Why am I always thinking about death? What therapists say

Information in this article may be triggering to some. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for assistance from a trained counselor. If you are in immediate danger, call 911.

Death is a fact of life, but everyone has a different relationship with it. One poll showed that roughly 7 out of 10 Westerners feel uncomfortable with death. Some people prefer never to think about it or talk about it. On the other hand, there are some who spend a great deal of time thinking about death, worrying about it, and trying to figure out how to put it off. In fact, for some people, worrying about death becomes something of an obsession.

I know about obsessions. In fact, I’m a therapist who treats obsessive-compulsive disorder (OCD), and I’ve also had my own first-hand experiences with it. My own obsession with death began at a very young age.

Of course, frequent worrying thoughts about death don’t necessarily indicate a mental health problem. They’re quite common: some research indicates that 42% of people report fearing death to some degree. 

But if you’re finding that you’re always thinking about death, keep reading to better understand if there’s actually cause for concern, and what you can do about your distressing fixation.

What causes persistent thoughts of death?

There are many reasons a person may have persistent thoughts about death. Let’s take a look at some possible explanations:

1. Losing a loved one, or coming to terms with mortality for the first time

I lost my grandmother at the age of 5. She drowned after a boating accident. This traumatic event triggered a fear of death in me that would haunt me for years. As a child, I spent hours ruminating about dying and grappling with the uncertainty of it. For a long time, I avoided all movies and books related to death and the afterlife—like ghost stories, scary movies, or murder mysteries. 

My life became a series of rituals aimed at sidestepping death. Before I was 10 years old, I was checking my pulse and monitoring my breathing daily, avoiding hard foods because I thought they would cause me to choke, and treating everyday life like a medical emergency was around the corner. I sought reassurance constantly from family and friends and prayed repeatedly for God to “give me a long long life.” 

2. Prolonged grief disorder (PGD)

The disorder, which was previously known as “complicated grief disorder” and “persistent complex bereavement disorder,” is defined as intense pain lasting a year after a loss, with an inability to resume past activities. 

People with prolonged grief disorder often struggle to fully accept the reality of their loss, which is why thoughts about death can become persistent. For instance, they may ruminate on other scenarios that could have unfolded in which their loved one’s death could have been averted—i.e., “If only my sister could have gotten into a clinical trial.” They may also engage in excessive avoidance of places or situations that remind them of the person they lost. 

3. Depression and loss of hope

Sometimes the persistent thought of death is linked to depression. Suicidal thoughts or ideation can occur in depression when a person feels that there is no hope, or nothing to live for. Suicidal ideation or intent is not something that should ever be taken lightly. Anyone experiencing ideation or intent to harm themselves should reach out for immediate help; there are many resources available to you, and you don’t have to go through this alone. Here’s a list of crisis resources: 

• Call 911
• Go to your Local Emergency Room
• Call 988 (Mental Health Crisis Line)
• Text HOME to 741741 for a crisis text line
• Dial 1-800-273-TALK (8255) National Suicide Prevention Line

4. Intrusive Thoughts

Intrusive thoughts, images, feelings, sensations and urges are mental experiences that are unpleasant and/or distressing and happen against one’s will. Intrusive thoughts can be about a variety of topics—and sometimes the topic is death. While intrusive thoughts do not necessarily mean you have a mental health condition (everyone has intrusive thoughts from time to time), persistent and distressing intrusive thoughts about death can be a sign of OCD or PTSD. 

One important thing to note is that there’s a major difference between an intrusive thought about death and intent to harm oneself. An intrusive thought about death will likely cause fear or anxiety. A person may have an intrusive thought that says, “What if your brother died?” or “You could jump off that balcony,” and they do not want to die. In fact, usually it is quite the opposite. This is very different from someone who is experiencing suicidal ideation or intent, but these thoughts can be very distressing nonetheless—especially if they become obsessions in OCD. 

Obsessive thoughts about death in OCD

As mentioned above, sometimes a person with OCD may experience persistent and distressing intrusive triggers related to death. But how exactly does it play out? Let’s take a closer look.

OCD is a disorder that involves two groups of symptoms: obsessions and compulsions. Obsessions are those unwanted thoughts and other triggers that cause distress. Some common obsessions that may be present in a person with OCD and a fear of death may be: 

• Worry that one has some fatal condition, like cancer
• Fear about the dying process
• Fear of dying alone
• Worry about a loved one dying
• Fears about being ready for death when it comes
• Fears about the afterlife
• Fears about religious repercussions due to their doubts about the afterlife

In addition to obsessions, someone with OCD also engages in compulsions. Compulsions are repetitive physical or mental acts that people do in an attempt to alleviate the distress brought on by obsessions or to avoid an unwanted outcome. Some common compulsions that may result from obsessive thoughts about death could include:

• Researching illnesses that lead to death
• Seeking reassurance from loved ones, priests, or others
• Avoiding any situations that could lead to death, such as driving
• Rigidly adhering to health practices to reduce anxiety about death
• Studying and exploring beliefs about the afterlife in response to anxiety
• Searching the internet for the stories of people who have had near-death experiences 
• Excessively checking in with loved ones to make sure they’re safe
• Excessive prayer

Unfortunately, engaging in compulsive behaviors only brings temporary relief. That’s why a person engaging in compulsions finds that over time, more and more compulsions are necessary to reduce their anxiety; it’s an endless cycle. The brain is learning a false message—“I must engage in compulsions to feel better”—that can do nothing to stop obsessions from returning again and again.

How to get help if you’re always thinking about death

What comes after death is uncertain. What one will experience while dying is uncertain. All of this can, understandably, feel very scary. However, there is hope.

If you’re struggling with depression or grief, talking to a therapist can be a good place to begin to find relief. Medication may sometimes also be a part of a holistic treatment plan and should be discussed with your doctor. 

If you think that you may be struggling with obsessions about death and compulsions like reassurance-seeking, a different kind of therapy is needed. Exposure and response prevention (ERP) therapy is the gold-standard treatment for all types of OCD. 

In ERP, people learn to accept the uncertainty behind their obsessions—uncertainty that’s a universal part of life. The success of ERP relies on exposing yourself to your fears rather than avoiding them or engaging in compulsions for a temporary, false sense of relief. It isn’t a vague “face your fears” therapy. It occurs in planned, structured exercises, with proper guidance, and moves at a pace that’s tailored to your needs so it doesn’t become overwhelming, while still leading to growth and progress.

Someone with a fear of dying may start with something like looking at pictures of graves on the internet, and then work their way up to actually walking through a graveyard or writing down what they want to put in their will. Essentially, you’ll take baby steps in the direction you and your therapist choose to go. But that doesn’t mean you won’t notice a difference quickly; in fact, many people experience significant benefits in a matter of weeks after starting ERP.

Where to get help for OCD, anxiety, or depression

If you think you may be struggling with OCD, anxiety, or depression, or would like to speak to someone about your symptoms, I encourage you to learn more about NOCD’s accessible, evidence-based approach to treatment for these conditions. 

As hard as it may be to believe, you don’t have to feel this way forever—there are people who can help you get better.