that can’t be solved right now. “I’ll deal with that if that situation comes up” or “Thinking/doing this is only spinning me up; what can I do right now that would be productive or useful”. 

It take practice to be able to notice and name whether a worry is productive or unproductive. But doing that in a situation where you worry can keep the worry from exploding into a Category 5 and shutting you down.


During treatment, most of my clients as me a variation of this question: “When will this anxiety/fear/panic/dread/doubt go away?” I understand why they ask this. The thoughts, feelings, and sensations that accompany anxiety can cause intense distress and a fear that your mind and body are not completely under your control.

My response to them is that anxiety is not the problem. It’s our interpretation of the anxiety that causes the distress. In fact, we do not want anxiety to go away. Anxiety is a biological response to potential threat. Among other things, it motivates our performance at work or school; it keeps us from wandering down dark alleys at night; it’s that “gut reaction” that tells us something is amiss in our surroundings. We need anxiety in order to survive.

I think what clients are really asking me is when will the suffering from anxiety go away. People who struggle with anxiety disorders have learned over time that anxiety is to be avoided, resisted, and eliminated. The problem with this response is that it has a rebound effect. There’s an adage is psychology that “what you resist persists”. The more one demands that anxiety be absent from one’s life, the more one is dismayed one anxiety inevitably shows up.

One way of easing suffering is to recognize that anxiety’s existence is a fact of life. The more effective question is to ask “How can I start responding to anxiety in a different way so that it doesn’t cause so much suffering?”