Existential OCD: When Life’s Big Questions Plague You

Understanding Existential OCD

Most of us have considered questions such as, “What is the meaning of life?” or “What is the purpose of human existence?” In fact, such questions can be an integral part of the study of philosophy.

Many of us have also pondered questions like, “What if the world I know as reality is actually a simulation?” Questions like these have also been explored in stories and films as entertainment. For most people, thinking about such questions is merely a thought exercise.

For individuals experiencing symptoms of existential OCD, these questions can lead to significant symptoms of anxiety, depression, and emotional distress.

What Are Existential OCD and Philosophical OCD?

Obsessive-compulsive disorder (OCD) can take many forms. “Existential OCD” — sometimes called “philosophical OCD” — is one such form. This type of OCD centers around recurrent and distressing thoughts (obsessions) about existential questions for which there are no definitive answers.

This can include questions like: Am I real? Is my perception of life one that reflects “true” reality? Are outside sources or my own free will controlling my actions? And, is what we think reality is really just a grand computer simulation?

Derealization and Related Anxiety Problems

Existential OCD can resemble anxiety problems known as depersonalization or derealization. Depersonalization is the feeling you’re observing yourself from outside your body. Derealization is the feeling that things around you aren’t real. Derealization and depersonalization are perceptual disturbances that involve feeling detached from your environment. Feelings of depersonalization and derealization happen more often for people who have experienced traumatic events or who have panic disorder. However, many people have passing moments of these experiences. What distinguishes existential OCD from depersonalization and derealization is which aspect of the experience is distressing. Depersonalization and derealization are distressing because of the uncomfortable perceptual experience itself, as well as the associated fear people describe of “going crazy” or “losing their grip on reality.” In contrast, existential OCD creates distress related to doubt. For those with existential OCD, it’s the possibility that the “what ifs” could be true that makes them so concerning and alarming.

Intrusive Thoughts and Uncertainty

The questions posed by intrusive thoughts cannot be answered with total certainty, which means they come with uncomfortable feelings of doubt and uncertainty. This leads to a compulsive urge to try to answer them and put these doubts to rest. This urge is what keeps people stuck in the obsessive-compulsive cycle, as with any other type of OCD.

Compulsions in Existential OCD

Some common compulsions that people with existential OCD perform include:

Trying to mentally “figure out” answers to their obsessions
Asking others for reassurance
Replaying past experiences in their mind to look for hints about whether or not they are real
Testing out whether or not things or people are real (e.g., looking for a reflection in a mirror to prove existence)
Reading philosophy books or taking classes to try to find the “truth.”

Existential OCD Treatment

Thankfully, the treatments effective for other types of OCD (e.g., exposure and response prevention) are effective for existential OCD too. So there’s no need to suffer the distress described above. Here are some tips from those treatments that can be helpful to keep in mind if you experience existential OCD symptoms:

Remember that an intrusive thought is just that — a thought. The thoughts can certainly feel urgent and/or important to answer when they show up. But the only thing that actually changes from the moment before you have an intrusive thought to the moment when you’re having one is an upsetting mental event.

Try to resist the urge to perform compulsions, including seeking reassurance from others or from the internet. Reassurance-seeking can provide momentary or short-term relief from an obsession, but in the long term, it strengthens the urge to perform compulsions. Resisting compulsions is easier said than done, but treatments (like exposure and response prevention) can help.

How can exposure and response prevention treatment help? Here’s an example:

Sara (not her real name) was bothered every day by doubt about whether she lived in the “real” world or in someone else’s dream. This caused her a lot of anxiety and she spent a significant amount of time looking for evidence that her lived experience was real. She did this by “testing” whether others remembered things the way she did.

She asked her friends to repeat to her, verbatim, things she believed she had said to them earlier. If she went shopping, she’d return to the store after a few minutes to approach the cashier again and ask them to describe their prior encounter in detail. At work, she asked coworkers to verify if tasks she believed she performed had actually been done (e.g., if the trash can was still empty after she emptied the trash). If Sara didn’t get reassurance or confirmation of her memories from others, she would get very upset and anxious.

Sara sought out exposure and response prevention therapy from an experienced clinician. Working together with her therapist, she planned and participated in a series of planned, repeated exercises called exposures. These exercises helped her practice tolerating the doubt she felt when she had intrusive thoughts.

Over time, Sara’s symptoms improved. She experienced fewer intrusive thoughts, and when they did come up, she was hardly bothered by them.

Note: This is a fictional account created from common experiences reported by individuals with existential OCD.

If you think that symptoms of existential or philosophical OCD are interfering with your well-being, consult with a CBT provider experienced in treating OCD.