What is existential OCD?

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In this blog we will discuss what existential OCD is. 

We will also explore what are the symptoms of Existential OCD, causes, and treatment options available for existential OCD. 

What is existential OCD?

According to the International OCD foundation,

Existential OCD is a type of OCD that is characterized by 

“…intrusive, repetitive thinking about questions which cannot possibly be answered, and which may be philosophical or frightening in nature, or both.”

The definition also expands to include that these interview questions are related to the meaning, Purpose, and reality of life, as well as the existence of the universe and the self. 

Simply put, Existential OCD refers to a manifestation of OCD that is characterized by intrusive thoughts related to existence, life, purpose, meaning; and compulsive behaviors in an attempt to appease the anxiety related to these intrusive thoughts leading to dysfunctioning in one’s life. 

Existential OCD is considered a manifestation of Obsessive Compulsive Disorder. Obsessive-compulsive disorder (OCD) is a diagnosable psychological disorder where people who have been affected have recurring, unwanted thoughts, ideas or sensations (obsessions) that make them feel driven to do something repetitively (compulsions). 

The thoughts and behaviors that are symptoms of OCD often disrupt their day to day life especially because for people with OCD these behaviors are rigid and these thoughts permanent- so that means they cannot focus on or do anything else.

People with OCD often realize that their thoughts are not realistic however, there are many people who without treatment do not have this insight. Irrespective of their level of sight people with thai disorder have difficulty not engaging in these thoughts and these behaviors. 

These patterns of thoughts and behaviors often cost them their time and their life in general- more than one hour a day is the diagnostic criteria, it also causes distress, inability to work and meet the demands of their day to day life. 

Other symptoms and manifestations of this disorder include:

  • Checking behaviors such as locks, or light switches, or even thinking you have a health complication. 
  • Fear of contamination is another issue that people face.
  • There is need for symmetry and ordering 
  • People also experience intense bouts of rumination and intrusive thoughts- some of these thoughts can also be violent and disturbing. 

Most of the intrusive thoughts and questions are very philosophical and might seem like questions that people often ask at one point in their lives. However for people with existential OCD they are unable to move on with their lives. 

They become obsessed with these questions and often, their behaviors are influenced by these questions that bring about much anxiety. It can even take control over their lives to the point that they are unable to focus on their work, their family, and other important aspects of their own lives- like self care, health, and diet etc.

People with existential OCD might spend hours of their day going over these questions and their ideas and often engage in behaviors related to these questions like- spending hours reading about these topics. 

They may become extremely anxious and their worries and fears might lead to a sense of hopelessness and meaninglessness that can lead to depression. 

Due to how anxiety provoking their intrusive thoughts are, people are often misdiagnosed with anxiety disorders like general anxiety disorder based on their persistent worry about almost everything and anything. 

What are the symptoms of Existential OCD?

Existential OCD, like other manifestations of OCD, manifests in the form of various symptoms. These symptoms include:

Intrusive Thoughts and Uncertainty

Like any other manifestations of OCD, Existential OCD is also characterized by intrusive thoughts that cannot be controlled and that cause extreme anxiety and worry. 

The thoughts are marked by themes of existentialism, and often are in the form of questions. The questions are usually the kind that cannot be answered with certainty which is what causes so much anxiety, doubt and worry. 

According to Choosing Therapy, common existential OCD obsessions include:

  • What is the meaning of life?
  • Why do I exist?
  • Do I exist at all?
  • Does my existence matter?
  • What happens after I die?
  • If only I was smart enough, I could figure it out
  • There must be an answer if I only look hard enough and in the right places
  • What is real?
  • What is reality?
  • How do I know what I perceive is right?
  • We will all die, so what is the point of anything?
  • Will how I lived my life have some influence on my afterlife?
  • How do I know who I am?
  • Is my life already mapped out or do I have free will?
  • Am I being controlled by some force without my will?
  • What if there is no point to my life?
  • Compared to the vast universe, are we all just insignificant meaningless little specks of matter? (ChoosingTherapy)


The intrusive thoughts and the anxiety they cause, individuals with existential compulsions are driven to act on them or act so as to answer their questions. 

These questions cannot be truly answered with certainty that it leads to more anxiety and hence leading them to behave more compulsively.

According to Choosing Therapy, some common compulsions that people with existential OCD perform include:

  • trying to mentally “figure out” answers to their obsessions
  • asking others for reassurance
  • replaying past experiences in their mind to look for hints about whether or not they are real
  • testing out whether or not things or people are real (e.g., looking for a reflection in a mirror to prove existence)
  • reading philosophy books or taking classes to try to find the “truth.”
  • Excessive research into the content of the particular obsession
  • Excessive reading philosophy books for answers and getting too many opinions that cause confusion and more questions
  • Repeatedly asking others their thoughts and opinions as a way to seek more clarity or insights
  • Constantly analyzing obsessions with the same thoughts and questions
  • Religion “hopping” – attending various religious services or compulsive reading of religious texts
  • Excessive internet searches to find answers to unanswerable questions that have no end point
  • Mental reviewing of events that occurred that day to verify that they actually happened
  • Mental reviewing the events of the day and trying to see if they felt real
  • Dominating conversations about existential ideas
  • Trouble letting go or moving on to topics others raise
  • Overthinking to the point of derealization
  • Meta-thinking (thinking about thinking)
  • Reading and re-reading to try to understand material about metaphysics (Choosing Therapy)

These compulsions often take most of their hours in a day and can get in the way of their responsibilities such as their work, parenting, and their role as a friend or spouse. 

These compulsions tend to impact their relationships as well as their well-being as they might disregard their own health.

Derealization and Related Anxiety Problems

Another interesting symptom of Existential OCD is that they can at times feel like they are not real, or that others are not real which is referred to as Derealization; a symptom of many psychological disorders. 

This symptom can often cause individuals to act on compulsive behaviors like checking if people around them are real or checking if things around them are real by taking photos or looking at mirrors etc. 

They might also experience a sense of detachment from their own body known as depersonalisation that is commonly associated with derealisation and these are both perceptual disturbances.

Their experiences of depersonalisation and derealisation are often themed with the questions of reality and existence which is what pushes them to behave compulsively as a reaction to these symptoms. 

What are the Causes of Existential OCD?

There is no single answer as to what causes OCD or External OCD. However, researchers have noted that OCD could be a manifestation of evolutionary instincts of survival- to control what we don’t know about what we cannot control. 

Other researchers believe that OCD is caused by traumatic events- like loss and abuse- that have occurred which lead them to experience a sense of loss of control which causes them to be hypervigilant about everything else. 

Scientific data also stresses that OCD could be a result of Genetics and family history as well as differences in brain structure that could be causing the symptoms. 

What are the treatment options available for Existential OCD?

When we consider the treatment options of existential OCD, it is likely that the treatments of other forms of OCD could be applied. Treatment options include:

Exposure and Response Prevention therapy

This is considered the gold standard for OCD treatment and is a type of cognitive behavioral therapy (CBT) where the clients are made to entertain uncomfortable thoughts but refrain from engaging in compulsions.

The goal of this therapy is to expose the individual to their fears and worries and other intrusive thoughts to develop a tolerance toward them by refraining from behaving compulsively. 

This process often grows intensively and clients tend to receive homeworks as well as gradual exposure to their feared stimuli. 

Mindfulness-based Cognitive Behavioral Therapy.

In terms of Cognitive behavioral therapies your therapist will teach you how to regulate your negative and irrational thoughts when you come across triggers. 

As you engage in therapy you will start learning to alter your thoughts, develop an awareness of how you feel, and as a consequence the way you react in situations where you are faced with a real or imagined trigger. 

Mindfulness-Based Stress Reduction (MBSR) for Scelerophobia

MBSR is an evidence-based program that involves mindfulness training to help people who are suffering from anxiety and other mental health issues. 

MBSR could be helpful in helping individuals deal with intrusive thoughts and compulsive behaviors as it has been found to be effective in tackling anxiety issues in most cases. 

The program involves teaching and training individuals to develop skills to cope with the anxiety or to reduce the intensity of the anxiety. 

Pharmacological treatment

If your anxiety is extremely severe your doctor may prescribe you antidepressants or an anti-anxiety medication to assist your phobia treatment, your panic, and other physical symptoms.


In this blog we have discussed what existential OCD is. 

We have also explored what are the symptoms of Existential OCD, causes, and treatment options available for existential OCD. 


Penzel.F. To Be Or Not To Be, That Is The Obsession: Existential and Philosophical OCD. International OCD Foundation. Retrieved on 9th March 2022.  https://iocdf.org/expert-opinions/to-be-or-not-to-be-that-is-the-obsession-existential-and-philosophical-ocd/#:~:text=Existential%20OCD%20 involves%20 intrusive%2C%20 repetitive,or%20even%20one’s%20own%20existence.

Valentine.K.What is Existential OCD and How Do I Treat It? NOCD. Retrieved on 9th March 2022. https://www.treatmyocd.com/blog/what-is-existential-ocd-and-how-do-i-treat-it

Arocho.J. Existential OCD: When Life’s Big Questions Plague You. ManhattanCBT. Retrieved on 9th March 2022. https://www.manhattancbt.com/existential-ocd/

Living with Existential OCD. Made Of Millions. Retrieved on 9th March 2022. https://www.madeofmillions.com/ocd/existential-ocd

Shapiro & Fuller. Existential OCD: Obsessions, Compulsions, & Treatments. ChoosingTherapy. Retrieved on 9th March 2022. https://www.choosingtherapy.com/existential-ocd/

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