Obsessive compulsive disorder - OCD treatment and therapy from NOCD

“Am I dreaming?” How to handle the fear that it’s all been a dream

By Jessica Migala

Jan 18, 20247 minute read

Reviewed byApril Kilduff, MA, LCPC

When something really great—unbelievable, even—happens, you might want to pinch yourself, and wonder if you’re just dreaming. And you may have the same feeling if a tragedy occurs.  

But if you find yourself worrying about whether you’re dreaming or experiencing reality—like if you’re having a lucid dream, living with certain mental health conditions, or aren’t sure whether something you said or did happened in a dream or reality, read on to learn more. We’ll help you figure out why you’re feeling the way you do, and when and how to get help.

How do I know if I’m in a dream state?

There are a few things you can do to answer the question, am I dreaming? For starters, you can literally pinch yourself. If you’re able to feel the pain, then it’s reality. 

Another sign is to look for things—people, places, things—that commonly pop up in your dreams, according to April Kilduff, MA, LPCC, LCPC, LMHC, a licensed therapist and Clinical Trainer at NOCD.

Then there’s reality testing. which is when you conduct a test—and it can be the same test every time—to know if you’re actually sleeping or not. For example, you might check your smartwatch to see if it’s the same each time you look. (If it’s noon, then then six, then the arms are all curvy, or skewed are now geckos, that’s a sure tell that it’s a dream.) The idea is to do reality testing when you feel fully awake, too, so that the differences between a dream state and reality are more obvious. 

When does worrying about whether I’m dreaming become a fear or obsession?

If you’re still not sure if you’re dreaming or fully conscious in the present, there’s a name for that: dream-reality confusion, or DRC. It’s defined as “a difficulty or an impossibility to determine whether an event or experience took place during wakefulness or if it was in the content of a dream,” according to research published in the journal Dreaming. About 7 to 71% of the population have experienced DRC in their life. (A wide range, to be sure, but studies differ on the commonality of the phenomenon.) People more likely to have DRC are those who have disordered sleeping, neuroticism, and can remember their dreams more easily, as well as those who have borderline personality disorder or other dissociative symptoms. 

Other evidence, published in Frontiers in Psychology, looked at DRC specifically in borderline personality disorder—since sleep disturbance is a common feature of the mental illness—and found that many people experience dissociative symptoms in their waking state, as well. Additionally, the study discovered that those with borderline personality disorder often have more negative dreams that tend to reflect what’s going on in real life, so they may be confused with reality.

That’s not to say that if you experience symptoms of DRC you have the personality disorder. Other symptoms include extreme mood swings, having intense and unstable relationships, self-harm, and impulsive behavior. Speak with a doctor if these ring true for you.

Dream themes in obsessive-compulsive disorder (OCD)

It’s also possible that what you’re feeling could be obsessive-compulsive disorder, or OCD. “The idea of ‘Am I experiencing reality’ is a common fear if you have a subtype of the condition called existential OCD,” says Kilduff. “One way that fear can come out is the worry about whether something that is happening is a simulation, dream, or hallucination.”

OCD is a chronic mental health disorder that centers around obsessions, which are intrusive thoughts, images, feelings, sensations or urges that cause you distress, and compulsions that are mental or physical behaviors done to counteract your discomfort. By performing a compulsion, you feel temporary relief from your obsession—but the catch is that this break from anxiety is fleeting, and once your obsession is triggered again, you’ll repeat the cycle.

The condition presents in an endless variety of ways, one of which is existential OCD. That’s when your intrusive thoughts have to do with impossible-to-answer questions, like the meaning of life, or the presence of God. Or, if you don’t know if you’re in a dream or experiencing reality, the underlying fear could be that you don’t have a self—that there is no you. “That can be a disturbing concept,” says Kilduff. “If you worry that there is no permanence, you can feel like you have nothing to be tethered to.” 

Another core fear in OCD is a worry that you’ll never be able to figure out the big, metaphysical questions you’re asking yourself. “The truth is that they’re not solvable, but you may still have a strong need to figure things out, and feel as if your concerns will plague your life if you don’t get to the answers,” Kilduff explains. That’s why you may find that you get lost for hours contemplating whether you’re having a dream, or what reality means, anyway.

That’s typical OCD, a disorder that needs you to be sure of something with 100% certainty. And it’s an illness that won’t let up until you get there. The problem is, without treatment, you never will. You’ll remain trapped in the loop of obsessions and compulsions.

Some common compulsions with existential OCD include:

  • Rumination. This is a form of overthinking, where you may have repetitive thoughts about something and/or try to solve an issue you’re wrangling with. With OCD, rumination may look like not just searching for an answer to the question of am I dreaming? But needing to feel certain about it.
  • Mental review of an experience you had to try to determine if it was a dream or reality.
  • Reassurance-seeking, by asking loved ones if this is real life now and they’re actually here with you.
  • Deep, extensive research into the nature of reality or dreams.
  • Avoidance of things because you’re not sure if they’re real or not. 
  • Physical checks to see if you are dreaming. For example, saying to yourself, If I do this, then I’m not in a dream.

What can I do about the fear that I might be in a dream?

For those brain blips where you ask yourself if what you said or did was actually in a dream or real life, you can keep on moving through them. “It’s normal–and a sign of the times we’re in. We’re so busy, and there are so many ways to communicate, and different devices we’re checking, that it’s easy to have this type of confusion,” says Kilduff. 

If it’s happening once in a while, it’s OK to shrug it off, especially if it’s not bothering you. But if it occurs frequently enough that it negatively impacts your life, then it’s time to seek professional help. That might be a mental health practitioner, such as a psychologist or licensed therapist, or your primary care provider—especially if you’re taking medications that can impact your memory, such as zolpidem (Ambien) or have other memory concerns.

If you suspect you may have OCD, then it’s important to seek out a qualified licensed therapist who specializes in the condition, like the practitioners at NOCD, who can evaluate you for OCD or an OCD-related disorder, and help you pursue treatment.

Existential OCD might also impact the way you make decisions, or the actions you do or don’t take, says Kilduff. For example, if you think you’re dreaming, do you believe you have control over events, or is everything predetermined by some outside force? Those questions can really get in the way of daily living. “People will put their life on pause until they can figure things out, but that’s dangerous because you won’t ever figure it out,” explains Kilduff. 

The gold-standard treatment for OCD—and all of its subtypes, including existential themes—is exposure and response prevention therapy, or ERP. During ERP, you’ll collaborate with your therapist to determine what things trigger your obsession-compulsion cycle. Then, you will be exposed to something that triggers your anxiety (this is the exposure part of ERP). Rather than using a compulsion to neutralize your distress, your therapist will give you tools to sit with your discomfort and let it subside (called response prevention). By facing your fears and avoiding compulsions—which only habituate you to that fear—you can treat your OCD. 

In terms of dreaming, Kilduff says that some exposures that your therapist might suggest include:

  • Creating a worst-case scenario script: If your life really is all a dream, how do you think that will play out in a negative way for you?
  • Practicing saying a statement like this may or may not be a dream.
  • Living your life. Kilduff says that she encourages clients to go ahead and live their life as they otherwise would. “You can’t put decisions on hold until you figure out if it’s reality,” she says. “It’s a type of exposure to say let’s go ahead and make plans rather than avoiding your life.”

While the concept of confronting these fears may sound scary, know that your NOCD clinician will be there with you every step of the way, and individualize your treatment to help you feel safe. 

To learn more about how ERP works and explore if NOCD’s online video therapy can help you, schedule your free 15-minute call with NOCD today and learn more about the science behind ERP. Above all, please know that you don’t have to live in fear and doubt forever—help is out there. 

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