What Is Existential OCD?

Table of Contents
View All
Table of Contents

Everyone experiences obsessive-compulsive disorder (OCD) differently. Sometimes symptoms of OCD can include obsessive philosophical ideas and fears about life, the universe, and human existence. This is referred to as existential OCD.

This article discusses the symptoms and treatment for existential OCD.

obsessive-compulsive disorder

Solskin / Getty Images

What Is Existential OCD?

Existential OCD symptoms are when repetitive and intrusive thoughts about the purpose of human existence cause symptoms of anxiety, depression, and compulsive behavior.

These thoughts might include:

  • Questioning the purpose of life
  • Feeling death anxiety (fear of your own death or the dying process)
  • Wondering what's real and what isn't
  • Feeling a sense of impending doom

Someone with existential OCD symptoms might also refuse to tolerate uncertainty about questions that are impossible to answer.

Existential OCD vs. Philosophical Questions

Everyone has philosophical questions about the meaning of life. These questions might include “Why are we here?” or “Where do we go when we die?” But with symptoms of existential OCD, these thoughts can turn into obsessions that interfere with daily life. They can drive a person to compulsive rituals, like:

  • Constantly seeking validation about one's path
  • Obsessing over philosophical ideas (like the nature of reality and the universe) for hours a day

When dwelling on philosophical questions causes symptoms of depression, anxiety, and compulsive behavior, a person might be suffering from existential symptoms of OCD.

Signs and Symptoms of Existential OCD

Symptoms of existential OCD might include:

  • Obsessively thinking about the reason for existence
  • Derealization, or a feeling that the world isn’t real
  • Refusing to tolerate uncertainty
  • Feeling depressed and anxious because of repetitive thoughts about life and death
  • Reassurance seeking, or constantly double-checking decisions with others out of fear of being on the wrong path
  • Not having an ability to reason with or apply logic to philosophical thoughts or questions 
  • Finding one’s own answers to philosophical questions but then doubting those answers 

Common Obsessions

Those with existential OCD might obsess over:

  • The purpose of living
  • The inevitability of death
  • Whether they're on the right path in a religious or philosophical sense
  • The nature of reality and the universe
  • Whether or not they even exist

Common Compulsions

Compulsions are repetitive behaviors that people with OCD might engage in to ease anxiety. At times, these compulsions can interfere with daily life. In the case of existential OCD symptoms, they might include:

  • Constantly researching philosophical questions without being affected by logic or others' ideas
  • Pondering one’s existence and reality for hours while neglecting daily life
  • Constantly asking others for reassurance about being on the "right" path
  • Doubting any logical conclusions

How Existential OCD Is Treated

Treatment for existential OCD symptoms might include therapy or medication. The following are ways a specialist might approach the disorder.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a form of psychotherapy (talk therapy) that focuses on thoughts that lead to unhelpful behavior. These thoughts are challenged with the help of a therapist and then replaced with more supportive ideas. CBT also includes learning how to manage emotions and reactions to daily life.

For example, a CBT session might include exercises like role-playing or reviewing larger belief systems a person has and helping determine whetherthey are helpful.

Exposure and response prevention (ERP) and mindfulness are two CBT techniques advised for existential OCD.

Exposure and Response Prevention

Exposure and response prevention (ERP) is a type of therapy in which a person is repeatedly exposed to thoughts and ideas that scare them so that they build tolerance. ERP might include “homework” assignments from a therapist, such as researching existential questions, listening to recordings from the therapist, and watching videos about the topic.

ERP also includes experiencing the emotions and anxieties that thoughts create and learning how to manage them without responding. ERP in someone with existential OCD might mean not asking others for reassurance and, instead, sitting with their doubts about reality, no matter the anxiety it might cause, or letting it pass.

Practicing Mindfulness

Mindfulness can be taught as an adjunctive calming skill (added on as a supplement) but is not necessarily a treatment.

Mindfulness is becoming aware of one’s emotional reactions without judgment. This can lead to accepting passing thoughts and “riding the wave” of emotions that they cause without engaging in compulsive behavior.

Over time, an intrusive thought becomes less critical and easier to manage. With existential OCD symptoms, mindfulness might mean feeling the anxiety or dread of more important life-and-death questions without acting on them or fearing the emotions they cause.


Existential obsessive-compulsive disorder (OCD) symptoms are marked by repetitive, intrusive thoughts about philosophical questions, such as the meaning of existence, the nature of reality, and ideas about life and death.

A Word From Verywell 

Everyone has pondered the more significant questions about life, death, and the universe. However, when these thoughts become obsessions you can't seem to escape from, they could harm your mental health and well-being.

If you find yourself ruminating over the more significant questions of existence to the point of depression, anxiety, and disruptions in work and relationships, existential OCD may be the cause. If you can’t find a therapist in your area or don't have access to therapy, finding online help or a local OCD support group might help you cope.

Frequently Asked Questions

  • Can OCD trigger depersonalization?

    Research suggests OCD can trigger depersonalization, in which a person feels like they are unreal or don’t exist. This might be because people with OCD can experience intense, intrusive thoughts about what might or might not be possible. The constant repetition of these thoughts can cause inferential confusion, which is when you fail to interpret reality correctly and confuse reality with possibility.

  • What is death anxiety?

    Death anxiety is a fear of death caused by memories or thoughts about death. Existential OCD can create an obsession with and fear of death that interferes with daily life. Death anxiety can feel like a sense of impending doom about the future, which can cause anxiety for those living with existential OCD.

  • How do you know you're having an existential crisis?

    An existential crisis occurs when a person wonders about the reason for their existence with the question, “Who am I?” This crisis can cause anxiety about life's purpose, death, and the nature of reality. An existential crisis might encourage fear and panic about identity and the future. The type of existential crisis a person experiences can depend on their age. A teenager might ask themselves who they are, while an adult might be concerned about their life's meaning and death.

9 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. International OCD Foundation. To be or not to be, that is the obsession: Existential and philosophical OCD.

  2. American Psychological Association. Derealization.

  3. Boysan M. Dissociative experiences are associated with obsessive-compulsive symptoms in a non-clinical sample: A latent profile analysis. Noro Psikiyatr Ars. 2014;51(3):253-262.

  4. Fairfax H. Mindfulness and obsessive compulsive disorder; implications for psychological intervention. J Mental Health & Clin Psychology. 2018;2(4):55-63. doi:10.29245/2578-2959/2018/4.1146.

  5. Chien WT, Tse MK, Chan HYL, Cheng HY, Chen L. Is mindfulness-based intervention an effective treatment for people with obsessive-compulsive disorder? A systematic review and meta-analysis.Journal of Obsessive-Compulsive and Related Disorders. 2022;32:100712. doi:10.1016/j.jocrd.2022.100712

  6. American Psychological Association. Death anxiety.

  7. Menzies RE, Dar-Nimrod I. Death anxiety and its relationship with obsessive-compulsive disorder. Journal of Abnormal Psychology. 2017;126(4):367-377. doi:10.1037/abn0000263.

  8. American Psychological Association. Existential crisis.

  9. Andrews, M. (2016). The existential crisisBehavioral Development Bulletin, 21(1), 104-109. http://dx.doi.org/10.1037/bdb0000014

By Neha Kashyap
Neha is a New York-based health journalist who has written for WebMD, ADDitude, HuffPost Life, and dailyRx News. Neha enjoys writing about mental health, elder care, innovative health care technologies, paying for health care, and simple measures that we all can take to work toward better health.