Existential OCD

The California OCD and Anxiety Treatment Center, located in North Orange County, California, treats Existential OCD with online therapy, Intensive Out-Patient, and face-to face in the Fullerton office.

Have you ever wondered why we are all here on Earth? Ever looked at someone else and wondered if they are even real, or wondered if they think you are real? How do we know what truth really is and what if we never know what’s really true? Are we just in a simulation? When I see the color blue, are we seeing the same color, or are you seeing a different color and calling it blue? Can I ever really know who I really and truly am?

These are questions that most of us think about from time to time when we are trying to sleep. Sometimes we debate these questions among friends at a party, or have to write papers on them for a college class. Either way, these questions, for most people, serve as an innocuous way to pass time or casually pontificate about existence.

While harmless to many people, these questions cause others to get stuck in a seemingly endless loop of intense evaluation, research, and testing. The results of their inquiry are not just an academic pursuit, but a matter of life and death that will dictate all future actions.

Existential OCD is a subtype of Obsessive Compulsive Disorder (OCD) focusing on abstract and existential questions. Like other forms of OCD, Existential OCD traps sufferers in a cycle of thought and action with a personal and emotional impact that can range from distracting to debilitating.

What is Obsessive Compulsive Disorder?

The OCD cycle is the common thread that ties all the OCD subtypes, such as HOCD, Contamination, and Harm OCD, as well as other anxiety disorders, together. At its most basic level, we must remember that all thoughts, feelings, relationships, and objects are simply neutral. However, anxiety disorders, such as OCD, creates a story about the object, relationship, or action and connects it to the sufferer. These feared stories, which are simply unwanted and intrusive neutral stories crafted by a creative and overly cautious brain, usually take the form of “If ____, then ____” or “What if…”.

This story runs counter to the sufferer’s desires, goals, or values, and since the brain will overestimate the level of risk and chances of risk pertaining to potential dangers, this story causes tremendous anxiety and uncertainty.  To return to a sense of normalcy, certainty, and safety, the OCD sufferer performs a series of physical or mental rituals, reassurance seeking, avoidances, or checking. These compulsions can range from subtle and quick to highly complex and time consuming.

Symptoms of Existential OCD

Common obsessions for those suffering with Existential OCD can include, but are not limited to:

• What is the meaning of life
• What if I never find my purpose
• How do I know this is real
• What if I am dreaming my life and I’m in a coma
• How do I know everyone experiences the same reality
• What if I’m completely forgotten after I die, and everything I did meant nothing
• How do I know I’m in love
• Why am I the person I am

Common compulsions for those with Existential OCD can include, but are not limited to:

• Repeatedly asking family, friends, or professors about their thoughts to these questions
• Mentally evaluating and comparing their feelings
• Being hyperaware of other’s responses to see if their responses are consistent with yours
• Reading blogs, books, and studies on the universe, psychology, and philosophy
• Praying excessively for wisdom or divine guidance
• Engaging in “reality testing” exercises, like pinching themselves or cause/ effect experiments

Curious or Compulsive?

A defining characteristic that separates OCD from a sense of curiosity and genuine interest is the urgency with which the sufferer pursues the answers. Someone with Existential Obsessive Compulsive Disorder experiences an intense drive to answer these questions in order to calm a physical and/ or emotional discomfort. It can almost feel like they cannot move on with their lives without a full understanding and complete clarity. Rationally, they know that they are responding excessively and beyond the way the average person would respond.

Conversely, a person without OCD may be able to casually express an interest in existential thoughts and abstract philosophical questions. They can stop the search when other matters or obligations arise. They need to sleep for work? No problem, they’ll just pick up the conversation and research tomorrow. Moreover, the neuro-typical person will likely get pleasure and entertainment from these thoughts. This is what we would call an Ego-Syntonic subject, meaning the subject of the thought and the response intensity is consistent with the individual’s typical thoughts, values, and responses.

Curious AND Compulsive?

A question I get a lot from my clients with Existential OCD is whether they can pursue their interest in existential and philosophical thought safely. In other words, some with Existential OCD acknowledge that, while they have obsessions and compulsions surrounding existential and philosophical concepts, they also report genuinely being interested in the subject and want to pursue their interest in a safe way. This commonly takes the form of someone wanting to major in philosophy, cognitive psychology, or theology.

This request, from some, is genuine. They honestly do gather some interest in these subjects. However, for a great number of others, their interest is rooted in a desire to continue their quest for answers disguised as honest academic interest.

Of course, these questions are interesting and mentally attractive, but they are also quicksand for those with Existential OCD. A decent comparison is someone who has contamination OCD and engages in compulsive cleaning and organizing. While they may genuinely enjoy a clean house, their drive for cleanliness is not rooted in an Ego-Syntonic, personally rewarding job well done, but in a hollow and fleeting yearning for the sense that their house is free of misperceived dangerous contaminants.

 A person with Existential OCD who is interested in pursuing these subjects should proceed with tremendous caution. Can an alcoholic work at a bar? Yes. Is it a good idea? Probably not. If they were to consider moving forward, they should be relentlessly honest with themselves about their limitations, their slippery slope subjects, and when they have crossed the line. Of course, none of this should take place until they have completed treatment.

Treatment for Existential OCD

Obsessive Compulsive Disorder is treated with a combination of Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness approaches, such as Acceptance and Commitment Therapy (ACT).  

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy for Existential OCD, while part of the standard treatment for all subtypes of Obsessive Compulsive Disorder, can be a double-edged sword. Typically, the therapist and client will begin their work by discussing what is at stake with these questions, and what it will mean for them if they cannot get to a satisfying answer. In other words, to learn the feared consequences that drive the compulsive researching and checking. Following this, client and therapist work to challenge the legitimacy of this fear and to consider alternatives to the feared outcome.

As previously mentioned, this is a double-edged sword. While challenging the feared thought is an important component of treatment, it often mirrors the compulsive rumination and evaluation that made the OCD a problem in the first place. Therefore, this is done cautiously, sparingly, or not at all.

Exposure and Response Prevention

Exposure and Response Prevention is a therapeutic approach in which the therapist guides the client through exercises designed to help the client face their fears in a progressive, controlled process. By facing their fears, clients learn that they can take on the weight of the anxiety associated with their fear without being crushed. Through repeated exposures, client’s experience a slow reduction of their anxiety; a processed called Habituation.

Exposures can be any activity that helps the individual confront their fears. This can include watching movies about existential subjects, reading the bible or other religious texts, writing stories about never feeling grounded in reality, or meditating on anxiety producing concepts. While this process is difficult, it is a necessary part of treatment and one that the therapist walks alongside them step-by-step.

Mindfulness Based Treatment

More recently, mindfulness based approaches have been used to supplement CBT and ERP for OCD and anxiety related disorders. One such approach called Acceptance and Commitment Therapy, or ACT, is effective helping those with anxiety related disorders resist their compulsive behaviors while building their strength to willfully experience their feared thoughts.

Existential obsessions draw sufferers outside of the present moment into a world of fantasy, so ACT helps them remain focused on the present moment.  Furthermore, ACT helps OCD sufferers build their ability to recognize the existential thoughts and obsessions as being optional thought experiments that do not have to overtake their life. The obsessions do they have to be answered immediately, if ever. ACT calls this Defusion, meaning not-fusing with the thought as if the outcome of the thought and the person’s very existence were one and the same.  This doesn’t mean ignoring them, or suppressing them, but acknowledging them as part of the present moment’s thought that will eventually be replaced by another thought.

If you would like to learn more about treatment for Existential OCD in the Fullerton, Orange County office, or learn whether online therapy could be a good option for you, please contact me for a free 15 minute consultation.

FearCast Podcast episodes about Existential OCD:

Episode 2- Existential OCD