Existential OCD

WHAT IS 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.

EXISTENTIAL OCD SYMPTOMS

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

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

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.

TREATMENT FOR EXISTENTIAL OCD

EXPOSURE AND RESPONSE PREVENTION (ERP)

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.

ACCEPTANCE AND COMMITMENT THERAPY (ACT) & MINDFULNESS

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.