If you find that thoughts of reality or life after death distract you from everyday life on a regular basis, this could be a symptom of existential obsessive-compulsive disorder (OCD).

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Obsessive-compulsive disorder (OCD) is a mental health condition in which someone experiences intrusive and unwanted obsessions and engages in compulsive behaviors.

OCD can look different from person to person, but obsessions tend to follow specific themes. Existential OCD is a subtype of OCD that’s characterized by obsessions involving existential and philosophical topics, such as the nature of existence, life, death, and other related topics.

Below, we’ll explore everything you need to know about existential OCD, including the symptoms, triggers, treatment, and what recovery looks like.

When someone has OCD, including existential OCD, the symptoms include obsessions and compulsions.

Obsessions are intrusive, repetitive, and unwanted thoughts, urges, images, or sensations that cause discomfort, anxiety, and fear. Some of the common obsessions in existential OCD include:

  • the meaning of life
  • the purpose of existence
  • what happens after death
  • the nature of reality
  • the nature of the universe

One common theme of existential OCD obsessions is that there are no true answers to these types of thoughts and questions, which can be extremely distressing.

Because these obsessions can cause significant anxiety, people with existential OCD engage in compulsive behaviors to lower these uncomfortable feelings. Some compulsions that people with existential OCD might do include:

  • seeking reassurance that things or people are real
  • constantly ruminating (going over in your mind) about the meaning of existence
  • asking others what they think about life and death
  • researching existential or philosophical literature
  • reviewing events to determine if they were real or not
  • avoiding media or conversations about life, death, and reality

For people with OCD, these compulsions can become severe enough that they affect someone’s ability to function in their daily life. When this happens, it can lead to other mental health symptoms, such as depression, that can make it even harder to function.

It’s also common for people with existential OCD to experience derealization and depersonalization. Derealization can cause someone to feel disconnected from the world around them, whereas depersonalization can make people feel disconnected from themselves.

Statistics suggest that OCD will affect roughly 2.3% of adults in the United States over the course of their lifetime. We don’t know exactly what causes someone to develop OCD, but several factors appear to play a role, including family history and changes in the brain.

Research also shows that stressful and traumatic life events can play a role in the development of OCD for some people. Some of the life events that may trigger existential OCD include:

  • illness or hospitalization
  • illness or death of a loved one
  • a new relationship
  • an engagement or marriage
  • a breakup or divorce
  • pregnancy or giving birth
  • loss of a pregnancy
  • starting or losing a job
  • trouble at work or school
  • family difficulties at home
  • assault, abuse, or neglect

Proven treatment options for existential OCD include therapy, medication, and other treatment approaches. Whether someone has existential OCD or another subtype, such as contamination OCD, treatment approaches are generally the same.

Therapy

Cognitive behavioral therapy (CBT) is one therapy approach that can help people with OCD manage their symptoms. CBT teaches people how to recognize and change the unhelpful thoughts, emotions, and behaviors that are fueling symptoms.

One form of CBT in particular, called exposure and response prevention (ERP), is one of the most effective treatment options for OCD. In fact, research from 2012 has shown that ERP is more effective at treating OCD than medication alone.

With ERP, you slowly and gradually face your triggers and the obsessions that they cause. If you have existential OCD, this might involve activities like discussing death, reading philosophical literature, or saying things like “I’m not real.”

As your anxiety and discomfort increase, you also learn coping skills that will help you avoid engaging in compulsions. Over time, the more you practice facing your fears without using compulsive behaviors to cope, the less likely you are to fall into the OCD cycle.

Medication

Some people with OCD also benefit from medications alongside therapy to help manage symptoms. Common medications used to help treat OCD symptoms include:

All of the medications above ― with the exception of clomipramine ― are a type of medication called selective serotonin reuptake inhibitors (SSRIs). SSRIs work by changing the levels of serotonin in the brain, which experts believe plays a role in conditions like OCD.

Clomipramine, a type of medication called a tricyclic antidepressant, is also effective at treating OCD symptoms. But tricyclic antidepressants are known for their increased risk of side effects, such as dry mouth, blurred vision, and drowsiness, among others.

Other options

Studies have shown that several other approaches may be effective for lowering OCD symptoms, especially in people with severe OCD. For example, transcranial magnetic stimulation and deep brain stimulation are two procedures that may help lower OCD symptoms.

Does existential OCD ever go away?

Although there’s no cure for OCD, research has shown that treatment is an effective way to reduce OCD symptoms and improve the quality of life for those with the condition.

Therapy can help teach you the skills needed so that you can better cope with your triggers when you encounter them out in the world. And medication can be helpful for managing the anxiety and other mental health symptoms that OCD can cause.

Was this helpful?

Existential OCD is a subtype of OCD that causes someone to experience obsessions related to philosophical and existential concepts, questions, and fears. It’s common for people with existential OCD to think about life, death, reality, and the universe and to engage in compulsions like mental checking, rumination, and reassurance seeking.

If you’ve found yourself thinking about existential topics to the point that it’s making it hard to function, consider reaching out to a doctor or therapist to discuss your concerns. If you do have existential OCD, the right treatment can help you get your symptoms under control.