What Is Existential OCD?

Everyone experiences obsessive-compulsive disorder (OCD) differently. Sometimes symptoms of OCD can include obsessive philosophical ideas and fears about life, the universe, and human existence. This is referred to as existential OCD.

This article discusses the symptoms and treatment for existential OCD.

What Is Existential OCD?

Existential OCD symptoms occur when repetitive and intrusive thoughts about the purpose of human existence cause symptoms of anxiety, depression, and compulsive behavior.

These thoughts might include:

• Questioning the purpose of life
• Feeling death anxiety (fear of your own death or the dying process)
• Wondering what's real and what isn't
• Feeling a sense of impending doom

Someone with existential OCD symptoms might also refuse to tolerate uncertainty about questions that are impossible to answer.

Existential OCD vs. Philosophical Questions

Everyone has philosophical questions about the meaning of life such as “Why are we here?” or “Where do we go when we die?” But with symptoms of existential OCD, these thoughts can turn into obsessions that interfere with daily life. They can drive a person to compulsive rituals, like:

• Constantly seeking validation about one's path
• Obsessing over philosophical ideas (like the nature of reality and the universe) for hours a day

When dwelling on philosophical questions causes symptoms of depression, anxiety, and compulsive behavior, a person might be suffering from existential symptoms of OCD.

Signs and Symptoms of Existential OCD

Symptoms of existential OCD might include:

• Obsessively thinking about the reason for existence
• Derealization, or a feeling that the world isn’t real
• Refusing to tolerate uncertainty
• Feeling depressed and anxious because of repetitive thoughts about life and death
• Reassurance seeking, or constantly double-checking decisions with others out of fear of being on the wrong path
• Not having an ability to reason with or apply logic to philosophical thoughts or questions 
• Finding one’s own answers to philosophical questions but then doubting those answers 

Common Obsessions

Those with existential OCD might obsess over:

• The purpose of living
• The inevitability of death
• Whether they're on the right path in a religious or philosophical sense
• The nature of reality and the universe
• Whether or not they even exist

Common Compulsions

Compulsions are repetitive behaviors that people with OCD might engage in to ease anxiety. At times, these compulsions can interfere with daily life. In the case of existential OCD symptoms, a few examples might include:

• Constantly researching philosophical questions without being affected by logic or others' ideas
• Pondering one’s existence and reality for hours while neglecting daily life
• Constantly asking others for reassurance about being on the "right" path
• Doubting any logical conclusions
  

What Can Trigger Existential OCD?

There isn't a single direct cause of existential OCD, however, potential triggers may include:

• Life changes
• Chronic stress
• Mood-altering drugs

How Existential OCD Is Treated

Treatment for existential OCD symptoms might include therapy or medication. The following are ways a specialist might approach the disorder.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy (talk therapy) that focuses on thoughts that lead to unhelpful behavior. These thoughts are challenged with the help of a therapist and then replaced with more supportive ideas. CBT also includes learning how to manage emotions and reactions to daily life.

For example, a CBT session might include exercises like role-playing or reviewing larger belief systems a person has and helping determine whether they are helpful.

Exposure and Response Prevention

Exposure and response prevention (ERP) and mindfulness are two CBT techniques advised for existential OCD.

Exposure and response prevention (ERP) is a type of therapy in which a person is repeatedly exposed to thoughts and ideas that scare them so that they build tolerance. ERP might include “homework” assignments from a therapist, such as researching existential questions, listening to recordings from the therapist, and watching videos about the topic.

ERP also includes experiencing the emotions and anxieties that thoughts create and learning how to manage them without responding. ERP in someone with existential OCD might mean not asking others for reassurance and, instead, sitting with their doubts about reality, no matter the anxiety it might cause, or letting it pass.

Practicing Mindfulness

Mindfulness can be taught as an adjunctive calming skill (added on as a supplement) but is not necessarily a treatment.

Mindfulness is becoming aware of one’s emotional reactions without judgment. This can lead to accepting passing thoughts and “riding the wave” of emotions that they cause without engaging in compulsive behavior.

Over time, an intrusive thought becomes less critical and easier to manage. With existential OCD symptoms, mindfulness might mean feeling the anxiety or dread of more important life-and-death questions without acting on them or fearing the emotions they cause.

Summary 

Existential obsessive-compulsive disorder (OCD) symptoms are marked by repetitive, intrusive thoughts about philosophical questions, such as the meaning of existence, the nature of reality, and ideas about life and death.

If you find yourself ruminating over the more significant questions of existence to the point of depression, anxiety, and disruptions in work and relationships, existential OCD may be the cause. If you can’t find a therapist in your area or don't have access to therapy, finding online help or a local OCD support group might help you cope.