 Existential OCD: When Your Brain Won't Stop Asking "Why?"Written by: Kat Harris, PhD, LCPMost people are familiar with the more commonly depicted presentations of Obsessive Compulsive Disorder (OCD) — hand washing, checking locks, needing things to be symmetrical or "just right." What is far less talked about, and often misunderstood, is a presentation of OCD that targets some of the biggest questions humans have ever grappled with: Why am I here? Does any of this matter? Is any of this even real? This is Existential OCD.
What is Existential OCD? Existential OCD involves intrusive, repetitive, and distressing obsessions centered on philosophical questions about existence, reality, meaning, and purpose. Obsessions can also involve obsessions about one's own existence. The questions that are posed are inherently unanswerable with certainty. Common obsessions include thoughts such as:
It is important to note that these questions are not unique to people with OCD. Most humans have pondered existential questions at some point in their lives. The difference is that individuals without OCD are generally able to sit with the uncertainty these questions produce, shrug, and move on. For individuals with Existential OCD, these thoughts and doubts become stuck. They are intrusive, unrelenting, and produce significant distress and anxiety. The person feels compelled to figure out the answer, even though, by the very nature of existential questions, no definitive answer exists. They search for certainty and answers that never come. How is Existential OCD Different from Normal Philosophical Thinking or Depression? This is an important distinction, and one that is often missed. Existential OCD can be confused with: General philosophical curiosity: Many people enjoy contemplating the big questions of life. The key difference is that philosophical curiosity is generally experienced as interesting or stimulating, while Existential OCD is experienced as distressing, intrusive, and impossible to turn off. Philosophical curiosity may temporarily elicit some anxiety or dread, but people without OCD can tolerate that discomfort and move on. In addition, if someone with philosophical curiosity is engaging in thought exploration, they can be interrupted or stop without significant distress. Depression: Individuals experiencing depression may also ruminate on themes of meaninglessness and hopelessness. However, in depression, these thoughts tend to be mood-congruent and tied to a generally negative emotional state. In Existential OCD, the thoughts are ego-dystonic, meaning they feel intrusive and inconsistent with how the individual wants to be thinking. The distress comes from having the thought, not from a pervasive low mood. Generalized Anxiety Disorder (GAD): Because of the worry-like quality of existential obsessions, Existential OCD is sometimes misunderstood to be GAD. However, there are some important distinguishing features. With OCD presentations, the thoughts themselves often triggers distress, which drives compulsive, repetitive, or ritualistic behavior aimed at reducing the distress or obtaining certainty. In GAD, the worry themes tend to center around worries that most people have such as finances, health, or concern for the safety of loved ones. In OCD, the themes tend to focus on highly specific content that the individual finds intrusive, unacceptable, or deeply threatening; content that often feels inconsistent with who they are and what they value. Additionally, in GAD, worry is typically experienced as an attempt to problem-solve or prepare, whereas in OCD, the obsessive thought feels uncontrollable and is followed by a compulsive urge to neutralize, undo, or resolve the distress. The OCD Cycle in Existential OCD Like all presentations of OCD, Existential OCD operates within a well-established cycle. An intrusive existential thought triggers significant anxiety and distress. The individual then engages in compulsions in an attempt to neutralize the thought, reduce the distress, or obtain a sense of certainty. These compulsions may include:
Unfortunately, as is the case with all OCD compulsions, these behaviors provide only temporary relief. Over time, they actually reinforce the cycle, teaching the brain that the thought is dangerous and must be dealt with, which makes the thoughts more frequent and more distressing. Why is Existential OCD Particularly Challenging? One of the things that makes Existential OCD especially difficult is the nature of the obsessions themselves. Existential questions are, by definition, unanswerable with certainty. There is no fact, study, or expert that can provide the 100% certainty OCD demands. This makes the compulsive drive to "figure it out" an endless urgent loop. Every answer generates a new doubt. Every reassurance eventually wears off. This is a hallmark feature of OCD that I discuss in my blog on Thinking Errors in OCD; specifically, Intolerance of Uncertainty. OCD demands certainty that simply does not exist, and existential questions are perhaps the most unanswerable questions humans have ever asked. Treatment for Existential OCD The good news is that Existential OCD responds to the same gold-standard treatment as all other presentations of OCD: Exposure and Response Prevention (ERP), a form of Cognitive Behavioral Therapy (CBT). In ERP, the goal is not to find the answer to the existential question. It is to build tolerance for the uncertainty and distress that the question produces, and to break the compulsive cycle that is maintaining the OCD. This involves: Exposures: deliberately and gradually confronting the existential thoughts, rather than avoiding or neutralizing them. This might include reading or listening to content that triggers the existential thoughts, writing out the feared thoughts, or deliberately sitting with the uncertainty without engaging in compulsive responses. Response Prevention: resisting the urge to mentally review, research, seek reassurance, or otherwise compulse in response to the obsession. ACT components: Acceptance and Commitment Therapy (ACT) can be a particularly useful complement to ERP for Existential OCD. ACT encourages individuals to accept the presence of uncertainty and uncomfortable thoughts without needing to resolve them, and to move toward a valued life even in the face of unanswered questions. The goal of treatment is not to convince the individual that life has meaning, or to answer the unanswerable. It is to help the individual develop a different relationship with the uncertainty itself. To be able to have the thought, feel the discomfort, and choose not to engage with it compulsively. You Do Not Have to Suffer If you find yourself spending significant time each day consumed by existential questions, if these thoughts feel intrusive and distressing rather than intellectually stimulating, and if you notice yourself engaging in mental reviewing, reassurance seeking, or avoidance in response to them, it may be worth speaking with a clinician who specializes in OCD. If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond. References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Penzel, F. (2013). To be or not to be, that is the obsession: Existential and philosophical OCD. International OCD Foundation. https://iocdf.org/expert-opinions/to-be-or-not-to-be-that-is-the-obsession-existential-and-philosophical-ocd/ Comments are closed.
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