Hello,
If anyone has experience with codiagnoses of MDD and OCD, how do you differentiate SI from an intrusive thought? How do you know when to engage with the thought (if it’s ocd) bs not (if it’s MDD)
I added context of my situation below but no need to read it, you can also drop your experience or recommendations just addressing the question
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I haven’t been active here much since my OCD got significantly better after medical and ERP treatment few years back, but wanted to come on here for more specific help.
About a year ago I started experiencing depressive symptoms which cumulated into an aborted attempt in April. Since early this year I’ve had a handful of minor crises (moments where I didn’t do anything but my god I really wanted to) and have been in the severe category for a few months.
We’ve been approaching this as a separate entity (MDD as opposed to OCD) because of how different it is, but there are some similarities as well. I ironically years ago had a theme around suicide (except I was afraid that I was going to instead of genuinely wishing for it), so it’s a bit hard for me to tell.
Part of the reason why this differentiation is important is because of how I should approach the thoughts. If it’s OCD, I need to expose myself to the idea of suicide, methods, mechanisms, locations, standing on an edge, etc.. If it’s MDD, then I technically shouldn’t engage in suicide related planning or actions because it allows an easy path during a crisis.
Similarities:
- the SI can appear in an intrusive-like manner of being seemingly out of nowhere
- sometimes they are distressing, mainly because it’s annoying while I’m trying to pay attention to class and have a semblance of a good day
- I want to do a certain action to make me feel better about said thoughts, which is looking up and establishing methods, planning letters, dates, etc., and resisting the urge to finalize my methods is both difficult and distressing.
Differences
- It’s MUCH more egosyntonic. And not in a “I’m worried that I want to commit suicide” way, in a literal I’m exhausted and I want out. If there was a bottle of pills that deleted me from existence to where no one would remember me, I’d take them in a heartbeat. I don’t have an inherent will to stay here, I’m only here because of my family and cats. Also ideal methods are kinda hard to access.
- Sometimes I find comfort in the thoughts, like it’s always an available emergency way out. When I get distressed from them, it’s usually less because of the thought and more because I don’t have an established plan so I feel trapped to live.
- Additional symptoms that appear with MDD and not always OCD (anhedonia, physical slowing, emotional blunting, hopelessness, weight fluctuations, random unexplainable bouts of tears, hypersomnia), like textbook MDD symptoms.
- sometimes when the SI is bad it tends to “cancel out” typical blips of ocd I have. For example, I sometimes still have thoughts about contamination and getting in a car accident, except when the thoughts appear they don’t bother me in the slightest, and if anything I avoid compulsions and embrace the possibility of them happening because it’s a good excuse to hit the road.
Feels like a bit of a catch 22 because if I engage in suicidal thinking/planning/rehersas, it either 1) could worsen my mental health if it’s from MDD, or 2) could help my mental health if it’s from OCD