Picture this: Life looks fine from the outside. Work is stable, relationships are intact, and nothing “obvious” is wrong. Yet inside, there’s a relentless, private interrogation running on a loop: Why do we exist? Is any of this real? What happens after I die? No matter how much reassurance, reading, or distraction you seek, it never calms for long. Instead of a deep or philosophical feeling, it feels like living in a constant state of panic.

Many patients secretly harbor a fear they find hard to admit: "I can’t stop pondering why we exist, whether any of this is real, and what happens after death. What's going on with me?"

Clinically, this usually isn’t classified as psychosis or simply depression. For some people, it’s a less familiar type of obsessive-compulsive disorder (OCD): existential OCD, also called philosophical OCD. Missing this information can result in years of suffering from a condition that is actually quite treatable.

From a diagnostic perspective, existential OCD is not officially classified as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Instead, it is an informal or “unofficial” subtype of OCD,........

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