Obsessive-compulsive disorder (OCD) is one of the most misunderstood mental health conditions. Often, it’s represented as someone who incessantly cleans or needs everything to be organized. However, OCD is really about intrusive thoughts and compulsive actions to relieve these thoughts. ¹

With that said, several OCD subtypes revolve around these symptoms. Existential OCD is one of the most unique and least discussed.

Simply put, existential OCD is when someone has intrusive thoughts surrounding questions that are impossible to answer. In turn, they’ll act out in manners that hope to relieve these thoughts.

Existential OCD Defined

While OCD is defined by intrusive thoughts and compulsive behaviors, its subtypes are defined by how these thoughts and behaviors play out.

When it comes to existential OCD (sometimes referred to as “philosophical OCD”), a person will have intrusive thoughts about questions that cannot be answered. These may include questions such as:

• What is the purpose of my life?
• Does God really exist?
• Is there a life after death?
• What happens when I die?

It’s natural for everyone to have these thoughts from time to time. However, people with existential OCD will find these thoughts all-consuming. They may spend hours at a time contemplating these questions.

Due to the weight of these thoughts, existential OCD often leads to other mental disorders, such as anxiety and depression.

The compulsions these thoughts produce vary from person to person. However, it’s common for a person to spend hours trying to find reassurance in these thoughts. This may involve research, reflecting on past experiences, or talking about it with others.

Since many of these questions are unanswerable, people with existential OCD are often left doubtful or unfilled. This may lead them to seek out new philosophical ideas.

Existential OCD Examples

To paint a picture of the intrusive thoughts someone with philosophical OCD may have, here are a few examples of continuing thoughts:

• “What if this isn’t really reality? Would I even know if I were in reality? How would I know? What if my entire existence is a part of a simulation and nothing around me is real? If this isn’t reality, should anything I do matter? What’s the point of my life if this isn’t reality?”

• “What if I was the only person to really exist? And everyone around me was simply a product of my perception? Is there any way they can prove they actually exist? Can I know anything beyond my own life experience?”

• “Does life really have meaning? Or was it all an accident? Do humans and other living beings have any purpose? Or do we just live briefly and go away when we die?”

As you can see, each thought carries into one another. The question, “Does life really have any meaning?” is followed by another question, “Or was it all an accident?” Since these questions cannot be answered, they’re only followed by more and more questions.

Causes

Researchers still aren’t sure what causes OCD, never mind its subtypes. Some have theorized existential OCD may be caused by the natural human fear of death. Simply put, since we have no way of knowing what happens after death, many feel a sense of dread and anxiety when questioning it.

While this is likely one of the causes, it’s just as certain other risk factors of OCD also play a role, including:

• Brain Function – Since the 1980s, it’s been clear that OCD is caused by abnormal activity in specific regions of the brain. ²

• Environment – Certain factors of your environment play a significant role in whether or not you develop OCD. Most notably, those with childhood traumas are more likely to develop OCD. ³

• Genetics – If a close family member (i.e. parent or sibling) struggles with OCD, you’re more likely to develop it yourself. ⁴

While none of these causes have been researched for existential OCD specifically, it can be assumed that these causes along with fears of death lead to the condition.

Misdiagnosis

Since everyone has existential thoughts, people with philosophical OCD likely won’t seek out treatment right away. This is because their behavior doesn’t appear out of the ordinary.

However, if these thoughts continue in a manner that inhibits daily life, finding the right treatment is essential.

Still, it can be difficult to even receive a diagnosis. ⁵ When discussing your existential OCD symptoms, chances are a doctor will confuse them for another mental health condition. One of the most common is depression as people with it often have similar questions.

Another common misdiagnosis is a type of anxiety disorder (usually, generalized anxiety disorder). Since you question life and death so much, a doctor may assume you simply have fears surrounding the answers to these questions.

Existential OCD is one of the most misdiagnosed forms of obsessive-compulsive disorder. For this reason, it may be worth consulting your doctor about the topic and whether or not you can be tested for the condition.

Treatment

As mentioned, all forms of OCD involve intrusive thoughts and compulsive behaviors. The only difference is the nature of the thoughts and actions. Therefore, treatment for existential OCD is largely the same as other forms of OCD.

Traditional treatment usually involves both medication and therapy. However, holistic treatments for OCD have also garnered popularity in recent years.

Regardless, there is no one-size-fits-all approach to treating existential OCD. Therefore, you’ll likely have to experiment with different medications and therapies before finding what’s right for you.

In terms of therapy, the most popular for OCD include:

• Cognitive Behavioral Therapy (CBT) – A form of treatment where a therapist will identify intrusive thoughts, where they come from, and how you can work to overcome them. ⁶

• Exposure and Response Prevention (ERP) Therapy – A form of treatment where you expose yourself to thoughts, objects, images, and situations that cause obsessive thoughts to identify how to overcome them. ⁷

In terms of medication, the U.S. Food and Drug Administration (FDA) has approved antidepressants for the treatment of OCD.

Final Word

Just like other forms of OCD, it’s important not to let existential OCD get out of hand. By intercepting symptoms with treatment, you’re much more likely to overcome this condition and move on with your life.

Still, as mentioned, it’s difficult to find the right treatment path for you. Beyond the fact that existential OCD is often misdiagnosed, there is no single cure for OCD in general. Therefore, you’ll likely need to experiment with different medications, therapies, and lifestyle changes before finding the best option.

FAQs

References

¹ Brock H, Rizvi A, Hany M. Obsessive-Compulsive Disorder. 2024 Feb 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 31985955.

² Jalal B, Chamberlain SR, Sahakian BJ. Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction. Brain Behav. 2023 Jun;13(6):e3000. doi: 10.1002/brb3.3000. Epub 2023 May 3. PMID: 37137502; PMCID: PMC10275553.

³ Dykshoorn KL. Trauma-related obsessive-compulsive disorder: a review. Health Psychol Behav Med. 2014 Jan 1;2(1):517-528. doi: 10.1080/21642850.2014.905207. Epub 2014 Apr 23. PMID: 25750799; PMCID: PMC4346088.

⁴ Pauls DL. The genetics of obsessive-compulsive disorder: a review. Dialogues Clin Neurosci. 2010;12(2):149-63. doi: 10.31887/DCNS.2010.12.2/dpauls. PMID: 20623920; PMCID: PMC3181951.

⁵ Raveendranathan D, Shiva L, Sharma E, Venkatasubramanian G, Rao MG, Varambally S, Gangadhar BN. Obsessive compulsive disorder masquerading as psychosis. Indian J Psychol Med. 2012 Apr;34(2):179-80. doi: 10.4103/0253-7176.101800. PMID: 23162197; PMCID: PMC3498784.

⁶ Foa EB. Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues Clin Neurosci. 2010;12(2):199-207. doi: 10.31887/DCNS.2010.12.2/efoa. PMID: 20623924; PMCID: PMC3181959.

⁷ Hezel DM, Simpson HB. Exposure and response prevention for obsessive-compulsive disorder: A review and new directions. Indian J Psychiatry. 2019 Jan;61(Suppl 1):S85-S92. doi: 10.4103/psychiatry.IndianJPsychiatry_516_18. PMID: 30745681; PMCID: PMC6343408.

⁸ Pittenger C, Bloch MH. Pharmacological treatment of obsessive-compulsive disorder. Psychiatr Clin North Am. 2014 Sep;37(3):375-91. doi: 10.1016/j.psc.2014.05.006. Epub 2014 Jul 24. PMID: 25150568; PMCID: PMC4143776.