What if the question you’re obsessing about has no answer, and never will?
Most of us have wondered, at some point, what the purpose of life is. We have wondered whether we are truly happy, whether we are making the right choices, whether anything really matters, or what happens when we die. These are deeply human and profound questions.
For someone struggling with existential obsessive-compulsive disorder (OCD), however, these questions can stop being philosophical explorations and start becoming obsessive rumination and intrusive thoughts that feel urgent, stressful, and scary.
- What if none of this is real?
- What if life has no meaning?
- What if I never feel happy again?
- How do I know I am actually enjoying my life?
- What if I spend my entire life searching for meaning and never find it?
Quick Read
Existential OCD involves distressing, persistent questions about life, reality, happiness, or meaning. Unlike ordinary philosophical curiosity, these thoughts create an urgent need for certainty. People with this form of OCD may spend hours analyzing their feelings, reviewing memories, researching, or seeking reassurance in an effort to find answers.
Exposure and response prevention (ERP) therapy helps people practice facing uncertainty while resisting compulsive attempts to resolve it. Treatment focuses on allowing questions to remain unanswered and reducing the mental checking, rumination, and reassurance-seeking that keep the cycle going.
Values-based work can support this process by helping people choose how they want to live, even when doubts remain. They can nurture relationships, make plans, and participate in daily life without first proving that life is meaningful or that they will feel happy.
When Thinking Becomes a Compulsion
For people with OCD, as well as for the mental healthcare professionals who work with them, existential OCD can be particularly difficult to recognize. This is mainly because many of the compulsions that are symptoms of existential OCD play out internally.
The person may not be performing common compulsions such as washing their hands, checking a lock, or engaging in other easily observable behaviors. Instead, they may spend hours analyzing, thinking, replaying, ruminating, or engaging in other mental compulsions that cause significant distress.
People with existential OCD—between 5 and 10 percent of individuals with OCD—may replay experiences to determine whether they were genuinely happy. They may compare their current emotions to how they remember feeling years ago. They may search online for information about consciousness, death, reality, happiness, or the meaning of life. They may monitor how they feel while spending time with friends, which can lead to social isolation and relationship difficulties; one study found that existential concerns can also be associated with relationship OCD.
In response to these investigations, they may repeatedly ask themselves:
- Did I actually enjoy that?
- Am I happy enough?
- What if I am wasting my life?
- What does it mean that I am thinking about this right now?
The compulsive behavior is often the attempt to find certainty about aspects of human experience and existence that have no definitive answers.
Existential OCD vs. Existential Thoughts
This distinction between OCD and general thinking about existential topics matters. Therapy can unintentionally become another place where the person tries to solve existential dilemmas.
A thoughtful therapist may understandably want to help the client explore meaning, identify values, challenge the frightening thought, or offer reassurance. But when OCD is driving the process, more discussion can sometimes become more fuel for the OCD cycle.
The goal of treatment is therefore not to provide a better answer to the existential question, but rather to help the person stop requiring one.
Conducting ERP When the Fear Is Abstract or Intangible
Exposure and Response Prevention therapy, a form of Cognitive Behavioral Therapy (CBT), is the gold-standard treatment for OCD. But ERP can feel less straightforward with existential OCD because there may not be an obvious external trigger. For example, you cannot simply expose someone to “the meaning of life” or other philosophical questions. But you can expose someone to uncertainty about existential themes.
ERP for existential OCD could look like the following:
- A person afraid that they will never enjoy life again might intentionally say: “Maybe I will never figure out how to enjoy my life.”
- Someone preoccupied with whether reality is real might practice saying: “Maybe this is real. Maybe it isn’t. I don’t need to solve that right now.”
- Someone terrified that life could ultimately be meaningless might intentionally engage with that possibility rather than immediately trying to disprove it.
Exposure might involve reading philosophy that triggers uncertainty, writing an imaginal script about never finding an answer, watching a movie that raises questions about reality, or deliberately allowing the thought “What if none of this matters?” to remain unanswered.
But the exposure itself is only part of the work.
Response Prevention for Existential OCD
The second part of ERP therapy, response prevention, is sometimes overlooked, but it’s equally as important as exposure work for reducing OCD symptoms. When it comes to existential OCD, response prevention can address patterns of behavior and obsessive thinking such as:
- Doing excessive research
- Reviewing previous moments of happiness
- Checking whether you “feel real”
- Comparing today’s emotions with yesterday’s
- Seeking reassurance: asking another person whether your experience sounds normal
- Spending the next hour mentally debating the question
Through response prevention, the person learns to notice the mind asking for certainty and chooses not to participate in the investigation.
Integrating Values into ERP Work
Other treatment options, such as values-based work and acceptance-based approaches like Acceptance and Commitment Therapy (ACT), can fit well alongside ERP for existential OCD. There is an important distinction, however. Values should help determine how someone wants to behave, not provide evidence that their existential fears are false.
A person does not need to prove that life has meaning before behaving as though relationships matter to them. They do not need to establish that they will be happy before making plans for the weekend, nor do they need certainty about who they are before choosing how they want to show up today.
This is a very different therapeutic message from, “Let’s figure out what gives your life meaning.” When it comes to OCD, the better question is: “If you stopped trying to figure this out, what would you be doing right now?” And then we help the person do that, using practical coping strategies to support their overall mental health.
Learning to Leave the Question Open
ERP is not about convincing someone that their feared outcome will not happen. It is about changing their relationship with uncertainty enough that the answer no longer determines their behavior.
Existential OCD illustrates why that matters. For example, there may never be a perfectly satisfying answer to some of life’s biggest questions, but maybe that is not a problem. The work is learning that existential concerns and questions can exist without becoming an assignment or a compulsive need. to find answers.
Ultimately, we learn uncertainty can be present without putting life on hold. And sometimes, the most meaningful response to the question “What if I never figure this out?” is surprisingly simple: Maybe I won’t .
And then we get back to living.
Newport Healthcare’s Treatment for Existential OCD and Other OCD Subtypes
Newport Healthcare’s specialized OCD treatment for teens and young adults addresses the excessive rumination and compulsive behaviors related to existential OCD and other subtypes of the disorder. Clients’ tailored treatment plans incorporate high-dose ERP, psychiatric care, and medication management.
Our whole-person approach focuses on improving overall well-being and reducing the intense anxiety and distress caused by OCD. Along with ERP, clients engage in other evidence-based modalities, such as EMDR, mindfulness techniques, Attachment-Based Family Therapy, and experiential activities. We also treat mental health concerns that can accompany OCD, such as depression, generalized anxiety disorder, and disordered eating.
Visit our outcomes page to see the results of our effective treatment for OCD, and get in touch with our Admissions experts to learn more about our OCD programming for ages 12–35.
