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A comprehensive guide to Existential OCD
Existential OCD is a form of OCD that involves obsessions and compulsions in regards to life, death and the meaning of existence.
It is not easy to determine the amount of people who have Existential OCD, as it involves many different symptoms; however, tangentially, we know that almost half of all people with OCD report having occasional suicidal ideation; with OCD-sufferers, this is mostly caused by intrusive thoughts and is usually not constant.
The aim of this article is to provide the reader with useful and helpful information in regards to Existential OCD – from its symptoms, to its causes, to treatment options and so on.
What causes Existential OCD?
As with many other subcategories of OCD, the causes for Existential OCD are difficult to verify. Nonetheless, the fear of death is a phenomenon that has been studied in psychology since at least 1896 (C.A. Scott, “Old age and death”), and has been talked about in philosophical and religious literature for centuries before that; this fundamental feeling of uncertainty about death is common in almost all people and this certainly could be a factor for why Existential OCD can develop.
Existential OCD is also likely maintained and reinforced by the seeking of reassurance from philosophers (or philosophy-related literature/videos etc), religious leaders and friends/family who are interested in existential questions; this reassurance-seeking is unhelpful to the sufferer, because it directly contributes to the obsession factor in Existential OCD by increasing the likelihood of intrusive thoughts in regards to existential questions, which then causes the compulsions that aim to decrease or relieve the anxiety being caused by these thoughts.
Examples of Existential OCD
- Obsessions and compulsions regarding life and death
- Obsessions to do with reading philosophy or having philosophical discussions
- Obsession with studying religions and/or religious scriptures
- Obsession with studying NDEs (near death experiences)
- Obsessive contemplation of the vastness (or emptiness) of the universe
- Intrusive thoughts and obsessions about your loved ones dying or being dead
How can Existential OCD be treated?
The treatment options for Existential OCD are similar to those of other OCD subcategories:
- The most demonstrably effective treatment is ERP (exposure and response prevention), which is a therapeutic technique that falls under the umbrella of CBT (cognitive behavioral therapy). The efficacy of ERP (on average) is 50-60% in terms of symptom reduction.
- Another effective treatment option (which is usually combined with therapy) is to have your psychiatrist prescribe an SSRI-category antidepressant, such as escitalopram (Cipralex) sertraline (Zoloft) along with an antipsychotic medication, such as aripiprazole (Abilify) or risperidone (Risperdal).
- One more viable treatment option is rTMS (repetitive transcranial magnetic stimulation), which approximately has a 1 in 5 response rate after active treatment.
What if my Existential OCD is treatment-resistant?
When the first-line treatment options don’t produce any significant results, there are some other options available for treating Existential OCD, such as:
- Intravenous clomipramine – When the oral/tablet form of clomipramine (a tricyclic antidepressant) has not worked, it is also a viable option to have it administered through an IV. There are several studies that have indicated the efficacy of this treatment.
- Electroconvulsive therapy (ECT) – This is a procedure that involves stimulating the brain with an electric field while the patient is anaesthetized; it has a great safety profile, and has yielded positive results in several OCD-related trials, such as this one from 2021.
- Deep Brain Stimulation (DBS) – This form of intervention should only be considered when all other options failed, as it involves the surgical insertion of a device known as a neurostimulator, which is then used to target a specific area of the brain. The responder rate for this treatment is ±50% (“responder” here was defined as a decrease in symptoms by at least 35% on the YBOC scale). This is an effective procedure, yet the potential risks/complications must be taken into account beforehand.
What’s the difference between Existential OCD and simply being interested in existential questions?
It may seem difficult to tell the difference between having Existential OCD and simply being interested in philosophy and existential contemplation, but there are significant dissimilarities between the two:
- Most importantly, Existential OCD is characterized by intrusive (egodystonic) thoughts, whereas an interest in philosophy is characterized by egosyntonic (non-intrusive) thoughts.
- Existential OCD can be very distressing and anxiety-inducing, due to what often becomes an unremitting and repetitive obsessive-compulsive cycle, whereas the sole contemplation of life and death is usually not comparably distressing or upsetting.
- Existential OCD (or, more specifically, obsessive-compulsive disorder with existential obsessions and compulsions) is something that can be (and should be) diagnosed and treated, so the person can continue to live a life of contentment.
How to help a friend or family member who suffers from Existential OCD
It can be difficult to see someone dealing with the existential kind of OCD, especially when the sufferer is someone you know. It is crucial to try not to delve into deep philosophical/religious discussions with someone who has Existential OCD, since it can act as a trigger and make the sufferer’s existential obsessions more intense.
If it seems to you that they’re possibly spending an hour a day (or more) engaging in compulsive behaviors (whether mental or physical) regarding thoughts of an existential nature, then you should suggest that they see a clinical psychologist and/or psychiatrist; according to the DSM-V handbook, a presence of OCD symptoms for a minimum of 1 hour per day is one of the primary criteria for an OCD diagnosis.
Talk to other people about Existential OCD
You can check out our community forum where you can talk to other people and share experiences about OCD, talk about treatments and so on!
Read more about Existential OCD – a few helpful resources
- The International OCD Foundation’s (IOCDF) article on Existential/Philosophical OCD
- An article about Existential OCD on Verywell (reviewed by a psychiatrist)
- About the Author
- Latest Posts
Hello, I am Jonas Eriksson. I suffered from severe OCD for many years and have now recovered. My OCD is related to an autoimmune disorder called Autoimmune basal ganglia disorder. Sadly I was undiagnosed for 27 years. The inflammation put my brain to be in a state of constant terror. By sharing helpful information, I hope someone will get motivated to seek treatment and learn more about OCD and related disorders.