What if I jumped? The call of the void and OCD
The urge to jump from a height is reported by roughly half of people with no mental health problem at all. The thought is universal; what makes it OCD is what happens next.
You are on a station platform and the thought arrives: what if I jumped. You are driving, and it is: what if I turned the wheel. At a window with a child, at the top of a staircase, on a balcony, and the same thing. It lasts a second. The second afterwards is horror, and the horror brings a question: why would I think that unless some part of me wanted to?
The call of the void
The urge to jump from a height has a name, the call of the void, and roughly half of people who have never had a mental health problem in their lives report it. Standing at an edge, a large proportion of ordinary people experience a brief impulse to step off, and a brief image of doing so, followed by stepping back. The people who report it are not people who want to die. They are people whose brains, registering a danger, produced an image of the danger.
The same is true of the wheel, the knife, the window. Minds produce images of the worst available action in a situation, constantly, in everybody. It is part of how a brain notices what could go wrong. Most people forget the image within seconds and never think about it again.
What makes it OCD
The thought is universal. What makes it OCD is what happens next: the meaning it takes on, and everything you start doing to make sure.
In OCD, the image does not pass. It sets off an alarm, and the alarm feels like information: this must mean something, a normal person would not think this, some part of me must want it. Then the defending begins. You stand further back on the platform. You grip the wheel harder. You move the knives, or stop being the one who cooks. You avoid being alone with the people you might hurt, or the places where an outburst would be unthinkable. And underneath it all, a constant self-monitoring: checking whether you still feel in control, testing the grip, watching for the moment it slips.
The monitoring makes it worse
Attention aimed at your own control makes control feel precarious, in anybody. It is the same effect as thinking hard about swallowing, or about walking down stairs: nothing was wrong with it until it was being watched. Rather than detecting a loss of control, the self-monitoring produces the feeling of one, and the feeling gets read as evidence, and the evidence drives more monitoring.
Thoughts and actions run on different systems
Early in treatment we usually spend a session on how intrusive urges actually work, because the mechanism is reassuring in a way that reassurance is not. Thoughts and actions run on different systems. Having an image of turning the wheel does not move your hands. The horror you feel is evidence that the thought is landing on somebody it is profoundly at odds with, which is precisely why it stuck to you and not to the person next to you on the platform.
What this is not
Part of assessment is telling apart an intrusive urge you find horrifying from genuinely wanting to harm yourself or someone else. Those are different things needing different responses, and separating them is routine work rather than an interrogation. An intrusive urge to jump horrifies you and you want it gone. Suicidal thinking involves wanting, however ambivalently, to die. If you are experiencing the second, that needs a different response, and you should say so straight away, including in a first email.
What treatment does
The treatment is CBT with exposure and response prevention, which NICE recommends for OCD. We are not going to try to establish that you are safe, because every time you have established it, it has expired within the hour, and the establishing is what we are treating. We map the cycle, then withdraw the safety apparatus gradually, by agreement: the standing back, the gripping, the moving of objects, the avoidance, and above all the self-monitoring. Then we get the ordinary things back: the platform, the kitchen, the drive, the quiet room.
This theme sits close to harm OCD, and plenty of people have both. If the thought at the edge has become the centre of your day, there is more on how I treat fear of losing control.