How to Respond to Intrusive Thoughts of Self-Harm

Whether you face an ongoing struggle with depression or OCD, or are experiencing an acute issue right now, the idea that your mind could be telling you to hurt or even kill yourself can be terrifying. When you feel alone, don’t have support, or are struggling with an unchecked mental illness, saying yes to these ideas could feel easier than continuing to resist. But your life is worth enough to fight for. Here are some techniques to respond to intrusive thoughts of self-harm that you can use to manage your situation, and make it through to a new day. 

Get Immediate Help for Thoughts of Self-Harm

If you or a loved one is experiencing thoughts of suicide or self-harm right now, you can get immediate help by calling or texting the Suicide and Crisis Lifeline at number 988. The lifeline is available 24/7/365 and offers confidential contact with a counselor specially trained to help you feel safe and provide resources to help you get through your experience. They also have an online chat option so you can get support right away. 

Suicidal Ideation Is an Urgent Issue That Should Not Be Ignored

If you have thoughts of hurting yourself or wish you were dead or not alive, you are likely experiencing what psychotherapists call suicidal ideation. The first sign of suicidal ideation is often passive. You may experience a wish to die or hurt yourself. Active suicidal ideation means more than passing thoughts. A person with suicidal ideation has recurrent thoughts about suicide or self-harm and a plan for how they plan to take action on those thoughts. Depending on the age of the person, that plan may be more or less complex (or achievable). 

The danger of you or your loved one pursuing any plan for self-harm or suicide is severe, so it should never be overlooked or allowed to go untreated. Even passive suicidal ideation can often escalate in times of stress. 

Intrusive Thoughts of Self-Harm Could Be a Form of OCD

However, sometimes you may experience intrusive thoughts of self-harm that you don’t want, or even don’t agree with. This form of obsessive-compulsive disorder (self-harm OCD) can be equally disturbing, and can severely disrupt your daily life, even if you have no intention of acting on the thoughts you experience. Instead, self-harm OCD means you experience unwanted thoughts about hurting yourself, and then feel anxiety over whether it could occur. For example, a person experiencing self-harm OCD may wonder about:

• Hurting themselves with a sharp or dangerous object they are using (such as cutting themselves with a kitchen knife)
• Wanting to cause injury (such as biting their skin)
• Losing control and causing self-injury unintentionally (such as causing a car crash)

Distinguishing Intrusive Thoughts of Self-Harm from Suicidal Ideation

Whether you are experiencing suicidal ideation or intrusive thoughts of self-harm generally depends on whether the thoughts you experience contradict or confirm your underlying feelings and values. People experiencing suicidal ideation may feel a sense of relief or engage with the thoughts, building on them, developing a plan, and ultimately becoming comfortable with the idea of carrying them out. Psychotherapists call these ego-systonic thoughts, thoughts that match your values. 

In contrast, self-harm OCD often takes the form of what psychotherapists call ego-dystonic thoughts, that is, thoughts that go against your own wishes or values. Experiencing these thoughts does not mean you want to act on them, but you may feel anxiety around resisting those urges. Often, people experiencing self-harm OCD will go through a cycle of: 

• Experiencing thoughts of self-harm, 
• Reassuring themselves they do not want to act on those thoughts
• Avoiding the item or experience that triggered the thoughts

How to Respond to Intrusive Thoughts of Self-Harm

Experiencing thoughts of self-harm or suicide can be very hard to deal with. It can be a sign that you are going through something very hard, and that you need to reach out for help. Here are some ways to respond to intrusive thoughts of self-harm, both in the short-term and once the moment has passed.

Get Support from Someone You Trust

If you are currently experiencing thoughts of self-harm or suicide talk to someone you trust. Sharing your feelings with a spouse, trusted confidante, or close friend can help reduce the urge to act on those impulses. It can also reassure you that you are important to the people around you, putting the idea of suicide into perspective and making it easier to say no to the thoughts. If you don’t have someone available immediately, use a helpline like the one above. 

Do Grounding Exercises or Deep Breathing

Mindfulness is a powerful tool to respond to intrusive thoughts of self-harm. Using an app, or practicing grounding techniques such as deep breathing or naming items in your space, can help you put distance between yourself and the thoughts or desire to hurt yourself. 

Distract Yourself from Intrusive Thoughts of Self-Harm

If the thoughts persist, make a point to do something you enjoy, especially something with a physical component like exercise, dance, or gardening. These activities can get you out of your head, distracting yourself from thoughts of self-harm. Physical activity can also improve your mood and reduce stress, which in turn will quiet your thoughts of self-harm. 

Avoid Alcohol or Controlled Substances

If you find that you continue to struggle with suicidal ideation or thoughts of self-harm, restrict or eliminate your use of alcohol or non-prescription drugs. These substances can increase symptoms of depression and anxiety and can trigger self-harming urges. 

Break Down Your Thoughts and Feelings About Them

An important step in responding to intrusive thoughts of self-harm is identifying how you feel about them. This can help you and your psychotherapist distinguish between true suicidal ideation and intrusive thoughts of self-harm. Take time to identify, or even write down, the thoughts, images, and urges that you experience. Ask yourself how you feel about them. Then look at what you do, mentally or physically, after you experience them. Do you try to avoid the thoughts, or do you engage with them?

Talk to a Psychotherapist About Your Experiences

Whether you are experiencing and engaging with suicidal ideation or experiencing intrusive thoughts of self-harm, it is important to get professional help right away. You can start by talking to your primary care doctor, who can provide you with resources and, in some cases, medication to address the symptoms. However, developing lasting techniques to manage and respond to intrusive thoughts of self-harm is often best done through cognitive-behavioral therapy (CBT) with an experienced psychotherapist. Through consistent sessions and therapeutic interventions, you can develop resilience to these thoughts so you are less likely to act on them when things get tough. 

David Stanislaw is a psychotherapist with over 35 years of experience. He helps adults and couples manage obsessive compulsive disorder, anxiety and other psychiatric issues. Contact David Stanislaw to get help for your relationship today.