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Existential OCD

Existential OCD or a ‘Deep Thinker’? How to Tell The Difference

5 min read
Caryn Gill
By Caryn Gill
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.

Existential OCD is characterized by the preoccupation with philosophical questions related to life and existence. For example, someone with existential OCD might experience intrusive thoughts centered on the meaning of life, the universe, and/or their human existence. They might experience frequent doubt about their perceptions of reality. Someone with existential OCD might also experience recurrent feelings of depersonalization and derealization, which only exacerbate their doubts about their experiences of reality. They might also frequently question the purpose of life. 

As with other presentations of OCD, it is helpful to look beyond the content of the obsessions and consider more the relationship between their thoughts, feelings, and behaviors. Just as someone with religious scrupulosity might appear to be an extremely devout follower of their faith, someone with existential OCD might appear to be a “deep thinker.” In fact, there is a whole field devoted to figuring out the meaning of life, and yet, not every philosopher has existential OCD. 

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So, what’s the difference?

The meaning one makes of their thoughts, the urgent distress one feels because of their thoughts, and the behaviors that follow this distress, is what separates people with OCD from those with a genuine interest in existential inquiries. 

Commonly, individuals with existential OCD experience an urgency to arrive at some sort of answer to these unanswerable questions. The lack of conclusion causes anguish for these individuals, which detracts from their ability to engage in their lives in a fulfilling and meaningful way. For example, while spending time with loved ones, these individuals might be stuck in a vortex of questioning if their loved ones are actually real. They might be questioning if they are actually present or if their perceptions of reality are wrong. Or, they might be trying to figure out what the meaning of these interactions are if there is no actual definitive meaning to life at all. These are just some examples of the way existential OCD might present in people’s lives. 

This sort of anguished search for meaning is not to be confused with the sense of ruminative hopelessness and meaninglessness that is common among people with depression, nor is it the equivalent to the type of endless sense of worrying germane to Generalized Anxiety Disorder. What distinguishes existential obsessions from the aforementioned experiences is the presence of compulsions. 

Common compulsions for individuals with existential OCD include mental checking/testing to gauge if one feels in touch with reality, ruminating in hopes that “this time” they will find the answers, and excessive research and reading of philosophical and scientifics texts.  Conversely, some may engage in avoidance of anything related to this topic, such as movies about simulations and videos about the universe, space, or the meaning of life. Individuals with existential OCD commonly also seek reassurance from others by asking them for their answers to their obsessive questions or asking them how they perceive reality. 

As is true for other themes of OCD, the best treatment for existential OCD is Exposure and Response Prevention. Unfortunately, as is common for many people with OCD, many individuals may end up in traditional talk therapy before they land in the right treatment. The rationale for ERP over traditional talk therapy is based on the idea that discussing possible answers to these unanswerable questions is, in fact, a compulsion. Even purely cognitive approaches, like the use of thought challenging and cognitive reframing, reinforce the idea that the individual in treatment sincerely needs to pay these thoughts any mind at all. Just like with other forms of OCD, when an individual uses an ERP approach, they learn to treat these thoughts just as they would treat anything else their imaginative brain spews out. 

In ERP, the individual would purposely approach the sources of their anxiety, allowing their distress to arise while actively resisting any sort of attempts to decrease their distress. Exposures can vary from person to person, but some general examples might include: 

  • Learning about theories related to alternate universes 
  • Telling yourself “I’ll never know for sure if I’m real”/”I’ll never know if there is meaning to life”/ “I might never know if I’m in a simulation” etc regularly throughout your day
  •  Watching movies/tv shows that feature themes of unreality/simulations/eternity/alternate universes 
  • Engaging in day-to-day tasks and saying, “I don’t know for sure if what I’m perceiving is real”

After engaging in these exposures, response prevention is key. It could be helpful to remind  individuals with OCD that people have been trying to figure out the answers to your obsessional questions since the beginning of time, and the likelihood that they are the one to unlock these answers is close to nil. Combine this infinitesimal likelihood with the fact that all of their attempts to think their way out of distress has only led them deeper into suffering– their options are to suffer more, or to sit with their distress right now, giving themselves a chance to learn that they don’t have to have an answer. 

If you have existential OCD, I encourage you to think about what else you could do with the time and energy you have been spending on compulsions. You might not have an answer to what this all means, but life resides in that gray space between knowing and not-knowing. Even with these questions unanswered, life beckons you to live it. 

If you are looking to break free from existential OCD, then I encourage you to learn about NOCD’s accessible, evidence-based approach to 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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NOCD Therapists specialize in treating Existential OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Gary Vandalfsen

Gary Vandalfsen

Licensed Therapist, Psychologist

I’ve been practicing as a licensed therapist for over twenty five years. My main area of focus is OCD with specialized training in Exposure and Response Prevention therapy. I use ERP to treat people with all types of OCD themes, including aggressive, taboo, and a range of other unique types.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

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