As a teenager, I remember wrecking my head with the size of the universe, the meaning of infinity, and death. Even though these questions melted my brain, they did not cause significant distress and affect my life; in the same way, someone with OCD experiences these thoughts as they become obsessive.
A few years ago, a 27-year-old graphic designer, Anna, came to see me for psychological therapy as her life was severely affected by the thoughts in her head.
While Anna had always been a reflective person, lately, she was consumed by doubts about her existence, the nature of reality, and the significance of her actions.
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Here are a few examples of the type of thoughts that Anna disclosed during the assessment:
Fear of Meaninglessness: She experiences intense anxiety when contemplating the possibility that life may have no inherent meaning. She felt overwhelmed by existential questions, constantly wondering if her actions were significant or if life was futile.
Intrusive Thoughts about Reality: Anna frequently experiences intrusive thoughts questioning the nature of reality. She becomes preoccupied with the idea that everything around her, including people and objects, may not be real and could be a creation of her mind.
Reassurance-Seeking Behaviors: She engages in excessive reassurance-seeking behaviours to alleviate her anxiety. She constantly seeks validation from others, asking friends and family for reassurance that life has meaning or that the world is real. She also spends hours reading philosophy books and searching online for answers, desperately seeking concrete explanations.
Anna was diagnosed with OCD due to the obsessive nature of her thoughts and feeling compelled to do things to ease the anxiety her thoughts created; specifically, she was experiencing existential OCD.
What is existential OCD?
Existential OCD is an obsessive-compulsive disorder where you obsess about the philosophical aspects of existence – questions about the meaning of your life. IOCDF notes that they are questions that cannot be answered.
Symptoms and signs of existential OCD
Obsessions About Death and Ending
The obsessions about death and ending associated with existential OCD are typically centred around questions which have no answer, such as the meaning and purpose of life, the inevitability of death, the nature of reality and the difference between right and wrong.
Thoughts That Life Is Meaningless
The obsessions in this type of OCD can include “What is the meaning of life?”, and”Why do I exist?”
Additionally, there may be fears of the afterlife, doubts over the world’s reality, and worries that one’s life is pointless.
Other signs of existential OCD may include obsessive questions about the nature of reality, such as, “Am I real?” and “Are you real?”, as well as doubts about one’s own identity, such as, “Is this conversation that we are having real?”, “How do I know that I am really me?” and “What if all of this is happening in my dream?”.
Fear of Going Crazy or Being Crazy
The fear of going crazy or being crazy is a common fear associated with existential OCD. This fear can arise from not knowing the answers to life’s big questions, such as death and life after death, and the existential angst of this unknown. Thinking about the unknown and contemplating questions without answers can be unnerving.
How is Existential OCD different from other types of OCD?
Existential OCD differs from other subtypes in its obsessions and compulsions are centred around deep existential questions about life and the meaning of existence rather than a fear of specific, concrete objects or situations.
People with Existential OCD are often consumed by these thoughts, feeling a compulsive need to search for answers and certainty.
Example obsessions in Existential OCD
What if my life has been a simulation and no one is real? What if I live in a virtual world without purpose or destiny? What if my life is meaningless, and all the things I’ve worked for and accomplished aren’t part of the real world?
What if everything is meaningless? This is certainly the type of question I struggled with during my teenage years, where you search for answers to difficult questions such as, “What is the meaning of life?” or “What is my purpose?”.
What happens after death?
Death is one of life’s greatest mysteries and fears many of us grapple with. For those with existential OCD, this fear can become an obsessive preoccupation. Questions like “What happens after death?” can become difficult to answer, leading to further rumination.
No matter how much we may search for the answer, the truth is that nobody knows for sure what happens after we die. As a result, it’s essential to focus on living a meaningful and fulfilling life, accepting that death is an inevitable part of life.
What about an existential crisis?
An existential crisis and existential OCD can appear similar to the untrained eye. Both involve fears and doubts about life and death that can lead to a person questioning their existence, meaning and why they are here. The main difference is that a stressful or traumatic life event usually brings on an existential crisis and doesn’t usually last as long. Also, those experiencing an existential crisis do not often engage in compulsive behaviours to relieve their uncertainty, whereas people with existential OCD do.
What types of talking therapy help?
Mindfulness can play an essential role in the treatment of Existential OCD. It is used as a calming strategy to help individuals become aware of their emotional reactions without passing judgment. Through this practice, individuals can learn to accept passing thoughts and “ride the wave” of emotions that come with them rather than engaging in compulsive behaviour.
Additionally, mindfulness can help individuals manage intrusive thoughts and build resilience by allowing them to feel the anxiety or dread of life-and-death questions without engaging in compulsive behaviours. As such, mindfulness can be used with Exposure and Response Prevention (ERP) to face triggers and manage intrusive thoughts without giving in to compulsions.
Exposure response prevention; ERP
ERP is an essential component of the treatment of Existential OCD. This intervention involves actively resisting compulsive behaviours associated with intrusive thoughts and obsessions. For example, someone with existential OCD may seek reassurance from others or the internet to mitigate their distress. However, research has found that these behaviours strengthen the urge to perform compulsions. Therefore, response prevention encourages the individual to practice instead of tolerating the anxiety and doubt they experience when they have an intrusive thought. This helps to reduce the symptoms of existential OCD over time.
If you are ready to start therapeutically, you can learn how to do ERP here.