What is existential OCD?

Existential OCD is a form of obsessive-compulsive disorder (OCD) in which intrusive thoughts about existence, death, or the meaning of life become distressing and hard to control. Some people also call this “afterlife OCD” when the obsessions focus on what happens after death. Instead of feeling like normal curiosity, these questions can trigger intense anxiety and a constant need for certainty.

Many people wonder about big questions like, “What happens after you die?” or “What is the point of life?” At times, this kind of thinking can be normal. But for people with existential OCD, these thoughts can become all-consuming. They may spend hours trying to find the “right” answer or feel certain. This cycle of obsessions and compulsions is a hallmark of OCD, and effective treatments are available.

What is existential OCD?

When most people think of someone with OCD, they typically picture a person who is hyper organized or obsessed with cleanliness. While there can be some truth to that characterization, OCD can take many forms.

For example, some people with OCD have intrusive thoughts (obsessions) about getting sick. They worry constantly about becoming ill, and this negatively impacts their mental health and quality of life. In turn, they engage in repeated behaviors (compulsions) in an attempt to rid themselves of their obsessions. This could mean cleaning the surfaces in their home several times per day. Or it could mean refusing to go outside due to a fear of germs.

Existential OCD is a lesser-known form of OCD that causes people to obsess about life’s big questions. They constantly worry about things like the meaning of life or what happens after death. And while you cannot be officially diagnosed with existential OCD because it is not a recognized mental health condition, many people use the term to describe their experience.

Wrestling with existential questions from time to time doesn’t mean you have a mental health condition. Most people can stop to ponder the limits of the universe or the purpose of life and eventually let the question go. But people living with existential OCD experience excessive, repeated thoughts about questions that cannot be answered. They feel unable to control their thoughts or the compulsive behaviors that accompany them.

Common symptoms of existential OCD

Every person living with existential OCD will have their own unique experience of the condition. But some common examples of the ways it manifests include:

Typical intrusive thoughts in existential OCD

• What is the point of life?

• Will anyone remember me after I’m dead?

• Why was I born?

• What happens after I die?

• Is there an end to the universe?

• What if I’m living in a simulation and none of this is real?

• When I look in the mirror, is that really “me?”

• Why is there so much suffering? Are we all doomed?

Common compulsions related to these intrusive thoughts

• Spending hours a day trying to answer existential questions

• Looking for “proof” that people, places, or things are real

• Frequently reading books or articles on topics like philosophy or physics in an attempt to find the answers to existential questions

• Constantly seeking reassurance from others about existential questions

• Rethinking past events or experiences to prove they actually happened

Effects of existential OCD

Left untreated, all forms of OCD can negatively impact your life in a variety of ways. Like other forms of OCD, living with symptoms of existential OCD can lead to:

• Social isolation

• Feelings of hopelessness

• Heightened anxiety

• Problems in your relationships

• Difficulty functioning at home, work, or school

• Trouble with focus and concentration

• Financial difficulties

• An increased risk of harmful substance use

• Self-harm and suicidality (in severe cases)

What causes existential OCD?

Researchers are still working to identify the underlying causes of all forms of OCD.  However, they have discovered some factors that may contribute to the onset of OCD, including:

• Genetics: Having a family history of OCD or other mental health conditions

• Environment: Experiencing trauma or major life transitions, especially at a young age

• Biology: Having abnormalities in the parts of the brain that are responsible for regulating serotonin

• Personality: Being a naturally hyper-organized or meticulous person who also feels the need to be responsible for others (in ways that are unhelpful)

• Mental health: Living with another mental health condition, like anxiety or depression

How is existential OCD treated?

Because existential OCD is an unofficial OCD subtype, there is limited data on treatment recommendations for this presentation of symptoms. However, some of the methods used to treat clinical OCD include talk therapy, medication, and self-care.

• Talk therapy: Cognitive behavioral therapy (CBT) can help you challenge obsessive thoughts, interrupt patterns, and change your response to triggers. Exposure and response prevention (ERP) is a subtype of CBT that involves gradual exposure to obsessions under your therapist’s supervision. This can help you increase your distress tolerance in a safe and supportive environment.

• Medication: Some prescription medications, like selective serotonin reuptake inhibitors (SSRIs), can be effective in reducing OCD symptoms. A doctor or psychiatrist can help you decide if these medications are right for you.

• Self-care: While not a replacement for professional health, self-care can help you strengthen your mental health. In addition to getting enough sleep, eating healthy food, and making time for exercise, a mindfulness practice can help you cultivate self-compassion as you work toward getting your OCD symptoms under control.

Clinician’s take

A common misunderstanding about existential OCD is assuming it’s just deep thinking or a philosophical phase. In reality, it involves intrusive questions and intense anxiety that can feel urgent and impossible to shut off. Fortunately, support is available to help you through these experiences.

Brandy Chalmers, LPC

Clinical reviewer