What Exactly Is Existential OCD

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 06/27/2022

When we hear the term OCD, we picture somebody that is excessive about cleanliness. We imagine behavior that is neurotic, among other external effects – never thinking in internal terms.

However, existential obsessive-compulsive disorder is a far more complicated issue, just as common as it is misunderstood. It is also thoroughly disabling; despite afflicting over 2 percent of the adult population, there is no set pathology or sure shot cure as with many disorders.

External symptoms of OCD, like some behaviors, are easily observable and can aid in diagnosis. Internal symptoms of OCD like thoughts are harder to recognize without a person explaining their thoughts to a mental health professional.

With existential fear or OCD, in particular, patients report thoughts that will come with questions that have hard answers.

When Should You Seek Professional Help?

The questions posited by thoughts associated with OCD may include the purpose of life, the meaning of life, the reason behind all existence, the separation of the real from what may be imagined, or ideas and apprehensions related to an alternate version of reality. In fact, it’s quite natural for all of us to engage in a deeply philosophical debate from time to time. Still, when the quest for an answer begins to affect the quality of life, disrupting a normal, healthy routine, one should realize there is a problem.

Another troublesome sign is the presence of fear or anxiety through the process of thinking. While dealing with these intrusive thoughts, the patient may have to develop ablutions or processes to deal with the anxiety and work around these questions. Hours upon hours may be spent in driving this internal discussion.

The challenge posited by these questions can severely engage the patient in finding answers and finding themselves trapped in worry and anxiety. The lack of control over thoughts and the involuntary nature of the thinking process is another characteristic. Counselors often refer to this involuntary aspect as the “mind having a mind of its own.”  Now you may appreciate how existential OCD stands out.

Obsessiveness and Compulsiveness Explained

The obsessive part relates to the thinking process and the stimulus. The uncontrollable nature of these obsessions, making the patient think about the abstract realities of existence, eventually drives them to compulsions.

Compulsions are activities, habits, or routines that a patient picks up to deal with their anxiety. For example, a patient may find themselves willingly consuming caffeine later in the evening to trigger and nurture their thought processes, or they may look forward to a session of thoughtfulness once they arrive home after work. They may convince themselves that it’s going to be a small, controlled session, only to find themselves enamored in the various facets of the thought process. Eventually, the patient finds themselves trapped in an obsessive-compulsive cycle. Thought after intrusive thought starts to float into their consciousness, and the patient finds themselves more than willing to engage in each one.

Most people do not realize that the more indulgent their obsession, the greater and the stronger their compulsion will be. Sometimes patients relate to it as being a monster that must be fed within. The whole process of affliction is this process of feeding this monster by giving it attention internally. But the idea here is to not let the symptoms take hold. The more symptomatic it gets, the stronger it is to tackle.

The pleasure and relief that comes out of compulsions are also reported to be short-lived in general. So, having existential fear or OCD is very similar to always having anxiety.

Of course, the ideal situation is for the patient to realize that the thoughts are trivial, nonsensical, or meaningless to the point that they should not be engaged. While some people would go into these thoughts with this understanding, a patient with existential OCD must go deep down within themselves to realize this truth. On the other hand, they will engage with these thoughts and get caught up in them. Even though they know that these thoughts are a mirage, there is always the element of doubt in their minds. The central idea of OCD is that of “what if” - the doubt that rules over and above all other signals, emotions, and memories. Then the requirement for complete certainty will force the patient into a repeat pattern. Uncertainty does not get a chance.

Existential OCD Obsessions

Obsession refers to the type of thoughts that cause a patient to worry excessively. The nature of this thought just depends on the individual. Existential OCD is notorious for causing a patient to worry just about anything. Even in a single patient, the origin and the thought constitution vary greatly from time to time. Still, there are some often-repeated themes of obsessions. These may include:

  • The patient pondering over the meaning of life, with repetitive, intrusive thoughts that lead them to believe that life is pointless
  • Worrying over the precise purpose of being alive and being disappointed in discovering that their life does not have one
  • Getting mixed up in reality and the abstract nature of the surroundings.
  • Patients have reported being afraid of actually being dead and not knowing. Likewise, they may assume that they are dreaming or are comatose while being fully conscious, engaging in such obsessive thoughts
  • The theme of questioning realness continues in relationships as well. Patients wonder if they truly are in love with a family member.

Commonly Experienced Compulsions in Existential OCD Or Philosophical OCD

Whereas obsessions are understood as thoughts that result in anxiety, compulsions are simply behaviors that patients engage in to manage their anxiety. A patient will experience relief, as fleeting as that may be, but that is usually enough for continuing with the cycle. Cognition doesn’t get a chance.

The fact is that all manner of healthy adults will engage in some kind of compulsive behavior (for example, existential thought), although tepid. But you know you have a problem at hand when compulsions take on a large profile, actually impacting your life and interfering with your lifestyle. Some of the most common forms of compulsions include:

  • Wanting validation and asking peers, neighbors, friends, or coworkers for answers to the same abstract questions on life, meaning, etc.
  • Finding oneself analyzing your feelings on a repetitive basis
  • Being fixated on the matters of the universe, spending lots of time and resources in pursuing this learning through textbooks and documentaries
  • The subject of philosophy holds a special meaning, and there is repetitive learning behavior over topics of interest
  • Communicating within the spiritual realm, or with their divine, seeking guidance and a sense of deeper purpose than anthropologically or humanely possible
  • Not believing in the absolute reality of even ordinary things in life and, as a result, begin experimenting to get over that doubt by pinching one’s skin to feel pain, asking people around them for validation, etc.
  • Engaging in other behaviors in ascertaining that you are indeed living in the real world, that you are not dead, or that you’re not experiencing an alternate version of reality

Reasons Behind Existential OCD

As with many other disorders, science and research still do not have concrete answers. What we do know, though, is that existential doubt/OCD brains function differently than normal brains. We also know that patients suffering from OCD cannot deploy the communication function within the orbitofrontal cortex, the striatum, the thalamus, etc. Research has also shown misfiring neurotransmitters in their brains. OCD patients are found to be low in both serotonin and dopamine. On the other hand, the neurotransmitter glutamate is found to be in excess. Sometimes this is a direct result of a genetic predisposition.


A section of researchers advocates for treatment on the level of neurotransmitters. The most recommended form of therapy includes cognitive and behavioral therapy, acceptance and commitment therapy, and, importantly, exposure and response prevention therapy. That’s pretty standard for most disorders. However, OCD is also helped with mindfulness techniques.

Coping with Existential OCD

The first step in coping with existential OCD is acknowledging that it is an issue that needs to be addressed. Once an individual can come to terms with this, they can get the help and support they need with a licensed counselor or therapist's help. If you think that you may have this form of OCD, we have put together a testing resource that is entirely free here. The test will allow you to assess your mental health and understand your OCD symptoms more deeply. This can help you take the first steps towards coping with OCD compulsions.