Obsessive compulsive disorder - OCD treatment and therapy from NOCD

What Is Existential OCD?

Apr 15, 20219 minute read

Existential OCD symptoms

Existential obsessive-compulsive disorder (OCD) is a subtype of OCD characterized by ongoing intrusive thoughts and compulsive behaviors related to a preoccupation with philosophical questions about life and existence. Anyone can be curious about the nature of reality, but for people with existential OCD, these thoughts are not primarily a source of curiosity or interest but rather intense anxiety. 

The ongoing spiral of intrusive thoughts someone with existential OCD experiences is uncomfortable and can even be frightening. These questions come with an urgency that demands a person answer them with 100% certainty. In an attempt to relieve themselves of the anxiety these questions cause, the individual often turns to compulsive actions aimed at gaining certainty and relief (e.g., spending hours researching the nature of consciousness). 

When it comes to a topic like the nature of humankind, where we came from or the meaning of life — questions humans have been trying to understand for many years — the chances of answering them with certainty are next to none. Thus, there is potential for endless intrusive thoughts, and it’s only a matter of time for them and the accompanying anxiety to return.

On the surface, someone with existential OCD may come across as generally curious or a “deep thinker.” After all, entire academic departments, books, and museums are devoted to answering these philosophical questions about mankind’s purpose. However, the main distinction between someone with existential OCD is that these questions cause tremendous anxiety and an urgent need to be answered with certainty in order to experience relief. 

For people with existential OCD, these intrusive thoughts interfere with their everyday life. The anxiety a person feels could disrupt their ability to concentrate at work, keep them up at night, or prevent them from feeling connected to family and friends. For example, while spending an evening with their spouse, a person’s mind may be racing with existential questions about the nature of love and connection to the point where they cannot be present with their partner. A person may spend the whole night researching questions about their existence. Even though they know tomorrow is an important workday and they need sleep, they feel they’re only a click away from finding the answer they’re seeking. This urgency will keep them glued to their screen all night, despite their better judgment, and they won’t get a full night’s rest. 

Examples of existential OCD obsessions

People with existential OCD experience ongoing intrusive thoughts that may sound like these:

  • “What does it mean that I can’t ever experience life as another person? How do I know that I am communicating with someone if I don’t know what they are thinking? What does it mean to be understood? How can love even be possible if I don’t know someone else’s experience? What is the point of communicating with other people if we never know what the other person is thinking?”
  • “What if I am not really here? Would I know if I was not really here? How would I know? What if my whole life has been a simulation and no one and nothing around me are actually real? If I am not actually here, then why does anything I do matter? What is the point of my life or anyone’s life if none of us are actually real?”
  • “What is my purpose in life? Why am I here? What should I be doing with my time on earth? Why do I have consciousness? What does it mean that I am able to reflect on my own thoughts? Does that mean I am separate from my consciousness? Does this mean I’m more than one person? If that’s the case, then who am I? If there’s no way to know who I am, what is the point of life?”

Examples of existential OCD compulsions

As in most OCD subtypes, people with existential OCD often practice compulsions to try to ease the anxiety caused by their intrusive thoughts. Here are some examples of common compulsions for people with existential OCD: 

  • Research: A person may spend hours or days researching particular topics they feel will help answer their questions. They may dive into philosophy, psychology, or religious texts in order to gain some relief from the anxiety that comes with their intrusive thoughts. When research is done as a compulsion, it’s not necessarily fun or engaging, but characterized by an urgent need to feel relief.
  • Mental reviewing: A person could spend excessive time mentally reviewing questions about existence. They may spend hours and hours trying to come up with answers to questions in their head. This might look like thinking about everything this person has learned that could answer their questions. They may repeatedly replay conversations they had with a philosopher or a religious figure in their head, hoping this will help them come to a sense of certainty about their questions and relieve their anxiety.
  • Seeking reassurance: They may ask friends and family members repeatedly for answers to their intrusive doubt. They may also question other people’s beliefs, asking, “What do you think is the purpose of life?” or, “Do you ever wonder about what happens after death?” They may turn to religious figures or experts on philosophy or biology with countless questions. When asking these questions, they hope to receive an answer that can provide certainty and ease their anxiety. Rather than a compelling philosophical debate, the underlying motive here is to experience some relief to the unbearable stress of their intrusive thoughts.
  • Excessive prayer: Some people may excessively pray to receive answers on the nature of existence. 
  • Physical checking: Some people may begin to worry that they don’t actually exist, and seek out physical reactions as a way to verify to themselves that they are real. This could look like pinching oneself or even causing oneself pain in an attempt to answer their intrusive questions. They may conclude, “If I feel this, that must mean I exist. Right?” 
  • Avoidance: Some individuals may avoid people, places, or subjects that trigger their intrusive thoughts. For example, they might avoid watching specific movies, TV shows, or books that feature themes of unreality, simulations, eternity or alternate universes. Or they may avoid lectures or classes where these questions will be discussed. 

Existential OCD ERP therapy

The best course of treatment for existential OCD, like all types of OCD, is exposure and response prevention (ERP) therapy. The idea behind ERP is that repeated exposure to obsessive thoughts, without engaging in compulsions, is the most effective way to treat OCD. When you continually reach out for the compulsions, it only strengthens your need to engage them. On the other hand, when you prevent yourself from engaging in your compulsions, you teach yourself a new way to respond and will very likely experience a noticeable reduction in your anxiety. 

ERP is considered the gold standard for OCD treatment and has been found to be 80% effective. The majority of patients experience results within 12-25 sessions. As part of ERP therapy, you will track your obsessions and compulsions and make a list of how distressing each thought is. You’ll work with your therapist to slowly put yourself into situations that bring on your obsessions. This has to be carefully planned to ensure it’s effective, and so that you’re gradually building toward your goal rather than moving too quickly and getting completely overwhelmed.

Unfortunately, traditional talk therapy is often the first place people with existential OCD turn to for treatment. While it is effective for treating other issues, it can potentially be counterproductive for someone with existential OCD. Here is a brief example: Say you are anxious to know how it’s possible to understand someone if you never have access to their point of view. In talk therapy, you might focus on how this concern makes you feel and what it brings up for you. The therapist might say something like, “Even if you can’t read someone’s mind, you can still feel connected to them. Can you remember a time when you felt close to someone?” Although this comment may feel helpful for someone anxious to understand the nature of connection, for someone struggling with existential OCD, it may fulfill the compulsive need for reassurance and certainty — thereby reinforcing the OCD cycle.

It might feel good in the short term to have your anxieties relieved, but this isn’t doing anything to address the existential OCD in the long term. ERP takes a targeted approach to address your obsessions and compulsions. An ERP-trained therapist will help by reviewing which thoughts or scenarios are causing you the most anxiety and then work with you to come up with a specialized treatment plan to alleviate them through gradual, controlled exposure to them. In this case, rather than engaging in reassurance-seeking, you’ll work with your therapist to become more comfortable with the stress of uncertainty. 

Examples of existential OCD exposures 

Let’s say you’re struggling with existential OCD and feel the need to seek reassurance from a friend or family member every time you experience intrusive thoughts about the nature of existence. The anxiety of these intrusive thoughts feels so overwhelming that the only apparent solution is asking a friend to answer the questions on your mind. With a therapist, you’ll work toward the goal of experiencing these thoughts without your compulsions interfering. A therapist may ask you to notice the urge to call a friend and prevent yourself from doing so. You might think, “There’s no way I can do that.” If an exposure feels too overwhelming to start, you’ll work with the therapist to find the right intensity for you. Maybe that’s sitting with the uncertainty for a few minutes before reaching out for reassurance. You might be asked to welcome the uncertainty by repeating statements like, “I don’t know for sure if what I’m perceiving is real. It’s impossible to be certain,” each time these intrusive thoughts occur in your mind.

It may be scary at first, but with practice, you’ll find the intensity of your intrusive thoughts and the need to engage in any compulsions will wane. You will get to a point where the anxiety subsides and you no longer feel the need to reach out to a friend every time you experience thoughts about the nature of existence.

How to get help

Existential OCD can be a difficult diagnosis to make and is unfortunately often misdiagnosed. Given that existential OCD often involves an evaluation of life and its meaning, it may be confused with depression. It is also possible for existential OCD to be inaccurately interpreted as general worry and existential fear, or even be misdiagnosed as generalized anxiety disorder

However, a mental health professional who specializes in OCD will be able to make an accurate diagnosis. Existential OCD can impose tremendous challenges on someone’s personal, professional and social life. Even if these thoughts and behaviors have been a part of your life since you can remember, and it feels like there’s no way to overcome them, treatment is available. 

If you’re interested in learning about existential OCD and how it’s treated with ERP, schedule a free call with the NOCD clinical team to find out how this type of treatment can help you. All of our therapists specialize in OCD and receive ERP-specific training and ongoing guidance from our clinical leadership team. Many of them have dealt with OCD themselves and understand how crucial ERP therapy is. NOCD offers live video therapy sessions with OCD therapists, in addition to ongoing support on the NOCD telehealth app, so that you’re fully supported during the course of your treatment. You can also join our Existential OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

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