“What is the meaning of life?” is a question that has spurred inspiration and curiosity for some of the world’s greatest philosophers, poets, and playwrights for centuries. Themes of contemplating the nature of human existence make for thought-provoking films, moving spiritual services, and fascinating late-night conversations with friends. However, for someone struggling with so-called Existential OCD, these questions can be more agonizing than interesting.
Existential questions are perfect fodder for those with Obsessive-Compulsive Disorder to get stuck on, due to their uncertain and abstract nature. Common obsessions for those struggling with Existential OCD can look like:
“What is the meaning of life?”
“What will happen after I die?”
“Do we have free will?”
“What if I am living in a simulation?”
“Am I really me?”
These thoughts can bring on a variety of distressing feelings for sufferers such as anxiety, depression, and depersonalization/derealization also sometimes referred as DP/DR. According to the Cleveland Clinic, depersonalization is characterized by feeling disconnected from your thoughts, feelings and body, whereas derealization can be characterized by feeling disconnected from your surroundings or environment. Other symptoms of DP/DR can consist of feeling “robot-like” or that those around you seem robotic, feeling emotionally numb, or feeling like you are “living in a dream world”.
Because of the distressing nature of the thoughts and feelings that coincide with Existential OCD, sufferers may find themselves engaging in compulsive behaviors in search of relief. Common compulsions can include:
Researching philosophical, religious, and scientific ideas for answers about existence
Asking others what their perspective is on the meaning of life
Trying to “figure out” questions about existence with excessive rumination
Checking to see if they “feel real”
Avoiding people, places, or media that remind them of this topic
Although this topic may seem like it encapsulates “the uncertainty of all uncertainties," the same combination of Acceptance and Commitment Therapy (ACT) and Exposure Response Prevention (ERP) is proven to be effective for gaining relief from these symptoms.
When someone is in the midst of struggling with existential fears, they may often be “fused” with various thoughts and feelings. For instance, this could look like someone struggling to not ruminate on the thought “What will happen after I die?” It can be useful for people to get practice with defusion skills, allowing them to “unhook” or have more space between themselves and the thought. This can be done in a variety of ways, but some examples include:
“I notice I am having the thought about “what will happen after I die?”
“Thanks, brain for giving me the thought about “what will happen after I die?”
Mindfully watching the thought “What will happen after I die?” as if the words are spread across a cloud floating by
This assists individuals in building the skill of allowing thoughts and feelings to come and go without attempting to “figure them out” with rumination or push them away as an attempt at avoidance.
Ironically, when one is struggling with this subtype of OCD, they begin to neglect their values, the very things that give their life meaning in the first place! Therefore, another useful aspect of treatment is helping people identify the most important aspects of their lives. For instance, someone may identify that they place importance on their physical health, spending time with their loved ones, and living in the moment. Through exploring their values, they may be able to see the ways they are currently “moving away” from living in alignment with them. This could look like excessively googling “the meaning of life” instead of going to bed at a reasonable time, avoiding a sick family member that reminds them of their thoughts about death, or trying to assess if they are feeling “real or not” instead of being present.
An individual struggling with Existential OCD will also likely need some practice sitting with difficult feelings without seeking relief from them. Building out a ladder of various actions (exposures) according to difficulty and coming up with new rules to reduce rituals (response prevention) can be a good place to begin. Items on this ladder could include exposures such as:
Reducing amount of time you can google search an existential question (ex: 15 minutes a day)
Reducing the amount of times you ask for reassurance from a loved one about existential questions (ex: 1x a day)
Putting a sticky note on your mirror stating something like “Life may or may not have meaning” to practice noticing this and moving on with your day
Writing out a script about never finding the answer to your existential questions and reading it out loud
Watching a movie or listening to a song that brings on distressing feelings (The Matrix, Inception, The Truman Show)
While carrying out exposures, it is important to keep in mind the response prevention part of ERP. For example, this could look like an individual really wanting to google something about living in a simulation after watching the Truman Show, but resisting that urge in order to expand their brain’s capacity to sit with discomfort and uncertainty.
By gaining skills of mindfulness, improved tolerance for difficult thoughts and feelings, increased acceptance of the unknown, and awareness of personal values, individuals can begin to actually live more of the life they want to live. The assistance of a trained professional familiar in working with OCD can be beneficial on the road to recovery.
Reference:
https://my.clevelandclinic.org/health/diseases/9791-depersonalization-derealization-disorder
