How do I know if I'm having intrusive thoughts or suicidal thoughts?

[LittleMachine]

I've been feeling awful for the last week and a half, getting worse as each day has gone on. For full info, I have various diagnoses, but they include GAD, OCD, PTSD and panic disorder. My OCD does often present as intrusive thoughts.

When I got up this morning, I had thoughts about self harming, cutting my legs with a knife. I didn't act on it but I did want to.

When I was driving to work, I had to stop myself driving into oncoming traffic. I got myself there, felt awful, had a panic attack but managed to get myself in.
Feeling this low is new to me - my anxiety usually sends me high not low, and then I eventually crash and burn.

I spent all day trying to hold myself together. I felt like I was moving and talking underwater all day, and I haven't felt real, like I'm in Alice in Wonderland.

How do I know if I'm genuinely feeling suicidal or if it's intrusive thoughts? And what should I do? I'm already on medication and had therapy which had been quite successful. Shall I try and get a GP appointment?

Hi OP,

This sounds like a really scary time for you right now so well done for reaching out.

I have OCD so understand what you mean about the intrusive thoughts.

The key is that you haven't acted on this - focus on that.

I would strongly recommend getting a GP appointment so you can get some professional advice and support.

Best of luck with this and well done again

I felt like I was moving and talking underwater all day, and I haven't felt real, like I'm in Alice in Wonderland.

What strategies do you normally use when you dissociate?

If you can bring yourself back from hypoarousal/dissociation to reconnect with the present/your surroundings it may reduce some of the thoughts.

In terms of risk, "genuinely suicidal" and "intrusive suicidal thoughts you want to act upon" are about the same - depending on how well you can keep yourself safe.

So do you feel able to keep yourself safe?

Noodle thank you, I was unsure if getting a GP appointment is the right thing to do as I'm already on medication and unsure if they can really do anything else.

User, I didn't know that was dissociation. I think I sometimes dissociate on purpose (can't explain it any better than that?) but if it's just happens, which it does sometimes, I don't know how to get myself out of it.
I don't remember if I ever discussed that with my therapist, I don't remember that much about my actual sessions and have to read all the print outs I was given to remember strategies to use.

I just feel completely lost and overwhelmed at the moment.

*user128472578267

In terms of risk, "genuinely suicidal" and "intrusive suicidal thoughts you want to act upon" are about the same - depending on how well you can keep yourself safe.

So do you feel able to keep yourself safe?*

I don't know, I think so. I'm not on my own, I'm at home with my husband and children now. I told my husband to some extent but I'm really bad at talking about it out loud.

Dissociation is common with trauma. It is possible to dissociate deliberately but also for it to just happen (especially if you're very distressed/overwhelmed/triggered).

When it's not deliberate then just being able to notice that you're dissociating is a really good first step towards being able to bring yourself back.

There is info here you may find useful: support.pods-online.org.uk/start-here

I'm sorry things are so tough at the moment.

Do you know what has triggered things to build up? And do you have any general self care strategies you can use to start soothing your nervous system?

(I hate when I'm feeling shit and people start talking to me about "self care" , however you know how soothing it feels when you're distressed and another person comforts or helps you? You can get a bit of that by being that person for yourself.)

In terms of safety, if you reached a point where you no longer felt able to resist the urge to act on your thoughts, that's when you call 999.

It sounds like it was quite frightening to have those thoughts and feelings. I think most people would be at least a bit unsettled by it.

User that link looks useful thanks, I haven't ever looked at dissociation in any detail. I'm not sure what's triggered me to build up but think the last straw was having to challenge something at work. I did all my current problem CBT stuff, followed the right procedure and got the outcome I wanted but just working through that completely overwhelmed me. I can't cope with any little thing in a normal way at all.
I was already deteriorating before then. I tried to describe it to my therapist once - sometimes I know what the trigger is but sometimes I literally feel my brain shift, like a physical feeling, and then I have an episode of being completely manic or like now really low (more unusual). If I get that physical feeling it's not triggered by anything and it's harder to get myself out of.
Usually just try and distract myself if I can. Play with the kids, watch TV, exercise, but have to be careful with that as I can use it as an unhealthy coping strategy.

I don't even know if I'm typing any sense here. I need to do something to make me feel more real, so I might go for a run because it's quite cold and it might make me feel something.

Hi OP. Sorry you're going through a rubbish time. What are you doing at the moment to help your mental health? Medication, therapy etc?

I have OCD and have experienced suicidal intrusive thoughts. All I wanted to add on here is that those particular thoughts terrified me. For example when I was working in London and had to get the tube in, there was a period of time where I would dread getting the train in case I wanted to jump in front of it. I would see images of myself doing it and break down hysterically. I would also turn to my husband for reassurance which is a huge symptom of OCD. From therapy I've learnt that if the thoughts scare you or make you question yourself, then it is almost certainly intrusive.

However you said you had to stop yourself from driving into other cars. What exactly happened? If you're feeling disassociated this could be triggering so many other symptoms.

I highly recommend practicing meditation every single day. When you wake up and before you go to bed. Mindfulness guided meditations and self compassion ones would probably help you today. Have a look at Sarah Blondin she is amazing.

Lastly, if you really are having thoughts that feel like urges please go to your local crisis team. There is ALWAYS support. Feel free to message me x

Thanks ilove, that makes sense actually about if you're questioning then it's an intrusive thought.
At the moment I'm taking sertaline and propanalol, no therapy at the moment. I had a GP phone appointment today and then was seen by the urgent care MH team in person (different service from the crisis team, they sit below them). I'm actually feeling a bit better today and I feel real again. I'm being reviewed in two weeks with the view to going on mood stabilisers if there's no significant improvement.

I'm not sure what was going on in my head with the cars, I just felt that being obliterated in a car crash would feel better than how I was feeling at that time.

I was definitely in crisis yesterday, how the fuck I got through a work day I have no idea. I don't feel like I am today.

@littlemachine, I know meds aren't the answer for everything, but I could have pretty much written the same as what you have earlier this year. I got put on another medication, and for me its made an incredible difference (and up to this point I hadn't felt any effect from a variety of meds, so I don't think it was placebo or surely I should have got placebo earlier lol). I don't know what mood stabilisers it is you might be going on, what I went on is sometimes described as that. I was quite worried to go on it for various reasons but it was so worth it. Just wanted to share as so many aspects of your post are exactly how I was before going on the new meds, and I now feel I've got my life back (sounds cheesy but its true). Obviously everyone is different, but just my experience in case it helps you worry less if new meds are suggested, and also just to let you know that feeling that way can be sorted. Remember to be kind to yourself, not easy constantly battling with your mind and not feeling able to trust it! Until things improve just hold tight to anything that does help improve your mood, or even just distract you for a while. Feel free to message me if it would help at all. Glad to see you are feeling a bit better today.

Thanks so much Hakuna. I'm feeling more stable again today. I've still been managing to work although I'm not sure how much use I've been.
I had a higher dose of sertaline today (thought I was on max dose but I wasn't). Feel a bit spaced out and in danger of shitting myself but I'm sure that will settle down.