Kristen Taylor-Ladd, MA, LMFT, of the OCD Center of Los Angeles discusses the common existential OCD, discussing its presentation, common existential thoughts, and treatment overview.

What is Existential OCD?

Existential OCD is a common but less recognized theme of OCD. This theme centers around unanswerable, philosophical questions often focused on topics such as perspective, meaning, life, death, purpose, and reality itself. While it’s natural for anyone to be curious about these big topics, those with Existential OCD may find themselves caught in an endless loop of uncertainty and analysis that becomes all-consuming, with the focus of trying to solve these questions to alleviate the discomfort caused from the unknown.

Existential OCD is often considered a part of a subtype called “Pure O” which stands for Purely Obsessional OCD. “Pure O” can be a little misleading because while externally it may look like someone is experiencing only obsessions or intrusive thoughts, there are also compulsions happening, they’re just mental as opposed to physical.

Common Obsessions

In Existential OCD, the obsessions oftentimes revolve around big-picture, unanswerable questions. Some examples of these thoughts could be:

“What if none of this is real?”

“How can I ever know if my life has meaning?”

“What is my/our purpose for existing?”

“How do I know if my body and/or perspective is real?”

“What if I’m not real?”

“Who am I?”

“What if nothing we do actually matters?”

Because these questions have no concrete or definitive answer, any attempt to find a solution will only lead to additional anxiety and mental looping, which can feel quite exhausting. The classic OCD cycle applies with Existential OCD as well, but the topics can feel even harder to grasp.

Common Compulsions

There are many ways Existential OCD can show up in day-to-day life. As mentioned above, oftentimes the compulsions for Existential OCD are mental, not physical. Some examples of mental compulsions could be:

– Mental Review: Repetitive thinking in the form of re-examining conversations, events, etc., to get a sense of certainty and resolve the unknown.

Ex: Mentally replaying a philosophical talk you watched in an attempt to find or remember an answer you could have missed.

– Mental Checking: Checking to see if a certain existential thought still bothers you (nine times out of ten, it still will, and you will have retriggered yourself and initiated rumination all over again).

Ex: Noticing you haven’t thought about the question of life’s purpose in a while, bring the thought to mind, your anxiety spikes, and you begin trying to solve the question all over again.

– Reassurance Seeking: Asking others what they believe about your existential questions to seek a sense of certainty or normalize your experience.

Ex: Asking your friends or family what they think happens after we die, or turning to Google/Reddit/ChatGPT to seek answers.

– Avoidance: Avoiding any triggers that may be associated with the nature of the existential thoughts.

Ex: Avoiding movies like Inception or philosophical books that could bring reality or perception into question.

With Existential OCD, people can sometimes confuse the intrusive thoughts with genuine curiosity. A key point to look for is the intention behind your exploration; does it bring you open-minded enjoyment to engage in philosophical texts and conversations on these topics, or do you feel a sense of urgency or distress due to the uncertainty, and you are hoping to find answers to assuage your discomfort of the unknown.

How Existential OCD is Treated

Like all subtypes of OCD, Existential OCD is often treated with and responds well to Exposure and Response Prevention (ERP). ERP is a form of Cognitive Behavioral Therapy (CBT) that helps you face your fears head-on and learn to cope with the discomfort those fears may bring. For Existential OCD, this could look like intentionally reading an article about the universe and sitting with the discomfort that comes from the lack of answers, or writing an imaginal about the idea of having no purpose in life.

Acceptance and Commitment Therapy (ACT) is another great therapeutic modality for Existential OCD. ACT leans into aligning with values even in the presence of uncertainty. Instead of desperately hunting for answers, through ACT we can learn to shift our focus towards what brings joy and happiness into our lives – I like to call this value-based living.

Additionally, incorporating mindfulness work can be very effective and helpful for managing the discomfort that comes with OCD and anxiety. Mindfulness can help us recognize our intrusive thoughts without over-attending to them; a thought can be observed and acknowledged as just a thought, not a problem we need to solve.

Existential OCD can feel very overwhelming but like any theme of OCD, it is absolutely manageable with effective tools and support! We don’t need to resolve life’s greatest mysteries in order to enjoy and live a fulfilling life, we just need to learn to accept and adapt to the presence of uncertainty. Choosing value-based living empowers you to move forward even in the face of the unknown.

•Kristen Taylor-Ladd, MA, LMFT, is a psychotherapist at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions.  In addition to individual therapy, the center offers nine weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.