Suicidal Obsessions or Suicidal Ideation? A Case Report and Practical Guide for Differential Assessment

Suicidal obsessions (SO) can be challenging to distinguish from suicidal ideation (SI). This can be in part due to low familiarity with diverse presentations of OCD, as well as the limited scope of common measurement tools for assessing suicide-themed thoughts within a cognitive, affective, and behavioral framework. Inaccurate assessment increases the risk of misdiagnosis and inappropriate treatment, which are critical to prevent. Therefore, we present a practical guide with a case example highlighting potential cognitive, affective, and behavioral criteria to consider in differentiating SO from SI, grounded upon a cognitive-behavioralframework and the extant literature regarding the phenomenology and assessment of OCD and suicidality. Through illustrative figures we also demonstrate examples of SO and SI with resulting cognitive, affective, and behavioral responses, and how they functionally interrelate with each other. We conclude with suggestions for future research validating the criteria provided in this guide. In summary, using this evidence-based guide to assess suicide-themed thoughts, emotions, and behaviors may help clinicians accurately distinguish between SO and SI, in turn optimizing interventions for their clients.