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The Conversation

Kayla Steele, Postdoctoral Research Fellow and Clinical Psychologist, UNSW Sydney

What’s the difference between intrusive thoughts and suicidal thoughts?

Suicide OCD Lifeline

We have thousands of spontaneous thoughts a day. Most of them are mundane, such as “Where did I leave my car keys?”

But every now and then a strange and distressing thought might pop into our mind, such as “What if I hurt myself or someone I care about?”

So, what’s the difference between these random (and sometimes scary) intrusive thoughts and suicidal thoughts?

And when can our thoughts be a warning sign we need help?

What are intrusive thoughts?

Intrusive thoughts are sudden, involuntary thoughts, mental images or urges. They often cover difficult themes such as causing or experiencing harm, contamination, making a mistake, or sexual or religious content.

Sometimes these thoughts can feel alarming or upsetting, especially if they’re unwanted and we feel an urge to get rid of them.

But most people experience intrusive thoughts and having them doesn’t mean you’re a bad person or will necessarily act on them.

It’s unclear exactly why we have intrusive thoughts. It might reflect the natural tendency of our minds to wander. This process is usually helpful, and can help us form new understandings or generate new ideas.

But under stress having intrusive thoughts can become less helpful, particularly when they are unwanted, upsetting or feel hard to control.

So if intrusive thoughts are mostly a signal of stress, not danger, when do they become a problem?

If these thoughts cause you distress and make it hard to manage everyday things such as work, school or relationships, this could be a sign of a mental health disorder such as obsessive-compulsive disorder (OCD), an anxiety disorder, depression or post-traumatic stress disorder.

What should you do about intrusive thoughts?

The more we try to push intrusive thoughts away, the more they return and the more intense they can become.

However, a type of psychological treatment that pairs cognitive behaviour therapy with “exposure and response prevention” is effective for dealing with intrusive thoughts in anxiety or OCD.

This involves allowing intrusive thoughts to be present without trying to control them, then gradually reducing less helpful responses (such as scrolling on your phone to try to block out the thought), so the brain learns the thoughts are not dangerous.

You can try a simple version of this at home:

label the thought (for example, “This is an intrusive thought.”)
reduce unhelpful coping mechanisms (for example, drinking alcohol to block out unwanted thoughts)
let the thought pass (for example, try a visualisation exercise where you imagine the thought drifting down a stream, without engaging with it or trying to get rid of it)
refocus your attention on enjoyable activities such as going for a walk, chatting to a friend, or focusing on a task like cooking. This is not to “escape” the thought but to let it sit in the background while you focus your attention on what’s important to you.

What if your intrusive thoughts are about death, self-harm or suicide?

Intrusive thoughts about experiencing harm such as your own death, self-harm or suicide are surprisingly common. We can also have intrusive thoughts about harm coming to others, including loved ones.

While they can feel upsetting, having thoughts such as “I wish I didn’t exist” doesn’t necessarily mean a person wants to or will act on them. However, it may indicate they are feeling emotionally overwhelmed, anxious or depressed.

Intrusive thoughts about your own death and specific ways of dying can also mean something more serious. It can lead to a greater risk of suicide or self-harm.

When do intrusive thoughts become a warning sign?

If intrusive thoughts are causing you distress, impacting your day to day life or you’re having thoughts about suicide, these are clear warning signs it’s time to get help.

Other important warning signs can include:

more frequent or persistent thoughts or images about death or suicide
increased hopelessness
actively thinking about, planning or preparing for death
behavioural changes such as withdrawing from others.

How can I get help and what can I do to help someone else?

You don’t need to manage these thoughts alone.

If you notice these warning signs in yourself, it’s important to ask for support. Talking to someone such a GP, psychologist, psychiatrist, trusted family member or friend can be a good first step.

If you’re having intrusive thoughts about suicide, your GP may ask you to complete a safety plan, which is a helpful reminder of ways to get support and keep safe when difficult thoughts, feelings or urges come up.

If you notice these signs in someone else, it’s important to check-in with how they’re doing at an appropriate time and in a caring way.

Here’s a four-step guide:

Ask directly about suicide. This won’t put the idea in someone’s head. When done sensitively, directly (“Are you thinking about suicide?”) and honestly, it can help people feel less alone.
Listen to the person, take them seriously and stay with them.
Get help (see examples below).
Follow-up and check in regularly.