- OCD subtypes
- Existential OCD
What is Existential OCD and How Do I Treat It
What is obsessive-compulsive disorder (OCD)? Often, it is misconstrued or misrepresented as that friend who is always cleaning and needs everything to be neat and tidy. Perhaps images come to mind of highly frequent or unnecessary showering or handwashing. While these are not incorrect portrayals of one’s possible experience with OCD, they are by no means a complete picture of the broad scope of this disorder. In reality, the subject of the intrusive thoughts that plague individuals with OCD are not one-size-fits-all and span across a wide variety of topics.
What is existential OCD?
With existential OCD, intrusive thoughts revolve around questions that are impossible to answer. These thoughts are often philosophical, and wouldn’t necessarily be out of character for someone without OCD: “What is my purpose?” or, “Is there a God?” or, “Is there life after death?” While these questions can be frustrating or even frightening to anyone, they are not usually all-consuming. For most, leaving these thoughts unanswered and moving onto other thoughts does not pose a challenge. However, for individuals with existential OCD, it is not quite as simple. People with this subtype of OCD may spend hours contemplating these questions and thoughts over and over again, the weight of which can cause a great deal of distress, anxiety and depression. Individuals with existential OCD may experience the following stream of thought:
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“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?”
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As with other manifestations of OCD, these intrusive thoughts are typically followed by the urge to perform compulsive acts. These compulsions are intended to eliminate the doubt that ensues from lack of answers to existential thoughts and questions and reduce distress. As with other types of obsessive thoughts, the compulsions related to existential OCD are numerous and varied. These compulsions can take many forms but frequently include time-consuming behaviors such as spending hours thinking about or researching these thoughts and questions in order to find answers. Other common compulsions related to existential OCD involve seeking reassurance from others that you are real or that they are real, evaluating past experiences for information to prove or disprove an obsessive thought or engaging in actions that may offer physical clues of existence, such as checking for your reflection in the mirror. The problem with all of these compulsive behaviors is that their aim is to find concrete answers to questions that do not have any. This leaves individuals constantly searching for answers that they may accept for a brief period of time — only to begin doubting them again and searching for new ones.
Common misdiagnoses of existential OCD
As discussed earlier, existential thoughts and questions are quite common. Because of how commonplace these thoughts and questions are, individuals with existential OCD may delay seeking treatment. But even once they do seek treatment, getting a diagnosis of existential OCD can be difficult. Because 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 misdiagnosed as Generalized Anxiety Disorder.
Treatment for existential OCD
Although it may be difficult to identify at first, the only real difference between existential OCD and any other form of the disorder is the nature of the intrusive thoughts. As such, the recommended treatment for existential related OCD remains the same as for any other variety of OCD: Exposure and Response Prevention (ERP) therapy, a type of cognitive behavioral therapy (CBT) that has been referred to as the gold standard approach for treating OCD. ERP therapy requires clients to lean into uncomfortable thoughts without engaging in compulsions to learn to tolerate uncertainty. The goal is that through repeated exposure to the feared thoughts or stimuli the individual will begin to develop a tolerance toward the negative feelings associated with those thoughts (e.g., anxiety). It’s important to note that while the work of ERP can be uncomfortable, every step of the process is a fully agreed upon collaboration between therapist and patient. ERP never starts with the most intrusive thoughts but rather a patient starts with thoughts that land in the middle to the lower end of the hierarchy and as a patient gets more comfortable they work to tackle more difficult thoughts.
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Where can I get ERP therapy?
At NOCD, all therapists specialize in OCD and receive ERP-specific training. ERP is most effective when the therapist conducting the treatment has experience with OCD and training in ERP. If you or someone you know is struggling with OCD, you can schedule a free call today with the NOCD clinical team to learn more about how a licensed therapist can help.
Keara E. Valentine, Psy.D., is a postdoctoral fellow at Stanford University School of Medicine in the OCD and Related Disorders Track, where she specializes in the assessment and treatment of OCD and related disorders. Dr. Valentine utilizes behavioral-based therapies including Cognitive Behavioral Therapy (CBT) and Exposure and Response Prevention (ERP) with children, adolescents, and adults experiencing anxiety-related disorders.
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- Obsessive compulsive disorder (OCD)
- OCD Subtypes
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NOCD Therapists specialize in treating Existential OCDView all therapists
Licensed Therapist, MA
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.
Licensed Therapist, LCMHC
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.
Licensed Therapist, MA
I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.