Existential OCD involves intrusive and persistent philosophical thoughts about the meaning or purpose of life, as well as doubts about what is real. Thoughts about whether reality or the Self exist cause endless ruminations and distractions from attending to real life events.
What Is Existential OCD?
In the case of existential OCD, the person is not so much contemplating their role in the world, but rather, they’re in a pursuit of definitive certainty. Not only that, but they 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 obsessive existential thinking. For instance, the former can provide a sense of purpose while the latter often causes despair.
Here are the differences between normal and obsessive existential thinking:
- Normal existential thinking:
- Accepting relative truth of a personal viewpoint
- Contemplative
- Sense of connection to a larger metaphysical system
- Can provide a sense of purpose
- Internally driven
- Flexible and dynamic
- Obsessive existential thinking:
- Needing absolute truth and certainty
- Anxiety-ridden; urgent
- Self-focused and disconnected from the larger
- Often causes despair due to obsessive doubt and uncertainty
- Externally driven
- Rigid, black-and-white thinking
Existential OCD & Depersonalization
Existential OCD is rooted in anxiety about your place in the world. In this process, there is little involvement of your own sense of self. This can lead to depersonalization, a feeling that you are watching your life from outside of your body.
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
- Need to know
- Indecision
- overwhelmed
- 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 marathon 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?”
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 are:
- Excessive research into the content of the particular obsession
- Excessive reading philosophy books for answers and getting too many opinions that cause 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
- Mental reviewing the events of the day and trying to see if they felt real
- Dominating conversations about existential ideas
- Trouble letting go or moving on to topics others raise
- Overthinking to the point of derealization
- Meta-thinking (thinking about thinking)
- Reading and re-reading to try to understand material about metaphysics
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.
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.
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 adolescent 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 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, stop the compulsions and rituals and 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.
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
(*) Be careful not 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: over-importance of thoughts, importance of controlling thoughts, perfectionism, inflated responsibility, overestimation of threat, and intolerance for uncertainty.6
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
How to Find a Therapist
It’s imperative that someone with OCD find a qualified, experienced therapist for treatment. Consider finding a qualified therapist by asking your PCP for a referral or by using an online therapist directory.
Can Medication Help?
Medication for OCD is a great 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.
Existential OCD Infographics
