by Fred Penzel, PhD
This article was initially published in the Fall 2013 edition of the OCD Newsletter.
Many people in the general public and the media have a very stereotypical image of what OCD is all about. Individuals with OCD are seen as people who either wash their hands too frequently, or who are super-organized and perfectionistic. Thus, it can be difficult to recognize the types of OCD that don’t resemble these common stereotypes. The reality is, there are many forms that OCD can take. The types and topics of your obsessions and compulsions are limited only by your brain’s ability to imagine. OCD is insidious, as it seems to have a way of finding out what will bother someone the most.
Many of us grapple with existential questions about the meaning of life, the universe, existence, and so on, at one point in our lives. However, for those with a type of OCD called Existential OCD, or “Philosophical OCD”, these questions can become all consuming.
Steve, a 26 year-old computer programmer: “I can’t stop thinking about why we’re all here and whether there’s any purpose to life. I keep going over it in my mind all day long. I have continual thoughts of how one day I’ll be dead and no one will remember me. It will be as if I never existed. Then I ask myself, what is the use of doing anything if we’re all going to die anyway?”
Existential OCD involves intrusive, repetitive thinking about questions which cannot possibly be answered, and which may be philosophical or frightening in nature, or both. The questions usually revolve around the meaning, purpose, or reality of life, or the existence of the universe or even one’s own existence. These same questions might come up in a university philosophy or physics class. However, most people can leave such classes or read about these topics and move on to other thoughts afterwards. Similar to other forms of OCD, individuals with Existential OCD can’t just drop these questions.
Existential obsessions are often difficult to recognize, as they might seem like the questions many of us wonder about sometimes and then move on from with a shrug of the shoulders. Existential obsessions might also be confused with the kind of thoughts people experience when they are depressed, continually going over negative thoughts about how meaningless life may seem. But, Existential OCD is far more complicated than that.
Individuals with existential obsessions typically spend hours going over and over these questions and ideas, and may become extremely anxious and depressed. When they do seek help, they may be seen as suffering from worries or existential fears, or be misdiagnosed as suffering from Generalized Anxiety Disorder. However, when a person battles ongoing intrusive, repetitive, persistent, anxiety-producing, doubtful thoughts of this nature, it is most likely Existential OCD.
Kristin, a 34 year-old homemaker: “I can’t get the idea out of my head that everything I see isn’t real. How do I know I’m not really in a coma, or else dreaming, and that my whole life is imaginary? I start to wonder if my husband and children are real and it frightens me terribly.”
Even if you do not have Existential OCD, you may have had existential obsessions at one point in time, spending hours analyzing why you are having your particular thoughts and questioning exactly what these thoughts may mean. This is just another type of compulsion that accompanies obsessive thoughts, and never leads to any true answers. When you have OCD, your obsessive doubts cannot be argued with, reasoned out, analyzed, or questioned — this is especially the case with Existential OCD. There are never any lasting answers to obsessive questions. Whatever answers you may come up with can last a few minutes, but then quickly slip away in the face of newer doubts. The doubts may vary a bit, but are mostly variations on a theme.
You may wear yourself out trying to find answers, or trying to get the thoughts out of your head, but these are the worst ways to deal with OCD. As mentioned previously, there are no answers to existential or any other obsessive questions.
Marty, a 19 year-old college student: “Every day I spend hours looking at myself in the mirror and I wonder – Is this really me? How do I know? What makes me, me, and how do I know I am who I think I am? How do I know the things I feel are my own real feelings, or that my thoughts are my own real thoughts? I also keep thinking about how vast the universe is and how we’re all just tiny specks that are meaningless. I keep thinking that because we are so insignificant, nothing we do matters, so why not give up on everything?”
Treating Existential OCD
So, what should you do? Research tells us that cognitive behavioral therapy (CBT) and medication are the best approaches to dealing with OCD — the same goes for people with Existential OCD. Some people go for the quick fix of relying only on medication, but this cannot change longstanding habits or your philosophy of how to deal with the things that scare you. The true purpose of medication in OCD treatment is that it makes it easier for you to do the therapy. The therapy, however, is ultimately what changes you.
While in therapy, you should learn to do the opposite of what your instincts tell you. Human intuition is meant to tell us to avoid or escape things that make us anxious. Unfortunately, there is no escape from fear, and there is definitely no escape from one’s own thoughts. You take your thoughts with you wherever you go. It is a paradox — the more you tell yourself to not think something, the more you then think of what you are not supposed to think about.
Another common theme in Existential OCD is that your thoughts mostly revolve around uncertainty, and in general we humans don’t like uncertainty. In a type of CBT known as Exposure & Response Prevention (ERP), you learn to face your thoughts and to build up a tolerance to them — both the anxiety the thoughts produce and the uncertainty that goes along with them. In order to do this, you have to go against your instincts and agree with the thoughts and also try to think these thoughts more, rather than less. I like to say, “If you want to think about it less, think about it more.”
In the “exposure” part of ERP, your therapist may ask you to deliberately and gradually expose yourself to the feared existential thoughts and images, and even learn to agree with them. You will learn to do this daily in a variety of ways that can include reading articles or books, watching videos, listening to home-made therapy recordings, writing feared words or sentences, actively agreeing with the thought of the moment, etc. As you do this, the thought gradually loses its impact, and even boredom can result. I have always told my clients that you cannot be bored and scared at the same time.
In the “response prevention” part of ERP, the goal is to not escape or avoid, so you are taught to agree with your existential thoughts, and to not try to analyze, question, or argue with them. You are also discouraged from seeking reassurance from others or even yourselves, as this is another form of escape. Over time, avoidance can unfortunately become a learned habit that becomes very automatic. You may avoid your triggers unconsciously, without even thinking about it. However, avoidance simply leads to more avoidance. How can you build up your tolerance to something you never come in contact with?
Some typical Exposure homework assignments for those with existential obsessions might include:
- Making a series of gradually more challenging 2-minute recordings on your phone that tell you the fearful thought is true, and listening to them several times daily
- Posting signs or notes around your house stating the feared idea. In the case of existential obsessions, a sign may say something like “Nothing is real.”
- Agreeing with the thoughts as much as possible whenever they occur, and also agreeing that there will be bad consequences because they are true. For example, recognizing “I won’t ever get answers to my questions, and as a result, life has no meaning.”
- Going to places and doing activities that bring on the thoughts.
- Reading articles that seem to agree with the feared thoughts.
- Watching videos or movies that bring on the thoughts (such as films like Inception).
- Writing feared sentences 25x per day until you get bored with them. Then, write new ones.
Some typical Response Prevention homework assignments might include:
- Not arguing with, questioning, or analyzing the thoughts in any way.
- Not seeking reassurance from yourself or anyone else.
- Resisting looking up articles that disprove the thoughts or tell you they don’t matter.
- Not trying to discuss the topics with others.
Acceptance is another very important piece of therapy for Existential OCD. There are several things that need to be accepted:
- That you have OCD.
- That there is no real explanation for why you have the particular thoughts you have.
- That there are no real answers to your questions and doubts.
- That the solutions you have previously come up with haven’t worked, aren’t working now, and will not work in the future, and therefore must be abandoned because there really is no escape.
- That you can have thoughts of the type you experience, that they will not simply go away on their own, and that they can be lived with.
- That your anxiety and uncertainty can ultimately be overcome, but only by confronting them and building up your tolerance to them.
- That it will take hard work, time, and practice to overcome your fears and the habits you have built up by avoiding them.
The most important thing to know is, based upon what we now know about treating OCD, you do not have to suffer! There is effective treatment out there, no matter what “flavor” of OCD you have — including Existential OCD. Every day that you are not getting help is another day you have to suffer. If you aren’t having much luck finding a treatment provider on your own, check out the “Find A Therapist” page on the IOCDF website to find an OCD treatment provider in your local area (https://iocdf.org/find-help/).