existential ocd

1) Overview what is Existential OCD ?

Existential OCD is one “theme” of OCD that, on the surface, looks like someone who is deep, curious, and loves philosophy… but at its core, it’s really a brain that gets stuck in a loop of uncertainty and tries to “close the case” by thinking about it over and over until it burns itself out.

It doesn’t start from playful curiosity, but from thoughts/questions that pop up on their own and drag emotions along with them—fear, emptiness, shock, confusion, or a sense of feeling alienated from oneself.

The classic questions are open-ended questions that can never really be answered 100% for sure, such as: “Does life have meaning?” “What is reality?” “Do I truly exist?” “When we die, is there nothing or something?”

People with Existential OCD are not “better at deep thinking than others”—it’s that once they start thinking, they can’t stop. And more importantly, they think because they feel they have to think.

It’s as if the brain declares a state of emergency: “If we don’t get a clear answer, life will fall apart / we’ll lose our grip on reality / we won’t be able to keep living.” Even though in the real world… you’re still sitting in the same chair, but the threat system in your head is blaring at full volume.

The crucial difference lies in the goal of the thinking.
Philosophical thinking in general is about understanding, exchanging perspectives, and then being able to put it down.

Existential OCD is thinking in order to “feel safe” and to “get rid of uncertainty”—which is almost an impossible mission for topics like these.

When that mission fails, the brain becomes even more alarmed and orders even more thinking—creating an OCD cycle that looks quiet on the outside but is extremely energy-draining on the inside.

Many people describe it as being forced to watch the same movie over and over without being allowed to leave the theater, and every time the movie “ends,” it still doesn’t end, because the ending never truly “closes the account.”

Another thing that makes this theme so tormenting is that a lot of the compulsions are rituals inside the mind, not hand-washing or door-checking that others can see.

For example, “arguing with the question in your head” to find the right answer, “analyzing your feelings” to see whether you truly feel something, “testing your sanity” to see if the world is real, “running through the logic” until it feels perfect.

It also includes searching for evidence via consuming content—reading philosophy, watching cosmology videos, digging through forums, asking others, seeking reassurance—just to feel secure for a moment.

The problem is, that relief usually doesn’t last long, and then the brain bounces back with a new question, a new angle, or a new counter-argument, making you feel like you’re “trapped in a maze of thoughts.”

Existential OCD loves to disguise itself as “intellectual seriousness,” which makes many people hesitate to call it a symptom.
Some people think, “I’m just a thinker,” or “I’m going through an awakening,” when inside there is very clear suffering: can’t sleep, can’t work, concentration shattered, joy gone, relationships disrupted.

And the nasty part is: when you try to escape (e.g. forcing yourself not to think, suppressing it, avoiding content), it often rebounds harder, because the brain interprets it as, “This topic is truly dangerous, so we must keep an eye on it.”

In the end, life starts to revolve around one single mission: “I must find the answer before I can live my life.” Even though the truth is… life does not need to wait for an answer before it can move forward.

So the most accurate way to capture the core of this Overview is:
Existential OCD is not just about the questions themselves; it’s about your relationship with uncertainty.
It is a disorder of “trying to make the brain feel 100% certain” about things whose very nature is “they can always remain uncertain.”

And the cycle that keeps it going is using “repeated thinking / searching for answers / checking for certainty” as a kind of self-sedative—bringing short-term relief while making the loop stronger in the long run.

The goal of understanding Existential OCD is therefore not to find the final answer to the universe.
It is to be able to see that “this is OCD using questions as bait,” and to start training the skill of staying with the question without performing rituals, until the brain learns that it does not need absolute certainty in order to be safe.

2) Core Symptoms

A) Obsessions (intrusive thoughts/images/questions)

In Existential OCD, the “main character” is not germs, not fear of contamination or disease, but philosophical / existential questions that pop up by themselves and get stuck on repeat, like a tab you can’t close.

Let’s look at the core clusters of obsessions, broken down by theme and the moods that tend to come with them:

1. Meaning / purpose of life (Meaning of life)

Most people have wondered, “What is my life for?” and can still get up and go eat afterwards.
But in Existential OCD, it feels more like:

“If life truly has no meaning, then why should I do anything next?”

“Working, having a family, doing everything… is it all just pretending and lying to myself?”

These questions don’t just pass through—they hang there like a browser tab left open permanently, making it hard to focus on anything else, creating feelings of emptiness and exhaustion even if you haven’t done anything physically demanding.

2. Reality / perception (Reality, “What is real?”)

This cluster revolves around questions like “What is real?” For example:

“What if this world is a simulation?”

“Am I dreaming right now? How can I prove that I’m awake?”

“If all feelings are just electrical signals in the brain, is there anything truly ‘real’ beneath them?”

The problem is, no matter how much you think, there is never a 100% answer—but the OCD brain interprets that as “I haven’t thought enough yet; I haven’t found enough evidence yet,” and orders you to keep thinking indefinitely.

3. Self / sense of “I” (Self, Identity, “Do I exist?”)

This comes with thoughts like:

“If I’m just a bundle of thoughts, then what is the ‘real me’ exactly?”

“If I can observe myself from the outside, then who is the ‘I’ that is observing?”

“Am I truly the same person, or am I just playing a role?”

Thoughts like these may extend into feelings of derealization or depersonalization—feeling as if yourself/the world is not real—which intensifies the fear of “Am I going crazy?”

4. Death / nothingness / eternity (Death, Nothingness, Eternity)

This cluster hits hard because it crosses the boundary of “death” and refuses to let go. For example:

“What exactly happens when we die? Do we disappear? Continue on? Are we aware?”

“If everything really dissolves into nothing, does anything we do now matter?”

“If eternity is real, isn’t existing forever even scarier than simply disappearing?”

These thoughts don’t only appear when you’re already stressed about death; they can suddenly pop up in the middle of an ordinary day—while eating or scrolling your phone—making your heart drop, like the ground has opened up beneath your feet.

5. Universe / meaninglessness (Universe, Absurdity)

Another cluster centers on “Is everything meaningless?” For example:

“Humans are tiny in this vast universe. Doesn’t that make everything I do completely meaningless?”

“If there’s no truly objective meaning and everyone is just convincing themselves there is, doesn’t that mean we’re all lying to ourselves?”

This can turn into a sense of boredom, emptiness, and withdrawal from work/people/relationships, because “nothing really matters anyway.”

6. Meta-obsessions: thinking about your own thinking

What makes this theme complicated is that it doesn’t stop at the first question. It spawns “questions about the question,” such as:

“Just by thinking like this, does it mean I’m going insane?”

“Do normal people think like this every day, or am I abnormal?”

“If I don’t find an answer right now, does that mean I’m not taking life seriously?”

So you’re no longer just thinking about the universe—you’re thinking about “you who are thinking about the universe” too.

Common features that show up in almost every case:

Intrusive / unwanted

These thoughts/questions don’t arise because you “enjoy pondering” them, but because they ambush you when you’re not trying to think about them—while driving, walking in a mall, eating, watching a series.

Suddenly the brain throws in a heavy existential question, and you feel: “I don’t want to think about this, but I can’t stop.”

They create an emotional spike

It’s not just “I think and feel confused,” but “I think and my chest drops; it feels like the floor has given way.” You feel fear, emptiness, sadness, confusion, panic all mixed together.

For some people, it becomes clear panic: heart racing, rapid breathing, feeling that nothing is real, terrified that they are losing their mind.

Intolerance of uncertainty = cannot tolerate not knowing

The core of OCD is “I must know for sure; I need 100% certainty.”

But most existential questions are things that “no one can answer perfectly anyway.” So an OCD brain is stuck in a loop all the time, because it is playing a game that is unwinnable by design: trying to turn something born uncertain into something fully certain.

B) Compulsions (behaviors/rituals to reduce anxiety)

In Existential OCD, most compulsions are not washing hands or checking locks, but mental rituals.
The common thread is: you “do something” to feel relief, to feel in control, or to silence the question for a while.

We’ll divide them into groups to make them clearer:

1. Mental rituals – “thinking in a ritualized way”

Ruminating – sitting and circling around, searching for answers without end
This is not just casual thinking; it’s a systematic effort to find an answer. For example:

Replaying reasons 1–10 in your head every night to reach a conclusion.

Arguing with yourself in your head like a philosophical debate that never ends.

Deciding, “I have to get this clear tonight or I won’t be able to sleep,” and then never actually feeling clear.

The difference between intellectual curiosity and OCD here is: if it’s curiosity, you can put it down when you’re tired; if it’s OCD, you feel guilty/afraid/anxious if you don’t think until you feel relief.

Mental checking – repeatedly scanning your own mental state
For example:

Checking, “Right now, do I feel like everything is real?” / “Do I still have a sense of self?”

Looking in the mirror frequently to check, “Am I still myself?” (On the surface it looks like checking your face, but really you’re checking existentially.)

Testing yourself in your head: “If I think the world is not real right now, how scared would I be? What would that mean?”

This is repeated self-scanning, like constantly checking the pulse of “reality” and “self-ness.”

Neutralizing in your head
For example:

When you think about the emptiness after death and feel scared, you repeat in your head, “No, no, the world has meaning,” over and over to cover it up.

Using positive phrases or mental images to overlay every time your brain throws an existential question at you.

Creating a certain logical framework and “playing it again” to feel secure, such as repeating, “As long as I feel pain or joy, I must have a self.”

This can look like positive thinking, but in reality it’s a ritual done out of fear, not because you genuinely want to see the world in a positive light.

2. Reassurance – chasing certainty from the outside

Asking people / experts / the internet over and over
For example:

Asking, “Everyone thinks like this sometimes too, right? I’m normal, right?”

Emailing/messaging therapists or online groups repeatedly to ask, “This is OCD, right? I’m not crazy, right?”

Asking friends/partners, “Do you feel like life has meaning? Tell me about it,” using their answer to suppress your own fear.

The problem is that every reassurance only helps briefly, and then the brain will raise the question again from a deeper or stranger angle.

Research / obsessive Googling
This means endlessly searching philosophy, religion, science, cosmology, reading deep articles, studying thinkers from all eras to “find one answer that makes me feel at peace.”

If you feel like you’ve been “studying philosophy/cosmology” your whole life even though your actual degree is in something else, you may need to check if you’re doing it for enjoyment or because “if I don’t find the answer, I won’t be able to live.”

3. Avoidance – avoiding triggers

Avoiding certain content
For example, not watching movies/series about multiverse, identity, death, meaninglessness; not reading philosophical articles; not touching religious topics, etc., because you know:

“If I touch this, my brain will burn me for the next three days.”

This can look like self-care, but if you avoid it purely out of fear that “the loop will start,” then it’s avoidance that actually strengthens the OCD.

Avoiding silence / being alone with your thoughts
Many people can’t stand silence; they must have music/podcasts/videos on all the time because they’re afraid that if everything is turned off, their brain will start firing existential questions nonstop.

This is another form of compulsion: using constant auditory/visual stimulation to seal off their thoughts so they don’t have to face them directly.

4. The classic cycle: Obsession → Anxiety → Compulsion → Relief → Obsession (Repeat)

Overall, it looks like this:

Obsession: A disturbing question pops up, like “What if life has no meaning at all?”

Anxiety: An emotional spike—heart dropping, fear, emptiness, despair.

Compulsion: You do something to reduce the fear—think harder for reasons, search the internet, ask others, or try to suppress the thought.

Relief: A little relief, like lifting your head above the water to breathe.

Obsession returns: Soon, the brain throws the same question back at you, or a newer, more subtle version of it.

This cycle repeats until almost the entire day is spent “managing the questions in your head” instead of actually living your life.

3) Diagnostic Criteria

As mentioned earlier: in the DSM there is no separate category for “Existential OCD.” A clinician will diagnose OCD and then note that “the content theme is existential/philosophical.”

But the core diagnostic criteria for OCD can be applied to Existential OCD directly.

Let’s look at each criterion in more detail:

Criterion A: Presence of obsessions and/or compulsions

1. Obsessions generally have these characteristics:

They are thoughts/images/impulses that recur and are unwanted (recurrent & intrusive).
It’s not “I decide to sit and think about philosophy,” but “I don’t want to think about this right now, but my brain throws it at me anyway.”

Most people with OCD feel:

“This is too much thinking / too obsessive / doesn’t make sense, but I can’t stop it.”

In other words, there is a certain level of ego-dystonicity (you feel like this is not how you want your mind to behave).

In Existential OCD, the content tends to revolve around life’s meaning, reality, death, self, etc.
But for diagnosis, the focus is not on what the content is, but on the pattern—does it intrude repeatedly and cause real distress?

2. Compulsions generally have these characteristics:

They are repetitive behaviors (repetitive), either visible (speaking, asking, searching) or purely mental (ruminating, re-checking, constructing logic to suppress fear).

The main goals of compulsions are:

To reduce anxiety / to feel relief.
To push the “terrible possibility” further away, e.g. “If I can find the answer, I won’t feel like I have no self.”

If you don’t perform them, you feel extremely restless, sometimes to the point that you can’t work or sleep.

Criterion B: Time-consuming / causing significant distress / impairment in functioning

OCD is not diagnosed just because someone has “strange thoughts.” It’s diagnosed because of the impact on life, such as:

Spending more than 1 hour per day on thoughts and rituals (and with Existential OCD, it can easily reach several hours, because the thinking can run silently while you’re doing other things).

Work/study/creative output starts to deteriorate because your brain is never free enough to focus on other tasks.

Relationships are affected, for example:

You don’t really hear your partner because you’re stuck in your own inner questioning.
You always need others to reassure you until they get exhausted.

Enjoyment in life decreases: things you used to enjoy (series, books, games, hobbies) become just background noise while your brain continues to ask existential questions.

You feel hopeless and discouraged with yourself, thinking, “Why can’t I stop thinking about these things?”

This part is very important:

If you just like talking about philosophy as a hobby, but can still work, sleep, laugh, enjoy other things, and you don’t feel hunted by your thoughts 24/7,
that may not be OCD.
But if it clearly “eats your life,” that’s the zone where clinicians start to strongly suspect OCD.

Criterion C: Symptoms are not due to substances or a medical condition

Clinicians will check that:

You’re not intoxicated / under the influence of substances that could directly cause odd symptoms.

You don’t have a brain disease/medical condition that would explain your symptoms better, such as a brain tumor, seizure disorder, etc.

If symptoms are primarily due to substances or a general medical condition, they are classified under a different category, not as primary OCD.

Criterion D: The disturbance is not better explained by another mental disorder

Here the question is, “Is this really OCD, or is something else a better explanation?” For example:

If it’s a psychotic disorder (e.g., schizophrenia):

The content of thoughts may be similar (questions about meaning, reality, existence), but in psychosis the person may fully believe that their thoughts are 100% true and not see them as a problem.
In OCD, most people still have some degree of insight: they know that “these thoughts may be exaggerated / this way of living is not reasonable—but I can’t stop.”

If it’s GAD (Generalized Anxiety Disorder):

GAD typically focuses on everyday practical worries—money, work, family, health. Existential themes may appear, but they are not usually the core of the loop.
OCD tends to show a clear pattern of obsessions–compulsions, such as specific mental rituals, or behaviors performed to get relief.

If it’s Major Depression:

Depressed people can also think about life being meaningless, but often these are mood-based thoughts (thinking this way because they feel worthless/hopeless), not obsessive loops where they feel they must find the “correct answer” to feel better.
In Existential OCD, mood may fluctuate more in line with “How much do I feel like I have an answer/confidence today?” rather than purely with depressive mood.

In reality, properly distinguishing these requires a qualified clinician/psychologist. It’s not something you need to sit and analyze alone in your head (because that easily turns into another obsession-plus-compulsion loop).

Key points about Existential OCD that often get overlooked

Even if there are no visible compulsions (no hand-washing, no lock-checking),
it can still be OCD if you are performing heavy mental rituals/neutralizing in your head—ruminating, gathering evidence, constructing logic to counter fear, constantly seeking reassurance.

Sitting and checking yourself with “Am I having OCD or am I actually going crazy?” and then thinking about that for hours every day
can itself become another loop of obsession + compulsion.

A real diagnosis requires structured, in-depth interviewing with a professional.
Articles and explanations like this exist to:

Help you name what is happening inside you.
Help you see that “you are not uniquely broken or alone.”
Help you know that there is a recognizable pattern and there are treatments.

They are not meant to give you more material to over-analyze yourself and accidentally create a brand-new compulsion for free.

4) Subtypes or Specifiers (sub-themes / specifiers)

A) “Theme/Subtype” (informal, used for communication)

Existential / Philosophical OCD: preoccupation with questions about meaning, reality, self, and death.

“Primarily obsessional / mental rituals” (sometimes mistakenly called “Pure O”): looks like “only thoughts,” but in reality there are compulsions inside the mind.

B) Formal specifiers (for OCD in general)

Insight specifier: how much the person recognizes that their beliefs/fears may be unreasonable (good/fair, poor, or absent insight).

Tic-related: whether there is a history of tic disorder in the individual (in some cases).

5) Brain & Neurobiology

When we talk about Existential OCD, we’re not just talking about “lofty philosophical thinking.”
We’re talking about a brain wired in an OCD way that happens to use the theme of “life’s meaning / reality / death” as its battlefield.

5.1 Core circuit: CSTC – the “error-detect, never close the case” loop

The big picture that researchers often describe is the CSTC – cortico-striato-thalamo-cortical circuit.
The name sounds fancy, but if we break it down, roughly:

Cortex (especially orbitofrontal cortex, anterior cingulate cortex)
This region is involved in:

Evaluating “Is something wrong?”
Deciding “Should I act / not act?”
In people with OCD, this circuit tends to be over-sensitive to the sense that “something is not okay yet; something isn’t finished.”

Striatum (especially caudate nucleus)
Involved in:

“Shifting gears” from one thought to another.
Switching from an old behavior pattern to a new one.
If the “gear” gets stuck, it becomes “thought loops” or “ritual loops” where you can’t change the subject.

Thalamus
Acts as a “traffic hub” for neural signals.
If signals from cortex/striatum keep looping, it’s like allowing electrical current to keep circulating in the same circuit again and again.

What’s the sum of all this?
A brain that “detects every possible error but can’t close the case.”
This is the core pattern seen in OCD in general—whether the theme is germs, safety, morality, or, in this case, existence/meaning.

5.2 How is this mechanism applied to the existential theme?

Imagine it like this:

The part of the brain that detects “something’s off / uncertain” (error detection) is more sensitive than average.

When it encounters an existential question like, “Maybe life has no meaning at all,” then:

A typical brain: “Hmm, could be, interesting thought,” thinks briefly and then goes off to eat.
An OCD brain: “Hold on—this is huge. If we don’t clear this up now, it means we’ve been living life in the wrong mode all along.”

Then the CSTC loop kicks in:

Cortex triggers an alarm: “ERROR: Not sure if life has meaning → must investigate further.”

Striatum doesn’t shift gears: you stay stuck on the same question—“So does it have meaning or not?”—over and over.

Thalamus keeps sending the signal back to the cortex → turning into “think again and again, circling endlessly.”

What makes Existential OCD particularly painful is that
the content the brain is looping on is something that no one on earth can finalize 100% anyway.
So the circuit never gets the chance to say, “Okay, done, case closed.”
It just keeps running the same path: “still not sure → think more → still not sure → think more.”

5.3 The “confidence system” hanging in midair

From a neurocognitive perspective, several theories suggest OCD may involve distorted confidence judgements.

A typical person:

“Okay, I’m about 80% sure, that’s enough, I can’t be bothered thinking further.” → the brain closes the case.

An OCD brain:

“80% is not enough. It has to be 100% to be safe/right/to live properly.”

When this “must be 100%” trait clashes with existential questions whose very nature is “you’ll never reach 100%,”
it’s like trying to grow a plant that needs full sunlight every day… inside a cave. Structurally, it can never really work from the start.

5.4 Neurotransmitters: serotonin, dopamine, glutamate, etc.

Serotonin

A major clinical observation in OCD is that SSRI medications (which increase serotonin in synapses) help reduce symptoms in many people.

This has led to the hypothesis that serotonin systems in the CSTC circuit are dysregulated, making the error-detection and compulsive loops overactive, so medication is used to “turn down the volume.”

Dopamine / Glutamate

Some models suggest that the dopamine system (involved in reward and learning from outcomes) also plays a role.

If the brain “rewards” you every time you perform a compulsion and your anxiety drops → it learns, “This is correct; do it again.”
Existential OCD thus becomes a game the brain likes to play: “ruminate → feel distressed → perform a ritual (think more/check/ask/search) → feel relieved → brain records: ‘Well done, do that again.’”

Glutamate is also discussed in some research as a neurotransmitter related to the CSTC circuit and its plasticity.

For patients in everyday life, what this means in practice is: there is evidence that OCD involves changes in multiple neurotransmitter systems—it’s not just “weak willpower” or “thinking too much for no reason.”

5.5 Networks beyond CSTC: the brain is not just one straight line

Recent research suggests OCD is not just about a single CSTC loop and done.

It involves broader networks, including:

Networks involved in self-referential thinking (e.g., the default mode network – DMN).

The salience network (what the brain tags as especially important).

Executive control networks (controlling behavior and shifting focus).

For Existential OCD, this is very relevant:

The DMN is activated when “thinking about oneself / the past / the future / the meaning of life.”

In someone stuck in existential loops, this network may be over-engaged, like a machine that never enters a true rest mode.

The salience network may tag existential questions as “very, very, very important,” and refuses to let them be ignored.

The executive control network tries to pull the brain back to work/daily life but loses against the pull of the error signal + the craving for certainty.

5.6 Summary you can actually use

Existential OCD is not “a person who thinks too much / is overly philosophical.”
It’s a brain where the error-detection circuit, the confidence system, and the reward system for compulsions are out of sync.

The existential theme is just the “story” these circuits choose to play out; the underlying mechanisms are similar to other OCD themes.

That’s why treatments like ERP + SSRIs help—not because they make you better at philosophy, but because they adjust the circuits that make you compulsively obsess over those questions.

6) Causes & Risk Factors

There is no single “cause” that makes someone develop Existential OCD.
It’s a layering of many factors: genetics + brain + personality + life experiences + environment/culture + stress at certain times.

We’ll break it into layers:

6.1 Biological layer: genetics + brain + development

Genetics / family history

OCD research as a whole finds that people with first-degree relatives who have OCD/anxiety/depression are at higher risk.

That doesn’t mean “if your parents have it, you must have it,” but it does mean certain brain tendencies may be inherited, such as:

Sensitivity of the error-detection circuit.
Ability (or lack thereof) to tolerate uncertainty.
Tendency to get stuck in loops of thoughts/worries.

Brain development in childhood/adolescence

This is when the brain is developing executive functions (controlling thoughts, shifting attention, making decisions).

If during this time, there is a combination of genetic risk + stressful environment + learned patterns of obsessive/compulsive behavior,
→ the risk of developing OCD in adolescence/adulthood increases.

Other co-existing conditions (neurodevelopmental/psychiatric)

ADHD, Autism spectrum, anxiety disorders, etc., can make it harder to manage thoughts and emotions.

When the brain is already tired from dealing with those, an existential loop can latch on more easily.

6.2 Personality and thinking style

Perfectionism (especially moral/intellectual perfectionism)

Needing to understand things “perfectly, correctly.”

Not accepting approximate or halfway answers.

Needing a “theory/framework” that seems to lock everything down.

→ When this meets existential questions that can only ever be answered with “it depends on perspective,” this kind of brain feels like it’s encountering a massive bug it cannot accept.

Intolerance of Uncertainty

Typical person: “I don’t know, and that’s fine. Life’s like that.”

Person with OCD: “If I don’t know, that equals danger / I can’t live like this / I must find out now.”

→ This feeling turns every existential question into a threat, not just something they can live with.

Analytical / overthinking style

People who naturally think very analytically can end up “feeding” OCD without realizing it.

A trait that is a gift (strong thinking, analysis) becomes a double-edged sword when the brain applies that analytic mode to questions that can never be fully confirmed.

That’s why in Existential OCD, you often see people who are the “I like to think, read, learn” type—but their braking system is broken.

6.3 Life experiences and environment

Trauma / loss / shock

Sudden loss of an important person.

Severe accident.

Near-death experience.

These can trigger people to start asking, “What is life, really?” and in some, if the brain structure + personality already have OCD tendencies, that question gets “stuck in a loop” and becomes Existential OCD.

High chronic stress

Long-term stress about money, work, family, health that never seems to resolve.

A brain stuck in survival mode might start seeing the world through a frame of “What’s the point of surviving / for what?”
If this coincides with a period where OCD is active, the existential theme becomes the battlefield.

Content/culture that feeds existential questions without a filter

Binge-watching movies/series/clips/articles about nothingness, unreality, multiverse, simulation, nihilism, etc.

For people without an active OCD system, this may just be “Wow… cool, fun to think about.”

But for someone whose error-detection + intolerance of uncertainty is already amped up, this can become a powerful trigger to start spinning non-stop.

6.4 Belief systems and worldview

Religious/philosophical/worldview background in childhood

Growing up in a home that is very strict about religion/morality → when existential questions arise later, they can trigger guilt and fear of being sinful or wrong.

Growing up in a home where “these topics are never discussed,” but then being thrown into an online world where everyone debates them intensely → the brain feels like it’s being thrown into an arena with no manual.

When old beliefs are challenged and there is no new framework to safely hold things together, OCD can step in and take over the role:

“Fine, then we’ll spend 24 hours a day in our head trying to sort this out until we feel safe again.”

Major religious/belief shifts

Someone once held a very strong belief system, and then one day it collapses (e.g., being deceived, abused by someone within that system).

The brain feels as though “the foundation of reality” has been pulled out.

If there is existing vulnerability to OCD, this becomes fertile ground for Existential OCD.

6.5 Comorbidities (co-occurring conditions)

Depression

Depression makes the world look bleaker; existential thoughts like “life is worthless / I don’t want to be here” become stronger.

If OCD is operating in the background, these are not just “sad thoughts,” but can become “obsessive loops about meaning that keep you up at night.”

Other anxiety disorders (GAD, Panic Disorder, etc.)

They raise baseline physical arousal and anxiety.

When an existential trigger appears, it’s very easy for it to escalate into panic + endless thought loops.

Certain personality traits

For example, high obsessive-compulsive traits, high perfectionism, high avoidant tendencies.

This doesn’t mean you necessarily have a personality disorder, but that your patterns of thinking/feeling/responding can strengthen OCD.

**6.6 Things that are not causes (but people love to blame themselves for)**

To clear up a lot of misplaced guilt:

Existential OCD does not arise because you’re stupid / overthinking / have nothing better to do.

It does not arise simply because you “read too much philosophy.”

Reading/thinking deeply can be a contributing/enabling factor in someone who already has underlying risk.
But it’s not the only factor that creates OCD.

It is not because you’re “too sensitive” or “too afraid of death” in a blame-yourself way.

Fear of death is very human and quite normal.
The difference is: your brain’s circuits have chosen this topic as the playing field for OCD.

6.7 Practical summary

Don’t go looking for one single culprit that “caused” your Existential OCD.
It’s the intersection of brain + genetics + thinking style + experiences + stress at certain times.

What is more useful to ask is:

Right now, what are your main triggers (being alone in silence, certain content, stress about work/life, etc.)?
How do you respond (what rituals give short-term relief but tighten the loop long-term)?

Because treatment (especially ERP + CBT) does not aim to fix “whether the world has meaning.”
It aims to change what you do next when your brain throws that question up.
And gradually teach your brain that “you can live without 100% answers, and you can survive without doing rituals every time.”

7) Treatment & Management

A) CBT with ERP = the “real deal” for OCD

The main approach is CBT combined with Exposure and Response Prevention (ERP).

The principle: intentionally expose yourself to triggers/uncertainty, and then refrain from rituals (response prevention), so your brain stops believing that it must perform compulsions in order to be safe.

For cases that look like “obsessive thoughts without clear compulsions,” NICE guidelines recommend CBT that includes exposure to the thoughts themselves and response prevention targeting mental rituals/neutralising directly.

Examples of ERP that fit Existential OCD (conceptual, not a personal treatment plan):

Practicing “staying with the question” without answering it—for example, deliberately allowing the sentence “We may never know” to sit in your mind.

Doing exposure by reading/listening to trigger topics in a structured way and then not allowed to:

Google for more answers,
Debate it in your head until you feel calm,
Seek reassurance from others or from yourself.

The goal is not to “think less,” but to “be able to think without needing to do rituals.”

B) Common medications

SSRIs are the main class of medication widely used for OCD.

Clomipramine may be considered when SSRIs are ineffective or not tolerated, according to NICE recommendations.

In real life, “medication + ERP” often function as a team: medication lowers the pull of the loop, and ERP teaches the brain to stop playing the game of “I must be completely sure before I can live.”

C) Helpful additional skills (so ERP doesn’t stand alone)

Psychoeducation: separating “philosophical questions” from “OCD processes.”

Mindfulness / detached mindfulness: seeing thoughts as thoughts, not puzzles that must be solved right now.

ACT-style stance: choosing to act according to your values even while the brain is still asking questions.

Lifestyle that calms the nervous system: sleep, exercise, moderate caffeine (doesn’t cure OCD, but reduces friction).

8) Notes (key observations, straight-up)

Existential OCD is very good at deception because it wears a suit labelled “I’m just a deep thinker,” when in reality it’s “I’m performing rituals to escape uncertainty.”

Trying to find a perfectly complete answer is usually gasoline on the fire.

If you also experience depersonalization/derealization (feeling not real / the world not real), it can amplify the “What is reality?” theme—but it can still be treated within an OCD framework (a professional assessment is the clearest way to map it).

If you have thoughts of self-harm or intense hopelessness, seek urgent help in your area immediately—this is not the time to be cool about it.

Read OCD (Obsessive–Compulsive Disorder)

References

Neurobiology / Brain circuits / Neurotransmitters

Goodman WK, Storch EA, Sheth SA. Harmonizing the Neurobiology and Treatment of Obsessive-Compulsive Disorder. Frontiers in Psychiatry. 2021.
Li B et al. Cortico-Striato-Thalamo-Cortical Circuitry, Working Memory, and Obsessive-Compulsive Disorder. Frontiers in Psychiatry. 2016.
Zhang H et al. Altered Functional Connectivity Between the Cerebellum and the Cortico-Striato-Thalamo-Cortical Circuit in OCD. Frontiers in Psychiatry. 2019.
Gargano SP et al. A closer look to neural pathways and psychopharmacology of OCD. Frontiers in Behavioral Neuroscience. 2023.
Jijimon F et al. Rewiring the OCD brain: Insights beyond cortico-striatal models. Neuroscience & Biobehavioral Reviews. 2025.

Genetics / Risk factors

Pauls DL. The genetics of obsessive-compulsive disorder: A review. Dialogues in Clinical Neuroscience. 2010.
Blanco-Vieira T et al. The genetic epidemiology of obsessive-compulsive disorder. Translational Psychiatry. 2023.
Dhiman A. Hereditary Patterns and Genetic Associations in Obsessive-Compulsive Disorder. Comprehensive Psychiatry. 2025.
BrainHealth USA. Can OCD Be Genetic? The Family History Connection. 2025 (psychoeducation article summarizing genetics + environment).

Existential / Philosophical OCD (clinical + psychoeducation)

International OCD Foundation (F. Penzel). To Be Or Not To Be, That Is The Obsession: Existential and Philosophical OCD. 2013.
Penzel F. To Be Or Not To Be, That Is The Obsession: Existential and Philosophical Obsession. WSPS.
Psychology Today – Existential OCD: When “Why Am I Here?” Won’t Let Go. (summarises case reports + IOCDF material).
Turning Point Psychology. Existential OCD. 2020 (clinical blog explaining signs & patterns of existential obsessions).
PESI UK. “How Do I Know Who I Am?” Identifying Existential OCD. (focus on self/identity-themed existential obsessions).

Guidelines / Treatment (ERP, SSRIs, clomipramine, mental rituals)

NICE Guideline CG31. Obsessive-compulsive disorder and body dysmorphic disorder: Treatment. 2005, last reviewed 2024. (ERP + CBT, SSRIs, clomipramine; includes specific section on obsessive thoughts without overt compulsions, and mental rituals/neutralising).
NCBI Bookshelf. Obsessive-Compulsive Disorder – Treatment Section. (summarises CG31 pharmacologic recommendations: first-line SSRIs etc.).
Poli A et al. Neurobiological outcomes of cognitive behavioral therapy for OCD. Frontiers in Psychiatry. 2022. (ERP/CBT normalising CSTC connectivity).
Longdom. The Impact of Serotonin in Treating Obsessive-Compulsive Disorder. (psychoeducation on SSRIs + ERP and serotonin role).

Existential OCD, philosophical OCD, existential obsessions, obsessive-compulsive disorder, OCD subtypes, intrusive thoughts, mental rituals, compulsive rumination, pathological doubt, intolerance of uncertainty, cortico-striato-thalamo-cortical circuit, CSTC loop, orbitofrontal cortex, anterior cingulate cortex, striatum, thalamus, cerebellar connectivity, serotonin dysregulation, dopamine pathways, glutamate signaling, neurobiology of OCD, brain circuits in OCD, ERP therapy, exposure and response prevention, CBT for OCD, SSRIs for OCD, clomipramine, genetic risk factors, family history of OCD, environmental stressors, trauma and OCD onset, comorbid anxiety, comorbid depression, perfectionism traits, overthinking, analytical thinking style, default mode network, salience network, executive control network

banner

ads-d

Existential OCD