Obsessive-Compulsive Disorder: Navigating Thoughts of Life and Death

Obsessive-Compulsive Disorder (OCD), suicide or no suicide?

Dear Doctor: I apologize for the interruption, and I appreciate your willingness to read the following content.
I suffer from obsessive-compulsive disorder (OCD), primarily characterized not by frequent cleaning behaviors but by doubts and worries.
I constantly think about the appearances, names, and even social media profiles of certain individuals who I perceive to have undesirable traits, such as being unattractive, short, or having experienced late marriages and breakups (I desire to marry early).
I feel compelled to think of another group of good people to counterbalance these thoughts, fearing that their negative qualities might transfer to me.

Additionally, when I take the bus, I worry about strangers, and at work, I feel as if someone is hiding behind my chair, listening to my thoughts.
Even seeing certain individuals makes me feel influenced.
This also occurs in class, or when sitting on chairs that many others have used, I worry about being affected.
I even doubt the intentions of colleagues who offer me food, fearing they might want to transfer their unfortunate life experiences to me.
Various symptoms can manifest at any time, and the above examples are just the more common ones.
Sometimes, I even buy clothes because I believe that purchasing them will make my wishes come true.

These episodes occur daily, from the moment I wake up until I go to sleep.
I have visited clinics and have been diagnosed with OCD, but recently I have begun to doubt myself more frequently, wondering if perhaps I do not actually have a disorder but rather possess the ability to foresee or influence the future.
For instance, sometimes I suddenly crave a specific food, and coincidentally, I end up eating it that day, which reinforces my belief in this ability.
However, I am truly suffering immensely.
I apologize for being a coward; I only have the courage to cry and seek help through a screen.
I lack the bravery to face a doctor in person and express these thoughts that I find irrational yet deeply believe in.
I have even started to avoid medication because I believe in this ability, which leads me to question whether I should continue living in this world.

Xiao Yao Guan, 20~29 year old female. Ask Date: 2019/07/09

Dr. Huang Xiaoxian reply Psychiatry

Dear Happy,
First of all, thank you for your question, and I want to commend you for being willing to express your concerns! From what you’ve described, your obsessive symptoms are causing you significant distress, and you also have many worries related to interpersonal interactions.
This indicates a high level of anxiety, and some of your symptoms may have developed as a way to alleviate your anxiety and compulsions, sometimes even overwhelming your rational thinking (knowing it’s unreasonable but feeling unable to control it).

Generally speaking, individuals have both rational and emotional aspects, and most of the time, these thoughts are balanced.
However, in certain situations, these two types of thoughts can conflict and fail to integrate.
From a medical perspective, this often indicates that both physiological and psychological factors are significantly affected.
I recommend seeking consultation and assistance from a physician, as medication and psychotherapy can help adjust and improve your condition.
Wishing you all the best!

Reply Date: 2019/07/09

More Info

Dear Patient,
Thank you for reaching out and sharing your experiences. It takes a lot of courage to express such deep and complex feelings, and I commend you for doing so. Your struggles with obsessive-compulsive disorder (OCD) and the accompanying thoughts about life and death are significant and deserve careful consideration and support.

From what you've described, it seems that your OCD manifests through intrusive thoughts and compulsive behaviors that revolve around the fear of negative traits in others and the belief that these traits could somehow affect you. This is a common experience for individuals with OCD, where the mind becomes trapped in a cycle of doubt and fear, leading to compulsive actions aimed at alleviating that anxiety. The thoughts you have about people and situations, as well as the need to counterbalance them with positive thoughts or actions, are indicative of the disorder.

It's important to understand that OCD is a recognized mental health condition that can significantly impact your quality of life. The thoughts you experience are not a reflection of reality but rather a symptom of the disorder. Many individuals with OCD experience similar fears and compulsions, and it is crucial to approach these thoughts with compassion and understanding rather than self-judgment.

Your concerns about having the ability to foresee or influence the future are also common among those with OCD. This phenomenon, often referred to as "magical thinking," can lead to a heightened sense of responsibility for thoughts and actions, creating an overwhelming burden. It’s essential to recognize that these thoughts are part of the disorder and do not indicate any special abilities or powers.

To navigate these challenges, I strongly encourage you to seek professional help. Cognitive-behavioral therapy (CBT), particularly exposure and response prevention (ERP), is considered one of the most effective treatments for OCD. This therapeutic approach involves gradually exposing you to the sources of your anxiety while helping you refrain from engaging in compulsive behaviors. Over time, this can help reduce the power of intrusive thoughts and allow you to live more freely.

Additionally, medication such as selective serotonin reuptake inhibitors (SSRIs) can be beneficial for many individuals with OCD. These medications can help balance the serotonin levels in the brain, which may alleviate some of the symptoms you are experiencing. It’s essential to work closely with a psychiatrist or a mental health professional who can guide you through the process of finding the right treatment plan.

I understand that facing these issues in person can be daunting, but I encourage you to take that step. You deserve support and assistance in managing your thoughts and feelings. Writing down your experiences, as you have done here, can be a helpful way to communicate your struggles to your therapist or doctor. They can provide you with the tools and strategies needed to cope with your OCD and the associated fears.

Lastly, it’s vital to remember that you are not alone in this journey. Many people experience similar struggles, and there is a community of support available to you. Engaging with support groups or online forums can also provide comfort and understanding from those who have faced similar challenges.

In conclusion, I urge you to seek help and explore treatment options that can assist you in managing your OCD and the distressing thoughts about life and death. You have taken a significant first step by reaching out, and I hope you continue to seek the support you need to navigate these difficult feelings.

Wishing you strength and healing,
Doctor Q&A Teams

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