Obsessive-Compulsive Disorder with SuicideObsessions in a First Responder without PreviousDiagnosis of OCD or History of Suicide Attempts

Obsessive-compulsive disorder (OCD) is a distressing and often debilitating disorder characterized by obsessions, compulsions, orboth that are time-consuming and cause impairment in social, occupational, or other areas of functioning. There are many publishedstudies reporting higher risk of suicidality in OCD patients, as well as studies describing increased risk of suicidality in OCD patientswith other comorbid psychiatric conditions such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD).Existing case reports on OCD with suicide as the obsessive component describe patients with long standing diagnosis of OCDwith suicidal ideations or previous suicide attempts. This report describes the case of a 28-year-old male, who works as a firstresponder, who presented with new onset symptoms characteristic of MDD and PTSD, with no past history of OCD or suicidalitywho developed OCD with suicidal obsessions. Differentiating between suicidal ideation in the context of other psychiatric illnessesand suicidal obsessions in OCD is critical to ensuring accurate diagnosis and timely provision of most appropriate treatment. Thecombination of exposure and response prevention therapy and pharmacotherapy with sertraline and olanzapine was effective inhelping the patient manage the anxiety and distress stemming from the patient’s OCD with suicidal obsession.