Existential OCD: When Life’s Big Questions Feel Urgent
TL; DR
Existential OCD causes people to feel consumed by urgent dread around unanswerable philosophical questions, like the meaning of life, the nature of reality, or what happens after death. Unlike philosophical curiosity, these thoughts feel terrifying rather than interesting, and often lead to compulsions like researching, ruminating, and avoiding triggers. Treatment is the same as other OCD themes: ERP, which involves leaning into uncertainty rather than trying to think or research your way to an answer. The goal of OCD treatment isn't to solve the big questions, but to stop letting the struggle run your life and drop the rope.
When Philosophy Stops Being Fun: What is Existential OCD?
I was a philosophy minor in undergrad, and I loved talking about big questions that don’t have definitive answers. I loved discussing philosophical thought experiments like the Ship of Theseus (check it out, it’ll blow your mind). It is exciting and intriguing to ‘try on’ different ideas and ways of thinking. This, for me, was fun and interesting and enriching. For people with existential OCD, it’s not like that at all. People with existential OCD are consumed with anxiety and dread, thinking about philosophical questions like:
What is the meaning of life?
What is reality?
What happens after death?
Do we have free will?
For those with this theme of OCD, these questions feel urgent. They aren’t interesting things to ponder; they are terrifying unknowns that the individual feels desperate to find an answer for. Folks with OCD are often stuck with repetitive, intrusive thoughts about the meaning of life, the nature of reality, or a number of other existential questions. Some folks might have intrusive thoughts about being in a simulation in which nothing is truly real. Others might feel stuck trying to solve the meaning of life, a truly unanswerable question. They may be terrified that there is no meaning, or afraid that they will simply never know. Folks may spend hours watching philosophy lectures and turning the problem over in their mind trying to think their way to an answer.
Existential OCD vs. Depression: How to Tell the Difference
On the surface, these thoughts may look similar to the thoughts of folks with depression. Often, people with depression begin thinking there is no point to life and that nothing has any meaning. However, these thoughts are accompanied by feelings of sadness or numbness, not fear. Additionally, people with OCD are going to feel more driven to answer the question and experience the thoughts as ego-dystonic (i.e., uncharacteristic of oneself, unwanted, and alien), whereas someone with depression may really think at that moment that there is no point.
Common compulsions for folks with this theme may include:
Researching philosophy
Asking loved ones for their thoughts about these questions
Checking rituals in an attempt to test whether this is reality
Compulsive mental rumination focused on trying to rationalize answers to these questions
Attempting to suppress or push away the intrusive thoughts
Avoidance of potential triggers of existential thoughts (e.g., movies such as the Matrix, reminders of death, deep conversation topics)
How Do You Treat Existential OCD?
The general treatment is the same as any other theme of OCD: exposure and response prevention (ERP) is the gold standard treatment. ERP involves intentionally exposing oneself to feared triggers (exposure) and preventing oneself from engaging in any kind of compulsive behavior (response prevention). Triggers include any stimulus, including one’s own thoughts, that creates anxiety and triggers the OCD cycle.
Folks with existential OCD often experience a lot of mental compulsions, such as compulsive rumination. By that, I am referring to the act of mentally rationalizing, reviewing information, and generally trying to think one’s way to a solution. Unfortunately, there is no solution that OCD is ever satisfied with. So the rumination continues, the anxiety builds, and folks find themselves stuck. ERP treatment for people with frequent mental compulsions may involve the use of mindfulness and other skills to resist the mental compulsions. However, response prevention is only one part of the treatment, and exposure work is usually necessary to see better outcomes.
As an OCD therapist specializing in ERP, I ensure that specific exposures depend on the individual’s fears and triggers. However, exposures for some with this theme might involve:
Writing an intrusive thought (e.g., “There is no meaning in life” or “Nothing is real”)
Watching a movie or TV show challenging the nature of reality (e.g., Inception) or the afterlife (e.g., Eternity)
Watching part of a philosophy lecture and resisting finishing it or researching any further
How to Stop Fighting Existential Intrusive Thoughts
Regardless of the exposure activity, the goal is to lean into uncertainty. Rather than doing what OCD wants, it is important to resist trying to figure it out and lean into the fact that these questions are unsolvable. Imagine the intrusive thoughts and fears are a monster standing across a pit from you. In the pit is anxiety or dread or that pit-in-the-stomach feeling. The monster and you are playing tug of war with the pit in the middle of you. Every time you do a compulsion or try to push away a thought, you are pulling on that rope. But every time you pull on the rope, the monster pulls harder, too. You and the monster are locked in this struggle, both trying to pull the rope hard enough to get the other to fall into the pit. Understandably, you are desperate to get rid of the monster, but as you struggle, the closer you get to falling in yourself.
You may have been struggling in this game of tug of war for months or years. And no matter what you try, you can’t get the monster into the pit. It’s just not working, and it’s not going to work. But there is another option: you can drop the rope. You can stop trying to get rid of the monster. You can find something else to do with your time! You may still feel anxiety or dread, and the monster will still keep hurling the intrusive thoughts at you, trying to get you to pick the rope back up. But you have the choice to stop wasting your time and energy on a struggle that has never been and never will be fruitful.
You Can Drop the Rope: Final Thoughts From an OCD Therapist in Wauwatosa
At Leap Counseling, I work with clients navigating all themes of OCD, including existential OCD. It’s easy to miss and often misdiagnosed as generalized anxiety or another disorder. However, it still follows the same cycle as other OCD themes, and people with this theme experience the same difficulty tolerating uncertainty. And these big philosophical questions are mired in uncertainty!
There’s just no way of knowing, so OCD treatment focuses on accepting that unknowing and learning to approach uncertainty and anxiety as opposed to avoiding it. And as one’s relationship to anxiety and uncertainty changes, therein lies freedom. Take a leap of faith, drop the rope.
You Don't Have to Solve Life's Biggest Questions to Find Peace: Online OCD Therapy in Wauwatosa, WI, Can Help
If existential thoughts have stopped feeling philosophical and started feeling terrifying, OCD therapy can help you change your relationship with those questions. Even when the questions themselves have no answers. Treatment isn't about finding certainty, but learning to live fully without it.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders, including existential OCD. Dr. Wood offers personalized, evidence-based treatment that helps clients stop struggling against unanswerable questions and start reclaiming the time and energy OCD has been consuming. Dropping the rope starts with one small step:
Reach out to schedule a free 15-minute consultation
Work one-on-one with an experienced OCD therapist in Wauwatosa who understands existential OCD
Begin learning to sit with life's uncertainties and stop letting them run your life
Other Services Leap Counseling offers Online in Wisconsin & PSYPACT States
Existential OCD can make it feel like you're trapped in your own mind, endlessly searching for answers that will never fully satisfy. OCD treatment can help you stop chasing those answers and start building a life that isn't held hostage by uncertainty. One where the big questions can exist without sending you into a spiral.
Existential OCD is one of many OCD themes and anxiety-related conditions I work with at my Wisconsin-based online therapy practice. If there are other concerns weighing on you beyond existential intrusive thoughts, you don't have to set them aside. There's space to address those, too. In addition to OCD treatment, I provide therapy for a range of anxiety disorders, including Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin and all PSYPACT states, I'm able to work with clients online across many locations.
You don't have to have life's questions figured out before starting therapy. In fact, that's kind of the point. Browse my mental health blog for more on existential OCD and anxiety treatment, and reach out whenever you're ready to take that first step.
About the Author
Dr. Johanna Wood knows what it's like when uncertainty stops being an intellectual exercise and starts feeling unbearable. Having personally experienced the intrusive thoughts and anxiety spiral of relationship OCD, she understands the desperate urge to think your way to an answer. And the exhaustion of discovering that no answer is ever quite enough. Her own ERP treatment taught her to drop the rope: to stop wrestling with uncertainty and start living alongside it, treating each exposure as a "leap of faith" rather than a threat to be neutralized. That hard-won insight is especially relevant when working with existential OCD, where the questions are unanswerable by design, and the only way forward is learning to tolerate not knowing.
Dr. Wood is a Wisconsin-based clinical psychologist specializing in evidence-based OCD treatment, including ERP. She earned her PhD in Clinical Psychology from Northern Illinois University, completed her doctoral internship at Rogers Behavioral Health in the OCD and Anxiety Adult Residential Program, and has supervised clinical staff in residential OCD treatment settings. Dr. Wood is licensed in Wisconsin and holds PSYPACT authorization, allowing her to work with clients online across many states. She is an active member of the International OCD Foundation and contributes to national education efforts on scrupulosity OCD, bringing both deep clinical expertise and genuine lived experience to her ERP-based OCD therapy practice.
