It’s natural to wonder about the meaning of life, our purpose, or what happens after death. These questions can inspire reflection and growth. But for some, these thoughts become intrusive, distressing, and impossible to shake. This experience is known as Existential OCD.

Existential OCD is a subtype of obsessive-compulsive disorder where the core obsessions revolve around deep philosophical questions about reality, existence, and life itself. Unlike ordinary curiosity, these obsessions create an urgent, overwhelming need for absolute certainty—something that’s simply not possible to provide. This uncertainty fuels intense anxiety, making it difficult to live in the present.

What Does Existential OCD Look Like?

People with existential OCD experience relentless intrusive thoughts about:

• Whether they truly exist.
• If the world around them is real or a dream.
• The purpose of life or if life even has meaning.
• What happens after death.
  

These thoughts can be all-consuming and often appear suddenly during everyday moments—even times when a person is usually feeling happy or connected. Unlike typical philosophical pondering, these thoughts don’t lead to peaceful insights but rather intense distress and doubt.

Common Symptoms and Behaviours

Existential OCD can look different for everyone, but some common experiences include:

• Obsessions: Repetitive, intrusive doubts and questions such as, “Am I really here?” or “What if this is all a simulation?”
• Compulsions: Attempts to reduce anxiety by engaging in behaviours like:
  • Excessive research into philosophy or spirituality.
  • Mental reviewing or replaying experiences to “prove” reality.
  • Seeking reassurance from others about existence or meaning.
  • Avoiding anything that triggers these thoughts.
  • Distracting oneself with superficial content to avoid deep thinking.

These compulsions may seem to offer temporary relief, but they reinforce the cycle, making the obsessions stronger over time.

How Does It Feel?

Living with existential OCD is draining. Many feel isolated, misunderstood, or even ‘like a deep thinker’ by others who don’t see the distress beneath the surface.

It’s common to experience:

• Depersonalization and derealization: Feeling detached from one’s body or surroundings, as if watching life through a fog.
• A sense of disconnection: From loved ones, activities, and even one’s own emotions.
• Loss of joy and motivation: Because the obsessive questions make life feel pointless or unreal.
• Social withdrawal: Avoiding others due to fears of being a ‘downer’ or constant reassurance-seeker.

Case Study: Emma’s Story

Emma’s existential OCD began after a period of stress. She became consumed by the fear that she didn’t truly exist—that her life was a dream or a coma state. This made socialising feel impossible, as she constantly sought reassurance from friends and family. Emma spent hours researching online, looking for proof that she was “real.”

Her compulsions escalated, interfering with work and relationships. After seeking help, Emma started Exposure and Response Prevention (ERP) therapy—a treatment where she gradually faced her fears and learned to resist compulsions. Over time, Emma’s anxiety decreased, and she began to reconnect with life beyond her doubts.

Why Existential OCD Is Different From Depression or Normal Worry

It’s easy to confuse existential OCD with depression or general anxiety. While someone with depression might question life’s meaning out of sadness, existential OCD involves intrusive thoughts that feel uncontrollable and cause severe distress. The urgency to find absolute answers and the compulsive behaviours to relieve anxiety set it apart.

Treatment: How ERP Can Help

Exposure and Response Prevention (ERP) is the most effective treatment for existential OCD. It teaches you to:

• Face uncomfortable thoughts about existence without performing rituals or compulsions.
• Build tolerance for uncertainty rather than seeking impossible certainty.
• Break the cycle of obsession and compulsion that traps you.

ERP might involve exercises such as reading triggering material and resisting the urge to seek reassurance or distraction. Therapists guide this process carefully and gradually, helping you build confidence in living with uncertainty.

Article written by Dr Emily O’Leary, Director and Clinical Psychologist at the OCD Clinic. If you have questions about psychological therapy please contact our intake team: reception@ocdclinicbrisbane.com.au