Existential OCD: What You Need To Know

For most of us, big questions about existence are a fun thing to talk about. Are we living in a simulation? Is God real? However, when these subjects become an obsession, they can become existential OCD.

What is existential OCD?

Existential OCD is a form of obsessive-compulsive disorder in which you simply cannot stop thinking about these questions. As these questions cannot be answered and can be frightening, it is impossible to break out of the loop by answering the question.

Some of these thoughts are similar to those experienced while depressed (wondering if life has any meaning, etc.). It is sometimes misdiagnosed as a generalized anxiety disorder.

In some cases, you might become unable to get rid of the thought. You may develop compulsions, including excessive research, spending too much time in church or equivalent, seeking constant reassurance from friends and family members, etc. This can affect your personal relationships.

What causes existential OCD?

The causes of obsessive-compulsive disorder, in general, are still poorly understood. They appear to be a combination of genetics, life events, and possibly illness. (Sometimes, children can develop OCD after a strep infection).

Why some people with OCD seize onto existential questions is also unclear, but it revolves around a common symptom of OCD — intrusive thoughts. These unwanted thoughts seem to pop into our heads randomly, often triggered by stress or anxiety. They might be violent, sexual, self-deprecating, or paranoid. 

While we all get intrusive thoughts every now and then, people with OCD cannot move on from those thoughts and find they circle around in their brains. When the intrusive thought you can't let go of is an existential question, it can be even harder to eliminate.

Existential OCD is also associated with dissociative experiences¹. This means a feeling of being outside of one's body and disconnected from your sense of who you are. This can tie into questions about the nature of reality, especially questions about one's own reality.

How is existential OCD treated?

OCD is typically treated with a combination of cognitive behavioral therapy and, in some cases, medication.

In general, the go-to treatment for OCD is exposure and response prevention therapy². Imaginal exposure therapy can be used to explore these questions in a controlled manner and break the cycle of intrusive thoughts.

Exposure therapy might involve watching videos or reading articles that validate your intrusive thoughts and then sitting with them rather than going to your typical ritual response.

Medication might also be used to help reduce obsessive thoughts. The go-to medication for OCD is selective serotonin receptor inhibitors (SSRIs), although not everyone responds to them. There are few good second-line therapies, making the combination of CBT and SSRIs the current standard of care.

How can I tell if my existential crisis is OCD?

The kind of philosophical questions associated with existential OCD are things we all might ask sometimes. Is there life after death? How do we know we're real?

Some people might hit an existential crisis, particularly at a low point in life, wherein they question whether their life has meaning and purpose. Most people move on from this. However, in existential OCD, they are unable to do so. Some signs that you might have existential OCD are:

• You spend hours going over existential or philosophical questions, even if it makes you anxious and depressed.

• You can't get a specific idea out of your head, such as being trapped in a reality show.

• When you have these thoughts, you have a strong urge to do a specific thing, such as seek reassurance, research it on the internet, evaluate past experiences, etc.

• You cannot stop wanting to "fix" or "solve" the question.

• You develop polarized thinking that something has to be true or false.

• You lose track of time contemplating these questions.

Therapy is a good idea for anyone with issues with existential questions, but it is essential for somebody with OCD.

Is existential OCD misdiagnosed?

Existential OCD is fairly commonly misdiagnosed. Most often, it is mistaken for generalized anxiety disorder. 

A key difference is that people with anxiety generally don't formulate ritualized behaviors to deal with their symptoms and are less likely to continually seize on a specific thing to be anxious about. However, both conditions are marked by very high levels of anxiety that generally cannot be dealt with without treatment.

Can existential OCD be cured?

The combination of therapy and medications can effectively treat symptoms of OCD in most individuals. In some cases, OCD can be hard to treat, and you may always have issues with intrusive thoughts.

Exposure and response prevention therapy can have long-term effects. Once your therapy is complete, you will leave with the tools to deal with your own symptoms. These can allow you to manage any obsessive thoughts that may arise in the future. 

The lowdown

Asking deep philosophical questions, some of which can be frightening and anxiety-inducing, is normal. However, if you cannot move on from a question, if you find yourself engaging in ritualized behavior to stop thinking about it, or if you lose track of time contemplating these questions, then you may have a problem.

Therapy and medication can help bring these intrusive thoughts under control, so they do not take over your life.