The OCD Cycle                                                                                                                       

We live in a society where we do not like to be uncomfortable and where we have difficulty tolerating distress. Anxiety is an emotion that has a lot of negative connotations and leads us to quickly try to find solutions and go into problem solving mode. For some people, the danger signal gets attached to everyday neutral things like other people, social situations, doorknobs, dogs, physical sensations or emotions. The actions we take when anxiety is present is called safety behaviors, or within OCD, compulsions. These actions are meant to decrease our distress, which they do, but only temporarily. Some common safety behaviors are avoidance of anxious triggers, reassurance seeking, researching, substance use, washing, counting, etc. Because these behaviors actually work (but only in the short-term), people continue to use them. Unfortunately, continuing to rely on these behaviors causes individuals to get trapped in this cycle and prevents them from learning that the fear was unfounded or tolerable. Ironically, these safety behaviors and compulsions actually only maintain the fear in the long run while simultaneously preventing growth and learning, which can severely limit an individual’s life. The thought, situation, emotion, or body sensation that creates the anxiety might be different within each presentation of OCD, but the cycle that maintains anxiety is exactly the same.

Please see our previous blog entry – Understanding the Cycle of Anxiety – for further information.

What is Existential OCD?

Existential OCD is a subtype of OCD defined by obsessions and compulsions related to a preoccupation with philosophical questions about meaning and purpose as well as existence and reality. While many people can be curious about these topics, individuals with OCD experience a high level of anxiety and fixate on determining answers to topics and questions that are unanswerable.

Common Obsessions with Existential OCD

Obsessions may include intrusive thoughts including:

• Where did we come from?
• Why are we here?
• What about the afterlife?
• What is the meaning of life?
• What if I am not really here?
• What is the point to life if I am not actually real?
• What is the purpose of life?
• How do I know if I am in love?
• Why am I here?
• What if my whole life has been a simulation?
• What should I be doing with my time on earth?
• Why do I have consciousness?
• How do I know if this is real?

These thoughts can create a high level of anxiety for the individual and make them feel a need to engage in compulsions and/or rituals in an attempt to mitigate their doubts. These intrusive thoughts can also impair their ability to concentrate at school or work and to connect with their loved ones, which creates additional obstacles and barriers to overcoming OCD.

 Common Compulsions with Existential OCD

Compulsions are defined as any intentional thought or behavior done in an effort to neutralize or reduce the distress caused by an individual’s anxiety. With Existential OCD, these can include:

• Researching and looking up answer to their questions (philosophical, psychological or religious texts)
• Mental reviewing questions and trying to come up with answers in their head
• Seeking reassurance by asking family members or friends questions to get answers to their doubts
• Excessive prayer for wisdom and divine guidance
• Engaging in reality-testing exercises to see if they are real (pinching themselves)
• Avoiding places that trigger these thoughts
• Rumination (Please see our previous blog entry – Rumination — for more information)
• Mentally evaluating and comparing their thoughts and feelings with others
• Religion hopping

 Treatment of Existential OCD

The most evidence-based treatment for Existential OCD is Exposure and Response Prevention (ERP) and Acceptance and Commitment Therapy (ACT). Through ERP, individuals can engage in exposures to help them to learn to tolerate uncertainty, discomfort, and doubt that their OCD creates, especially because these thoughts and questions often do not have answers. Exposures can include anything that triggers uncertainty about the nature and existence of the universe, including creating worry statements, watching certain movies (Matrix, Shutter Island, etc.), reading articles, or posting comments or statements around their house that creates the uncertainty that they fear. Through anxiety counseling in Orland Park that focuses on exposing individuals to these thoughts and having them refrain from engaging in compulsions, individuals are able to teach themselves a new way to respond and will likely experience a reduction in anxiety. If their anxiety does not decrease, they will at least learn that they can handle the anxiety and uncertainty that these thoughts create. Please see our previous blog entry — What is Exposure and Response Prevention (ERP) – for more information about this treatment.

Within ACT, individuals are introduced to the concepts of mindfulness and acceptance, helping them to be present with these thoughts without trying to change them or engage in compulsions. Interventions focusing on increasing acceptance of uncertainty and doubt are necessary to supplement ERP work in the treatment of Existential OCD. Using ACT-based strategies, individuals are better able to differentiate their thoughts and values from their OCD and identify if the behaviors they are engaging in provide them joy and pleasure (which is the goal), or if they are behaving in response to anxiety and uncertainty stemming from their OCD. They are able to learn to be aware of their thoughts and fears while not paying more attention to and/or over-engaging with them. The goal is to learn to live life and participate in activities that are important, even if the thoughts are present. Thus, ACT is employed to increase psychological flexibility and reduce the cognitive rigidity seen in OCD by helping people to defuse from their obsessive/intrusive thoughts and maintain a present-focused awareness. Outside of therapy, individuals with Existential OCD can also benefit from medication.

 Need help or support?

If you or a loved one are struggling with OCD or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about these diagnoses and how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE.

For these or any other mental health concerns, please contact The OCD and Anxiety Center at (630) 522-3124 or info@theocdandanxietycenter.com. We have offices in Oak Brook and Orland Park that specialize in helping individuals overcome anxiety. We provide telehealth services that are available in Illinois, Indiana, and Iowa.

At The OCD and Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, etc.). We will work closely with you to create an individualized treatment plan and discuss the frequency of visits, having the ability to meet with you once a week or more if needed. We look forward to hearing from you!

Click here for more information on OCD Treatment.

Jacqueline Jones is a licensed clinical social worker at The OCD & Anxiety Center in Oak Brook, IL.  She specializes in treating all forms of OCD and anxiety in children, teens, and adults.  She provides Exposure and Response Prevention Therapy and is comfortable working in and outside the office, wherever anxiety happens.