Existential OCD


Existential OCD involves fears about the nature of existence and reality. People with this subtype might, at first glance, appear like philosophically minded individuals who enjoy pondering some of the world’s questions. In reality, these people are consumed with a desire to know things that cannot be known. That said, knowing that something cannot be known doesn’t stop people with this form of OCD from trying to figure out the questions that are the source of their anxiety. By the time people with this subtype show up to therapy for Existential OCD, they are often lost in an ongoing philosophical debate with themselves.


How do you know if you have OCD? Only a licensed practitioner can perform an official assessment and provide a diagnosis. That said, the symptoms of OCD include the presence of obsessions and compulsions that take up a significant amount of time, cause distress and impair social, occupational and other important areas of functioning.


Obsessions are intrusive, upsetting, repetitive, distressing thoughts, images and urges. In Existential OCD, obsessions can include thoughts like:

  • What if we’re living in a simulation?
  • I might be in the matrix!
  • What if I’m not real?
  • I could be dead already and this could be the afterlife.

You can learn more about obsessions and OCD in general here.


Compulsions are behaviors that individuals do in order to get rid of the anxiety, doubt, and distress that often result from obsessions. These actions can be overt or covert. A person might do any number of things compulsively. They might wash, check, avoid, seek reassurance, analyze thoughts and more. In Existential OCD, compulsions can look like:

  • Checking to see how you feel in order to make sure that you are real
  • Ruminating about the nature of reality
  • Asking for reassurance from loved ones that you are real
  • Avoiding certain movies, TV shows, books or articles that might lead you to question reality

You can learn more about compulsions here.



We approach the treatment of every subtype of OCD in the same way, with Exposure and Response Prevention (ERP). This involves facing the things that trigger thoughts and feelings without giving into compulsions. For instance, someone with Existential OCD might watch the film “The Matrix” and disengage from any attempts to figure out whether or not they could be living in the Matrix. This could look like dropping rumination or making the choice not to ask for reassurance. The idea is to bring about the obsession without doing any compulsions.

The goals of ERP for Existential OCD are to:

  • allow for the presence of doubt thoughts about the nature of reality
  • make space for distress
  • accept that one cannot be certain about the nature of reality

We want to be careful not to focus too much on the content of OCD as the thoughts themselves are not important. Still, there are some common challenges and roadblocks that people with this subtype face. ⁠If you’re interested in support for this subtype, our therapists have extensive experience supporting those with Existential OCD. You can learn more about the treatment and services we provide here, or email us here to find out more about working with her.


While ERP is considered the gold-standard treatment for OCD, Acceptance and Commitment Therapy (ACT) is also an evidence-based treatment for OCD that can be used in conjunction with ERP. ACT draws upon mindfulness principles in order to support people in non-judgmentally witnessing and accepting their thoughts and feelings. By supporting this objective view of these internal experiences, ACT helps people to accept thoughts and feelings while they take actions based on what matters most to them. You can learn more about ACT here.

General Mindfulness as well as Meditation are also helpful approaches that support recovery from Existential OCD. Given that this subtype is a form of Pure Obsessional OCD, learning how to deal with mental compulsions is key to treatment. Meditation can support people in disengaging from mental compulsions. Mindfulness can support individuals to peacefully coexist with thoughts and feelings.


Are you or a loved one struggling with symptoms of Existential OCD and looking for help? Therapists at the Center for the Obsessive Mind uses Cognitive Behavioral Therapy, Exposure and Response Prevention and Acceptance and Commitment Therapy to support those with Existential OCD. You can learn more about the treatments and services we provide here.


The Center for the Obsessive Mind offers

therapy in several states and internationally.

Learn more about where the staff practices, below.

Pastel skies and a pristine beach in Northern California, one of the areas where Lauren helps people with Existential OCD.


The Center for the Obsessive Mind’s staff therapists offer online treatment for Existential OCD throughout California. Our Clients span from San Francisco down to Southern Orange County and San Diego. Whether you’re in Silicon Valley, Santa Barbara, Beverly Hills or Dana Point, the Center’s staff can support you in your recovery.

The red rock spires of Bryce Canyon in Utah, one of the states where Lauren offers counseling for Existential OCD.


Staff members at the Center for the Obsessive Mind offer therapy for Existential OCD in the state of Utah. Since we provide online treatment, we work with people who live in different areas of the Beehive State – from Salt Lake City and its suburbs, like West Jordan, Syracuse, Highland and Riverton, to Park City and St. George.

Clear turquoise waters in the Keys, one of the places where Lauren practices psychotherapy in Florida.


Therapists at the Center for the Obsessive Mind also offer treatment for Existential OCD online in Florida. We see people from all corners of the Sunshine state. Whether you’re from Naples, Orlando, Miami, or Boca Raton, we can provide specialized counseling remotely in your area.

The placid, clear waters of Sand Harbor in Lake Tahoe, one part of Nevada where where Lauren offers therapy for Existential OCD.


Therapists at the Center for the Obsessive Mind also practice teletherapy in Nevada. So if you’re seeking help in Glenbrook, Incline Village, Reno or Las Vegas, we offer specialized therapy for Existential OCD online across the Grand Canyon State.

The Seven Sisters sea cliffs in Sussex, England, one international locale where  The Center for the Obsessive Mind provides counseling.


In addition to all of the locations previously listed, the staff at the Center for the Obsessive Mind offer teletherapy for Existential OCD to a number of countries internationally.

Cozy couch and computer: all you need for teletherapy and what your treatment for Existential OCD with Lauren could look like.


Online therapy isn’t right for everyone. An assessment must be done to determine if online therapy is appropriate for your needs. You can reach out here to learn more.


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Disclaimer: The information contained on this website is intended for informational and education purposes only and is not meant to be a replacement for therapy. If you are interested in treatment, you can email us and we will happily provide you with more information.