Existential OCD: Obsessions, Compulsions, & Treatments

What Is Existential OCD?

Existential OCD (sometimes called philosophical OCD) is a type of OCD involving an obsessive pursuit of definitive certainty about the world. They might wonder about their own role in life, and may also feel the need to get the answer from some external power about the “right” way to exist.

“Existential OCD involves obsessions, or unwanted or intrusive thoughts, about philosophical questions,” says Brian Zaboski, associate research scientist in psychiatry at Yale School of Medicine. “Research differentiating existential OCD from other domains is sparse, and it generally is believed to overlap with some of the common OCD domains recognized by clinicians and researchers, such as spirituality and religiosity. Nevertheless, some research indicates that individuals with select forms of existential OCD (such as death anxiety) may have worsened OCD symptoms than individuals without it, and that existential OCD can lead to a grab bag of compulsions (such as cleaning, praying, ordering/arranging) depending on the individual.”

Existential OCD Vs. Asking Deep Philosophical Questions

There is a difference between normal existential thinking and OCD-related existential thinking. For instance, the former can provide a sense of purpose while the latter often causes despair.

Here are several differences between normal and obsessive existential thinking:

Existential OCD Vs. Having an Existential Crisis

An existential crisis is usually a limited period of high stress and dissatisfaction, sometimes brought about by a life transition, death, or other milestone. These tend to be mildly problematic, while resolving with time.

Existential OCD is a type of OCD involving obsessions and compulsions. Symptoms may escalate over time and come to demand a lot of time, attention, and energy. OCD will almost always need professional treatment to address.

Signs of Existential OCD

Obsessions consist of various types of intrusive and unwanted thoughts that provoke doubt and uncertainty. Since these thoughts spike high anxiety or distress, OCD sufferers often feel a moral sense of obligation to confirm that they (their thoughts) have not caused any harm.

Signs of existential OCD can include:

• Intolerance of uncertainty
• Distress
• Indecision
• Overwhelm
• Overthinking
• Polarized thinking: all/nothing; black/white; right/wrong; good/bad; feeling hopeful/despairing (i.e., is life meaningful or a total void?)
• “Why” questions always lead to more “why” questions in an infinite, unresolvable stream
• Losing track of time due to extended thinking sessions

Common Existential OCD Obsessions

People with existential OCD often believe there is a “right” answer to their obsessive questions and that they just haven’t looked hard enough or in the right places. Common questions they might obsess over include, “What is the meaning of life?” and “Do I have free will?”

Common existential OCD obsessions include:

• What is the meaning of life?
• Why do I exist?
• Do I exist at all?
• Does my existence matter?
• What happens after I die?
• If only I was smart enough, I could figure it out
• There must be an answer if I only look hard enough and in the right places
• What is real?
• What is reality?
• How do I know what I perceive is right?
• We will all die, so what is the point of anything?
• Will how I lived my life have some influence on my afterlife?
• How do I know who I am?
• Is my life already mapped out or do I have free will?
• Am I being controlled by some force without my will?
• What if there is no point to my life?
• Compared to the vast universe, are we all just insignificant meaningless little specks of matter?

Common Existential OCD Compulsions

As with all the other OCD types, the compulsions related to existential OCD are directed at reducing the distress caused by obsessive doubt and the quest for achieving certainty. They are aimed at resolving the problem, finding the answer, figuring it all out, and making peace with one’s place and purpose in the universe.

Examples of compulsive behaviors common to those with existential OCD include:

• Excessive research into the content of the particular obsession
• Excessive reading of philosophy books for answers and getting too many opinions, causing confusion and more questions
• Repeatedly asking others their thoughts and opinions as a way to seek more clarity or insights
• Constantly analyzing obsessions with the same thoughts and questions
• Religion “hopping” – attending various religious services or compulsive reading of religious texts
• Excessive internet searches to find answers to unanswerable questions that have no end point
• Mental reviewing of events that occurred that day to verify that they actually happened
• Dominating conversations about existential ideas
• Trouble letting go or moving on to topics that aren’t existential
• Overthinking to the point of derealization
• Meta-thinking (thinking about thinking)
• Reading and re-reading to try to understand material about metaphysics

How Does It Feel to Have Existential OCD?

There is no form of OCD that presents with desirable feelings. Like other forms of OCD, existential OCD can negatively impact a person’s life in very drastic ways.

Here’s how it can feel to live with existential OCD:

• The sense that you’re not truly living: Existential OCD can make you feel like your life is an illusion, a joke, or a dream. You could feel like life is meaningless.
• Deep feelings of isolation: With existential OCD, you could have the sense of being disconnected from the people and things around you.
• Lack of joy in life: OCD may distract you from the present moment, so feelings of joy and happiness could be rare.
• Existential OCD and depersonalization: OCD can make someone feel detached from the moment, with depersonalization being a possible outcome of this effect.

What Causes Existential OCD?

Existential OCD may be affected by the human fear of (and emotions related to) the enigma of death and questions about an afterlife. Perhaps the not knowing, since there is no way to substantiate the truth or reality to these questions, is what provokes existential dread and anxiety.

Evolutionary Instinct

All types of OCD have been considered by some researchers to be manifestations of evolutionary biological preservation instincts.¹ In other words, our primordial fear of the unknown has produced belief systems designed to help manage the terror we may feel about forces beyond our control causing things to happen.

Reaching Adolescence

Adolescents typically reach a stage in their cognitive development when they begin to have questions about the “big picture,” also known as the formal operational stage or teenage angst.² Concepts about death, infinity, identity, and life’s purpose can be spiritual and emotionally overwhelming. Most youth find their way out of overanalyzing these topics, but teens with OCD may get stuck.

How Do I Know It’s OCD?

It can be hard to know if you have OCD, but asking yourself some questions can give you some insight into where your concerns may be coming from. Regardless of how you answer these questions, if you are struggling, it is important to seek professional help.

Some questions to ask yourself to determine whether you might have OCD include:

• Do I have unwanted and compulsive thoughts that stop me from doing things I need to do?
• Do I have a fear around certain things like contamination or germs?
• Do I struggle with anything that isn’t black and white?
• Can I sit and function in uncertainty?
• Do I need to have things in a certain order or placed a certain way?
• Do I need to check things multiple times before I leave the house?
• Can I manage my negative feelings and aggression when they come up?

Common Misdiagnosis of Existential OCD

Because OCD has symptoms and tendencies tied to other mental health conditions, it is possible that OCD can be diagnosed incorrectly. OCD is often misdiagnosed as generalized anxiety disorder. Due to the high level of anxiety and worry tied to OCD, it can overlap with the main symptom of generalized anxiety disorder.

Existential OCD Treatment

The goal of existential OCD treatment is to learn how to allow obsessive thoughts to exist without acting on them. In other words, once you stop the compulsions and rituals, the thoughts and feelings will be free to simply come and go.

Exposure & Response Prevention (ERP)

Existential OCD is treated like any other OCD subtype, with ERP being the gold standard treatment option.³ The most effective way of knowing what exposures to conduct for any OCD subtype is to do the opposite of the obsession. If the obsessive thought is, “I can’t go on if I don’t know my purpose,” then the exposure is to keep going and stop attempts to analyze the question. Finding meaning and purpose in life could even become worthwhile pursuits once the OCD is under control.

Potential Existential OCD Exposures

Examples of existential exposures conducted with response prevention are:(*)

• Assume life has no meaning or purpose while continuing to function
• Live with the uncertainty of not knowing what the meaning of life is while resisting urges to analyze the problem or emotions
• Watch films with an existential theme and sit with the thoughts and emotions that occur
• Repetitively write out and/or record:
  • Life isn’t real
  • I will never know what meaning my life has
  • I am just randomly floating through time and space
• Write a detailed imaginary script about knowing your life is meaningless
• Write your eulogy or a script about your death
• Read obituaries
• Drive by funeral homes and cemeteries
• Work on accepting that life has no absolute answers about what is right and wrong
• Resist urges to research, ask questions (of self/others), ruminate, or make futuristic assumptions about these issues

(*) It’s important to work through exposures with an experienced therapist. It is not safe to engage in existential exposures of this nature if you are clinically depressed.

Metacognitive Therapy

Metacognitive therapy is another strategy used for existential OCD treatment.⁵ It can address factors related to the six cognitive belief domains that are specific to OCD:⁶

• Over-importance of thoughts
• Importance of controlling thoughts
• Perfectionism
• Inflated responsibility
• Overestimation of threat
• Intolerance for uncertainty

Metacognitive therapy might involve asking yourself, “How would my life change if I was unable to find the answers to my questions?” Or, “What would happen if I could put this aspect of exploration on hold?” It also addresses thought-action fusion or the belief that having a thought is the same as doing the thought (this is especially problematic for someone who believes he is sinning by having intrusive sexual thoughts).⁷

Mindfulness as Part of OCD Treatment Plans

Because detachment, disconnection, and depersonalization are all effects of existential OCD, mindfulness training is a great tool to incorporate into treatment. Mindfulness helps a person get and stay connected to themselves, their surroundings, and their thoughts.

How to Find a Therapist

It’s imperative that someone with OCD find a qualified therapist for treatment who has experience with exposure and response prevention. Consider finding a qualified therapist by asking your doctor for a referral or by using an online therapist directory.

Can Medication Help?

Medication for OCD can be a helpful option for treatment in addition to therapy. Medications such as SSRIs can be helpful in improving OCD symptoms and episodes as they work to even out serotonin in the brain. Working with a therapist and psychiatrist together can be a great way to figure out which medication may be right for you.

Many people opt for both ERP and medication; however, if a choice has to be made, ERP therapy for OCD on its own has a better track record than medication on its own.⁵

Final Thoughts on Existential OCD

Personal identity, quality of life, education, and leisure are often put on hold due to existential OCD and its interference with concerns about making the “right” decision. If you’re struggling, know that you’re not alone.