Harm OCD vs. Suicidal Ideation: How Individual Therapy and OCD-Focused IOP Provide Effective Treatment
Obsessive-compulsive disorder (OCD) is often portrayed in the media as being focused on germs or wanting things to be even, but many types of OCD do not involve either of these types of challenges. Some themes of distress in OCD can be particularly difficult to explain and come with shame when talking about the theme of the obsessions, which can lead to delays in seeking treatment and concern about what they feel comfortable sharing.
One example of a type of obsession that can be challenging to discuss is when the obsessions surround harm, either harm coming to the person with OCD or harm coming to those around them. In some cases, these obsessions can be focused on intrusive thoughts or images around suicide; when a loved one or healthcare professional does not know this type of OCD, learning about these types of obsessions can lead to concerns about suicidal ideation or thoughts about suicide. This is where an IOP for harm OCD in Austin, TX, may be helpful.
What Is True Suicidal Ideation?
To understand the difference between true suicidal ideation and obsessions about suicide, it is important to first understand true suicidal ideation. Suicidal ideation varies in severity, especially when it comes to intent. Specifically, while some people have only thoughts about death or about dying by suicide, others also have the intent to follow through with these thoughts and attempt suicide. Intent can also vary between days or even between hours, and many people with suicidal ideation are not completely sure whether they intend to follow through. One helpful question to ask is for someone to rate to which they have intent to die by suicide, as this allows for more nuance regarding intent. Additionally, the Anxiety and Depression Association of America (ADAA) has outlined the following are signs of risk to watch for if you are concerned that a person may be experiencing true suicidal ideation:
If a person talks about being a burden to others, feeling trapped, experiencing unbearable pain, having no reason to live, and killing themselves.
Specific behaviors, such as increased use of substances; looking for a way to kill themselves; acting recklessly, isolating from family and friends, sleeping too much or too little, visiting or calling people to say goodbye, giving away prized possessions, and aggression.
People who are considering suicide often display one or more of the following moods: depression, loss of interest, rage, irritability, humiliation, and anxiety.
If you believe a loved one may be truly considering suicide, the link from ADAA has resources for what to do, and you can also call 988, which is the mental health emergency line. The Austin area also has a local resource, the Mobile Crisis Outreach Team (MCOT), that you can call to assess a loved one and determine if they’re safe. In Travis County, the number is 512.472.HELP (4357).
How Suicide Obsessions Differ From Suicidal Ideation
If someone is experiencing true suicidal ideation, they may or may not find the thoughts distressing or disturbing. Some may actually find relief in thinking about suicide. Regardless, in the case of suicidal ideation, the thoughts are consistent with the person’s true desires and values. When someone experiences thoughts about suicide in the context of an obsession, this is not the case. People with suicide obsessions generally perceive the thoughts to be disturbing or distressing in some fashion, and they are not consistent with their true desires and values. However, some may have doubts about whether this is the case, as they may have intrusive thoughts that ask them to consider the possibility that their thoughts are, in fact, true suicidal ideation and not OCD. Still, in those with strong insight, they will be able to report that suicide obsessions are not consistent with their true desires. Additionally, some people may experience both true suicidal ideation and suicide obsessions, which can lead to challenges with differentiating the two.
One of the most important reasons to differentiate suicidal ideation from suicide obsessions is treatment, as the treatment for the two is different, though there is some overlap. For example, both presentations can benefit from building a toolbox of distress tolerance strategies that they can use to cope with distress as opposed to making a choice that exacerbates their emotional distress or makes the situation worse. Both presentations also benefit from building awareness that they are experiencing these thoughts, so they can implement strategies they are learning in therapy at the appropriate time. However, the most common form of evidence-based treatment for OCD is exposure and response prevention, which is not used to address true suicidal ideation.
Can Exposure and Response Prevention (ERP) Help with Suicide Obsessions?
Broadly, exposure and response prevention (ERP) involves facing the fears that lead to obsessions or are being avoided because of obsessions and, over time, reducing or delaying the compulsions or avoidance behaviors that the obsession triggers the urge to do. For example, people with a suicide obsession may have an urge to avoid any sharp objects due to worries that they will suddenly use them against themselves, or avoid watching television in case the topic of suicide comes up and sets off obsessions. Compulsions may include asking others for reassurance that they are safe, as well as mental compulsions of checking their mood or whether they have a true desire to kill themselves. Mental compulsions can be particularly challenging, as they often happen so quickly and automatically, so it is crucial to work on building awareness that they are occurring. If someone was working on reducing reassurance seeking, response prevention may involve asking questions less often or delaying how quickly they ask the question.
The Role of Reassurance and Psychoeducation in Treatment
Along these lines, the treatment of suicide obsessions must involve thought about how much psychoeducation to provide about the difference between these obsessions and suicidal ideation. While everyone with OCD should learn to identify their obsessions as such, providing too much reassurance that what they are experiencing is OCD can become part of a compulsion or ritual. Healthcare providers and loved ones can all be pulled into the ritual through the person asking questions seemingly designed to determine whether they are experiencing suicidal ideation or suicide obsessions, and the more they do these rituals, the more distress they will experience around the obsessions. For people experiencing these thoughts, it can help to make a plan with those whom they tend to turn to for reassurance, for how they would like those people to respond when they seek reassurance. Options can include validating the distress the person is experiencing from these obsessions, asking them if they can cope with not having this question answered, or having a code word that conveys support and acknowledges that answering may be unhelpful. Additionally, treatment would need to help someone learn not to engage with the content of the intrusive thoughts and instead use helpful cognitive strategies that encourage sitting with the discomfort of the emotion.
Other Evidence-Based Treatments and When to Seek Help
For adults, there are also other options for evidence-based treatment of OCD, such as inference-based cognitive behavioral therapy (ICBT; for more information about ICBT, see this link: https://icbt.online/what-is-icbt/). If you are concerned about whether you are experiencing suicidal obsessions as part of OCD, true suicidal ideation, or a combination, it is best to seek the advice of a mental health professional, especially one who has expertise in OCD. They will be able to assess your symptoms and determine whether the appropriate level of care given various risk factors and the severity of symptoms.
Written by Dr. Rebecca Suffness
Individual Therapy with Dr. Rebecca Suffness
Dr. Rebecca Suffness is a licensed psychologist specializing in working with children, adolescents, and families. Her primary clinical interests include depression, OCD, generalized anxiety, and other anxiety disorders. She has received training in cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), and exposure and response prevention (ERP). Dr. Suffness also provides assessment services, including assessments for ADHD, learning disorders, and general mental health assessments. Dr. Suffness earned her Bachelor of Arts degree in Psychology at Duke University. She also received a Master of Arts and Doctor of Philosophy degrees in Clinical Psychology from the University of North Carolina at Greensboro. While Dr. Suffness is adamant that she is not a “cat lady,” she will openly discuss her fondness for her blonde tabby named Oscar Wildecat. Dr. Suffness enjoys various movies and TV shows, reading fiction, and eating excellent food. As a Dallas native, she is a fan of the Dallas baseball, basketball, and hockey teams. Additionally, as a Duke alumna, she is a fan of Duke basketball. Dr. Suffness also loves to travel, both abroad and domestically, and she has a goal to visit all 50 states. To schedule an appointment with Dr. Suffness or another therapist at Austin Anxiety and OCD Specialists, contact us at 512-246-7225 or hello@austinanxiety.com
Individual Therapy at Austin Anxiety and OCD Specialists
Individual therapy at Austin Anxiety and OCD Specialists provides a focused, one-on-one environment for understanding your symptoms, learning effective strategies, and building confidence in managing intrusive thoughts. Dr. Suffness, along with other therapists at Austin Anxiety and OCD Specialists, specializes in evidence-based therapy for OCD, including ERP and ICBT, and tailors each session to your specific needs, values, and goals. Whether you’re navigating harm obsessions, suicidal obsessions, or general anxiety, individual therapy offers structured guidance and compassionate support as you begin to regain control of your life.
Intensive Outpatient Program at Austin Anxiety and OCD Specialists
For individuals who need a higher level of support, Austin Anxiety and OCD Specialists offers a comprehensive Intensive Outpatient Program (IOP) in Austin, Texas, designed specifically for OCD and anxiety disorders. Our IOP provides multiple treatment hours per week, combining exposure and response prevention (ERP), cognitive behavioral therapy, acceptance and commitment therapy, ICBT principles, skills training, and ongoing support from clinicians with advanced expertise in complex OCD presentations, including harm OCD and suicidal obsessions. This level of care is often ideal for clients whose symptoms are interfering with work, school, or daily functioning, or for those who have not made sufficient progress in traditional weekly therapy or those who wish to accelerate their progress through a more intensive approach to OCD and anxiety therapy. By participating in an anxiety and OCD-focused IOP in Austin, clients benefit from structured treatment, accountability, and a collaborative environment that helps them build momentum more quickly. Our program emphasizes measurable progress, personalized treatment planning, and tools to maintain improvement long after completing the IOP. If your symptoms feel overwhelming or you’re unsure what level of care is right for you, our team can help you determine whether an OCD-specific Intensive Outpatient Program is the most effective next step.
Meet the Team Supporting Your IOP Experience
A meaningful IOP experience is built on trust, expertise, and compassionate care. At Austin Anxiety and OCD Specialists, our clinicians are dedicated to helping clients regain emotional stability and clarity during challenging periods. Each provider brings specialized training, evidence-based approaches, and a grounded presence, meeting clients where they are and supporting sustainable progress.
Dr. Samantha Myhre, PhD, Assistant Clinical Director & IOP Coordinator, treats anxiety and OCD using evidence-based, mindfulness-informed approaches that support self-worth and emotional insight. She works collaboratively with individuals in Austin, TX, helping them build confidence and practical coping strategies.
Ann Elise Taylor, LCSW, PMH-C, specializes in adult and perinatal mental health, with extensive experience treating anxiety, OCD, and trauma. Using CBT and ACT, she offers steady, supportive care that helps clients restore balance and resilience, particularly during high-stress situations.
Ayla Bridges, LMFT, works with children, teens, and families managing OCD, anxiety, and behavioral challenges. Through CBT and ERP, she supports young clients in facing fears, strengthening emotional expression, and building confidence in new or unfamiliar situations.
Dr. Ansimone Youssef, PsyD, focuses on adolescents and young adults with OCD, anxiety, and depression. Her culturally responsive, individualized approach ensures clients feel understood while progressing at a pace that feels safe and sustainable.
Our IOP for harm OCD in Austin, TX, offers compassionate, evidence-based care tailored to your needs. Our team is here to help you move forward with greater stability, confidence, and support.
Begin Compassionate Therapy in Austin, TX
Harm OCD and suicidal ideation can look similar on the surface, but they require very different clinical understanding and treatment. When these thoughts start to take over your days, increase anxiety, or lead you to question your own safety or character, specialized support can make a meaningful difference.
At Austin Anxiety and OCD Specialists, we provide individual therapy and IOP for harm OCD in Austin, TX, designed specifically for individuals struggling with intrusive harm-related obsessions. Our adult Intensive Outpatient Program offers structured, OCD-informed care that goes beyond reassurance or generic coping strategies. Using evidence-based approaches such as Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT), we help clients learn how to respond differently to intrusive thoughts, reduce compulsive safety behaviors, and regain trust in themselves.
For individuals experiencing suicidal ideation alongside OCD, treatment is carefully individualized. Our clinicians are trained to assess risk accurately, distinguish OCD-driven fear from true intent, and provide appropriate levels of care. Through a combination of individualized therapy and IOP support, clients can build skills to tolerate uncertainty, regulate distress, and move out of the cycle of fear and avoidance that harm OCD creates.
If you’re considering IOP for harm OCD in Austin, TX, we invite you to take the next step:
Call 512-246-7225 or email hello@austinanxiety.com to schedule a free consultation.
Learn more about how our IOP for harm OCD supports adults who feel trapped by intrusive thoughts, constant monitoring, and fear of “what if.”
Relief is possible. With the right support, intrusive thoughts can lose their power, and you can begin to feel steadier, safer, and more like yourself again.
Additional Mental Health Services at Austin Anxiety and OCD Specialists in Austin, TX
At Austin Anxiety and OCD Specialists, we understand that anxiety and OCD-related challenges don’t follow a one-size-fits-all path. Each person’s symptoms, daily demands, and personal history influence the kind of care that will be most effective. For that reason, our services extend well beyond our IOP for harm OCD in Austin, TX, offering adaptable, evidence-based treatment for children, teens, and adults at various points in their recovery. Our clinicians support individuals experiencing concerns such as OCD, panic disorder, social anxiety, phobias, PTSD, generalized anxiety, selective mutism, emetophobia, depression, separation anxiety, tics, and body-focused repetitive behaviors, with care that is always tailored and research-informed.
In addition to individual therapy, we provide a range of specialized supports, including parent coaching, SPACE treatment for families, group therapy, and thorough psychological evaluations. For adults managing busy schedules or families located throughout Texas, our secure teletherapy services offer the same high standard of evidence-based care in a convenient, accessible format.
We also offer Camp Courage, an experiential therapeutic program designed to help children and teens face fears gradually, build confidence, and develop practical coping skills within a supportive, age-appropriate setting.
Whether you are new to therapy, considering the added structure of an IOP in Austin, TX, or looking for ongoing, specialized support, our team is dedicated to offering compassionate, nonjudgmental care. We’re here to support you and your family as you work toward greater stability, resilience, and long-term emotional health.