Self-harm and suicidality in young people with obsessive-compulsive and related disorders and chronic tic disorders
This study reveals that self-harm and suicidality are highly prevalent among adolescents with obsessive-compulsive and related disorders and chronic tic disorders, with body dysmorphic disorder representing the highest risk group, while multimodal treatment significantly reduces these risks in obsessive-compulsive disorder and body dysmorphic disorder patients.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the landscape of adolescent mental health, a specific cluster of conditions often goes unnoticed by the public eye, even though they can be deeply distressing for those who live with them. These are disorders where the mind gets stuck in loops of worry, repetitive behaviors, or intrusive thoughts about appearance, alongside conditions where the body involuntarily twitches or jerks. While these conditions are well-known to clinicians, a critical question has remained largely unanswered: how often do young people struggling with these specific diagnoses also struggle with thoughts of ending their lives or hurting themselves? Understanding this connection is vital because self-harm is a strong warning sign that someone might be in immediate danger. If we know which of these conditions carry the heaviest burden of such thoughts, we can offer better, more targeted support to the teenagers who need it most.
A team of researchers at a specialist clinic in Stockholm, Sweden, set out to map this dangerous terrain. They gathered data from 699 young people, aged 12 to 17, who had been referred for treatment. These teenagers fell into four main groups based on their primary diagnosis: those with obsessive-compulsive disorder, where unwanted thoughts and rituals take over; those with body dysmorphic disorder, a condition where a person is consumed by a perceived flaw in their appearance; those with body-focused repetitive behaviors like hair-pulling or skin-picking; and those with Tourette syndrome or chronic tic disorders. The researchers did not just look at the numbers once; they followed the young people who received treatment, checking in again after their therapy sessions to see if the distress had lifted. They asked direct questions about whether the teenagers had ever hurt themselves without meaning to die, if they had ever thought about suicide, and if they had ever tried to end their lives.
The picture that emerged was stark. Self-harm and suicidal thoughts were not rare occurrences; they were common across the board. In the group with body dysmorphic disorder, three out of every four teenagers reported having experienced some form of self-harm or suicidal behavior. This group stood out as the most vulnerable. When the researchers compared them to the group with obsessive-compulsive disorder, they found that the teenagers with body dysmorphic disorder were twice as likely to have a history of self-harm and more than twice as likely to have had thoughts of suicide. The gap was even wider when looking at suicide attempts: young people with body dysmorphic disorder were nearly five times more likely to have tried to kill themselves in the past compared to their peers with obsessive-compulsive disorder. This difference held true even after the researchers accounted for age, gender, and how severe the symptoms were, suggesting that the intense shame and anxiety specific to body dysmorphic disorder might drive this risk independently of other factors.
The other groups told different stories. The teenagers with body-focused repetitive behaviors, such as hair-pulling, showed rates of self-harm and suicidal thoughts that were similar to the obsessive-compulsive group. However, the group with Tourette syndrome and chronic tic disorders appeared to be at a lower risk. In fact, they were about half as likely to have ever thought about suicide compared to the obsessive-compulsive group. This was a notable finding because this group had more boys and younger children, demographics that usually correlate with lower risks for these behaviors. Despite being the "safest" group in the study, the researchers noted that one in seven still had a history of self-harm, and one in four had experienced suicidal thoughts, indicating that no group was entirely free from risk.
The study also offered a message of hope regarding treatment. Most of the teenagers received a mix of therapy and, when necessary, medication. The researchers tracked whether the thoughts of self-harm and suicide faded as the young people got better. For the groups with obsessive-compulsive disorder and body dysmorphic disorder, the results were encouraging. After treatment, the odds of a teenager having current thoughts of self-harm or suicide dropped by about sixty percent. This suggests that treating the underlying disorder effectively can also calm the most dangerous thoughts. However, the data for the other two groups was too sparse to calculate similar improvements, simply because so few people in those groups reported these behaviors at the start. Even with this improvement, the researchers pointed out that suicidal thoughts did not disappear completely; in the body dysmorphic group, about one in five teenagers still reported having these thoughts after treatment.
The takeaway from this work is that while these conditions vary in how they affect the mind, the risk of self-harm and suicide is a shared challenge that requires constant attention. Body dysmorphic disorder emerged as a particularly high-risk condition, carrying a burden of suicidal behavior that goes beyond what is seen in other similar disorders. The study confirms that evidence-based treatment can significantly reduce these risks, offering a path forward for many. Yet, because these thoughts can persist even as other symptoms improve, the researchers conclude that doctors and families must remain vigilant. Regular check-ins on suicide risk should be a standard part of care for any teenager navigating these difficult conditions, ensuring that the most vulnerable are never left without a safety net.
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