Psychological factors of suicidal behavior formation in obsessive compulsive and social anxiety disorder

This article describes the development of life-threatening and suicidal behavior in obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD). Current research on conditions and comorbid states that increase the risk of suicidality in OCD and SAD including the transdiagnostic features and mechanisms of the suicidal behavior formation (ruminations, focus on errors, perfectionism, impaired emotion regulation, alexithymia) are analyzed. The role of general cognitive mechanisms and cognitive style features in SAD and OCD is revealed. Social interaction in SAD is often disrupted, accompanied by a disturbed belongingness and perceived burdensomeness, which creates the conditions for an increased risk of suicidal behavior. The importance of feelings of hopelessness and / or helplessness in the process of developing suicidal thoughts and appropriate behavior in disorders is noted. The need to comprehensively explain the increase of suicide risk in OCD due to depressive state is signified as a discussion subject. The significant predictive role of the history of suicide attempts in the context of the future suicidal behavior likelihood is shown, which is consistent with the concept regarding common (socio-demographic, psychiatric) risk factors. Suicidal behavior is considered as a dynamic, time-unfolding process, which causes distinguishing primary and derivative disturbances in the structure of mental activity. It is discussed whether it is important to distinguish between suicidal thoughts and obsessions associated with auto-aggression. The question is raised about the mechanisms of development of suicide in OCD and SAD: what are the content of obsessions and intrusive ruminations, the rules for making judgments, or the chronicity of cumulative stress in the “psychological field”? An opinion is expressed regarding the role of perfectionism as a system of maladaptive thoughts and a special cognitive style in the formation of suicides in the studied disorders. The unequal role of obsessions and compulsions at different stages of the course of OCD and the development of suicide is shown. Impulsivity is considered as a neuropsychological feature that characterizes the chronicity of a pathological condition and increases the risk of suicidal behavior in OCD. The question is raised about common and different conditions for the suicide in OCD and SAD. The use of worry, anxiety, and catastrophizing strategies for controlling mental activity is associated with an increase in suicide risk in people with OCD. Gloomy anxious ruminations and negative prognosis in SAD are associated with the risk of suicidal behavior. An anxiety component is qualified as an additional source of increasing stress, spending human compensatory resources in both disorders. In SAD, emotion regulation disturbance in the evaluation situation is typical, actualization of unmediated safety behavior is characteristic. The problem in relation to comprehensive evaluation of suicide risk is signified. In accordance with the model of life-threatening and suicidal behavior, the mechanism of suicidality in SAD, OCD in the form of increasing cumulative stress, maladaptive compulsive regulation of intrusions with the phenomena of emotional and personal decompensation is proposed in the context of the motives hierarchy evolution and the developmental crisis. The most significant influence of the thought component as a triggering mechanism for the development of pathological processes, compulsions as a factor in the disability of mental state and catalyst for suicide is shown. The model is associated with the concept of Ambrumova regarding suicidality as a complex phenomenon. The prospect of further research is analyzed, including such a topic as the acquisition of an independent personal meaning in the context of self-injurious behavior by the mechanism of “the shift from the motive to the goal”.