Existential OCD: An Obsession with Why

Most of all, it’s more nuanced: While OCD can involve obsessions and fears that focus on order, organization, or cleanliness, it can involve many other things too. In fact, there’s really no limit to where OCD latches on.

One little known (or at least rarely discussed) type of OCD is Existential OCD. Sufferers of this OCD “flavor” experience intrusive, scary, and repetitive thoughts that involve questions impossible to answer. These questions may focus on the meaning of life, the purpose of existence, the challenge of what’s real and what’s imagined, or the fear that one’s living inside an alternative reality. Individuals may also obsess, over and over again, about why they’re on this planet.

Existential thinking, in itself, is not necessarily a sign of OCD; surely most anyone, at one time or another, has questioned the meaning of life or their purpose in the grand scheme of things. Drunken nights with friends and college philosophy classes are ripe with conversations on this subject matter.

But Existential OCD isn’t marked by curiosity or interest; it’s marked by anxiety and fear. It’s not enough for the sufferer to benignly ponder the inner workings of the universe, they must spend hours going over and over the same questions and engage in rituals in an attempt to assuage their angst-causing doubts. The inability of the sufferer to solve the riddles of the world and know with certainty the who, what, and why of life causes an endless cycle of worry.

OCD: The Gist

Compulsions act as the partner to obsessions, a duo that is anything but dynamic to those who understand this illness. Sufferers engage in compulsions in order to neutralize their anxiety. This creates an obsession/compulsive cycle – the sufferer experiences an intrusive thought, they engage in a compulsion, they feel momentarily relief, a new intrusive thought comes along, they engage in a compulsion, and so on.

OCD cycles are progressive; the more the suffer engages in compulsions, the more obsessions they’ll have. Another way to think about this is to imagine OCD as some sort of monster inside the mind, one that can only survive if given enough attention. When the sufferer engages in compulsions, they unwittingly give OCD the attention it craves. This gives OCD power, making the monster bigger and bigger. The more the sufferer checks, the larger OCD looms and the more it controls their lives.

For example, someone with Existential OCD who is afraid of living in an imagined reality may compulsively ask those around them to assure that things are real.

Once they get this assurance, they feel relieved. But OCD is never satisfied and it doesn’t demand that the sufferer check once or twice; it demands full commitment. While compulsions do provide reprieve, it’s extraordinarily short-lived. In some cases, the anxiety returns in a matter of minutes.

Intrusive Thoughts in the Normal Population

OCD and intrusive thoughts go hand-in-hand, like a terrible tasting peanut butter and jelly sandwich. But that doesn’t mean intrusive thoughts are limited to those with this mental illness. Intrusive thoughts are experienced by everyone, regardless of OCD status.

The difference is that people without OCD are able to see intrusive thoughts for what they are: Nonsense. Those with OCD, on the other hand, take these thoughts seriously….or at least seriously enough to act.

This doesn’t mean the OCD sufferer buys into these thought entirely; conversely, they know, deep down, that these thoughts aren’t real. But OCD is a disease of doubt – What if? is practically branded into the brains of those who have it. And it’s also a disease that requires 100% certainty. Not even 99% suffices.

These impossible requirements are one of the reasons the OCD cycle perpetuates. In the sufferer’s mind, uncertainty is not an option.

The Specifics of Existential OCD

Someone suffering from Existential OCD may become consumed with questions regarding why humans exist or questions about their own individual purpose. They will then spend time, tons of it typically, looking for reasons. They may engage in specific compulsions that help assuage the angst their thoughts cause. Someone who fears they have no purpose may compulsively pray for a sign that they do.

Existential OCD sufferers have thoughts that question reality as well. They may fear that the world and people around them aren’t real, engaging in compulsions to assure that they are. They may even question the existence of self.

As previously discussed, these obsessions go well beyond normal (and healthy) curiosity. Existential OCD sufferers are so consumed by their thoughts that they may stop attending classes or going to work, preferring to look for meaning in the world instead. They may neglect hygiene or basic needs too, refraining from showering or eating because they’re preoccupied with their search for resolution (or because they’re not entirely sure the water in the shower or the pile of mashed potatoes on their plate are real).

OCD sufferers never find the answers they’re looking for, either. While their compulsions may provide temporary relief, the anxiety in Existential OCD (like the anxiety in all types of OCD) returns, forcing the sufferers into compulsive behavior once more.

This sets the stage for the vicious cycle for which OCD is infamous. Questioning begets more questions and the search for certainty uncovers more doubt, giving OCD more and more power along the way.

In some regards, having Existential OCD is like being inside Shakespeare’s most famous soliloquy. As Hamlet asks, “To be or not to be….that is the question,” those with Existential OCD begin to search, compulsively, for the answer.

Existential OCD Incidence

It’s hard to say exactly how many people have Existential OCD, partly because sufferers (and their healthcare providers) may mistake Existential OCD for good old fashioned wondering; they may think the person questioning their own existence is merely digging deeper into the world around them.

Another reason it’s hard to gauge incidence is that OCD sufferers, by nature, are a secretive lot. While those impacted by the well-known and better understood flavors may be more open to speaking about their struggles candidly, those who experience rarer known or misunderstood thoughts are more likely to stay quiet.

If OCD conferences and chatrooms are any indication, Existential OCD is not one of the most common types (or, at the very least, it’s not one of the most discussed).

Some types of OCD (such as Harm OCD and Pedophilia OCD) invoke so much shame inside the sufferer that they retreat into the silence of safety.

While Existential OCD isn’t likely to come packaged with as much self-disgust in regard to the nature of the intrusive thoughts, it is a type of OCD where sufferers may fear sounding overly “crazy.” A sufferer who questions whether they really exist might feel more removed from reality than a sufferer who wonders if the doorknob they touched contains germs. And this perception of craziness is possibly enough for people to keep their thoughts to themselves.

Common Existential OCD Obsessions

OCD sufferers are never surprised by the amount of creativity OCD possesses. In other words, it can cause worry about ANYTHING. With Existential OCD, sufferers may experience a variety of thoughts that range from minor to truly bizarre. Different sufferers experience different thoughts and these can change hour by hour.

Even so, there are certain obsessions most common in Existential OCD. Including:

• Sufferers wonder about the meaning of life and may experience intrusive thoughts that suggest life is pointless
• Sufferers ponder their purpose and may experience intrusive thoughts that suggest they have none
• Sufferers question whether things are real (they may question the actuality of everything from a person to an apple)
• Sufferers fear that they’re dreaming, in a coma, or that they died and do not know it
• Sufferers fear that they’re in an alternative reality
• Sufferers question their relationships, wondering (for instance) if they’re truly in love with their husband or wife
• Sufferers worry about why they’re the person they are

Common Existential OCD Compulsions

Obsessions invoke anxiety on the part of the sufferer (if they didn’t, that person would not have OCD). In order to manage this anxiety, sufferers rely on their compulsions, routines of thoughts, actions, or words that provide relief. Though the relief is temporary (as previously mentioned), the sufferer convinces themselves that – this time – it won’t be. So, they engage in the compulsion hoping the relief will last forever.

Compulsions are not minor inconveniences – they are life-changing and life-interfering. They also feed the OCD disease: It cannot exist without the compulsions that validate it.

Like obsessions, compulsions are individualized and vary from person to person, day to day, and hour to hour (they may change minute by minute as the sufferer is desperate to regulate their anxiety and willing to engage in all sorts of things to do so). The most common ones that presents with Existential OCD include:

• Sufferers ask people around them (friends, family, neighbors, coworkers, or teachers) for their thoughts regarding things like purpose or the meaning of life
• Suffers analyze, again and again, their feelings
• Sufferers devour textbooks and articles in the areas that address the matters of the universe
• Sufferers take philosophy classes repeatedly
• Sufferers compare and contrast their thoughts and feelings against others to make sure they’re consistent with what’s normal
• Sufferers pray excessively to God or a higher power, asking for insight and guidance
• Sufferers engage in cause and effect experiments to test reality (they may kick themselves to make sure it hurts or they may throw a handful of mud against the side of a house to make sure the mud leaves a mark)
• Sufferers repeatedly seek reassurance from those around them, asking for proof that things are real
• Sufferers question others, hoping for proof that they’re not living in an alternative reality

What Causes Existential OCD?

They struggle with neurotransmitters, too. These are things like dopamine and serotonin, the body’s chemical messengers that run low in OCD sufferers. When the chemical messengers are compromised, so is the message. That’s why OCD sufferers tend to give nonsensical thoughts so much power.

Glutamate, another neurotransmitter, may play a role as well but not in the way we might assume. Rather than possessing low levels of glutamate, OCD sufferers might possess high levels (though it’s certainly possible to have OCD without extra glutamate). It plays a role, but the starring one.

Glutamate is the most excitatory neurotransmitter and influences how neurons communicate. OCD researchers aren’t sure if high levels cause OCD or if OCD causes high levels, but – in sufferers with a genetic predisposition to glutamate – treatment that focuses on their levels may prove beneficial.

OCD comes with plenty of this genetic predisposition. The serotonin transporter gene (hSERT) is compromised in some OCD sufferers, which is why serotonin isn’t properly transported through the brain.

OCD tends to run in families too, affecting multiple immediate family members 25% of the time.

However, genetics come with a caveat because they are not the end all, be all. For example, women who have their genes analyzed through companies like 23andMe are likely to find that they have several genes that make them more likely to get breast cancer and several genes that make them less likely, turning genetics into a bit of a crapshoot.

A woman who has 100 genetic mutations that make her more likely to get breast cancer and 150 genetic mutations that make her less likely, might enjoy an overall reduced risk but there’s no guarantee what gene will triumph.

Of course, some genes are more powerful than others. In keeping with the breast cancer example, the BRCA gene is extraordinarily important and those who have it possess as much as a 70% chance of breast cancer by the age of 80. A woman with the BRCA gene is likely to get breast cancer even if she has other genes that decrease her risk.

The BRCA gene is well-known because breast cancer is well-studied. Doctors have yet to discover an OCD gene on the same level as the BRCA gene. But, if they did, a solution would prove tricky. Women with the BRCA gene often opt to have their breasts and ovaries removed, body parts they can live without. When the gene manifests as a problem in the brain, we don’t have that option and other solutions (such as gene suppression) must be considered.

The above demonstrates that genetics are a factor in OCD, though not the sole (and maybe not the most crucial). One thing that matters to development and severity is behavioral conditioning or the compulsions that perpetuate the OCD cycle.

Behavioral conditioning doesn’t cause OCD as it must already exist in order for the sufferer to engage in compulsions that attempt to control it. But behavioral conditioning gives OCD the power to become a full-fledged disorder. Without it, it’s fair to argue that OCD would pass over the sufferer, recognize it has nowhere to latch and move on.

What About an Existential Crisis?

Existential crises may happen to people with or without OCD. Those in one’s throes start wondering what life means and what their purpose in the world is. Again, like with OCD, a crisis is different than curiosity as the person in crisis, like those with OCD, is unable to find answers that satisfy them. This uncertainty leads to terror, frustration, and sadness.

The Causes of an Existential Crisis

These types of crises can affect anyone, even kids. But there are common causes that make the experience more likely. These include:

• Sufferers may experience a lack of success or a struggle to succeed
• Sufferers may go through a traumatic experience or suffer a devastating loss
• Sufferers may experience extreme guilt about something
• Sufferers may lose a loved one and find themselves facing the reality of their own death
• Sufferers may feel socially isolated from their peers
• Sufferers may suffer from low self-esteem or a general sense of dissatisfaction with oneself
• Sufferers may have a history or repressing their feelings and bottling up their emotions

The Types and Symptoms of Existential Crises

There are many types of existential crises, including:

• Freedom and responsibility: Freedom may prove overwhelming, triggering a crisis.
• Death and mortality: People may experience this type of crisis following the death of a loved one or as they approach a certain age (such as turning 60).
• Isolation: Because humans are naturally social, fear of isolation can lead to the idea that life has no meaning.
• Emotions and experience: This type of crisis involves the blocking out or numbing of pain, leading to a false (and empty) feeling of happiness.

There are several different symptoms too, including:

• Depression
• Anxiety
• Suicidal tendencies

Existential OCD isn’t the same thing as an existential crisis, though the symptoms and thoughts involved are similar. One important difference is, in the person without OCD, the crises makes up a period of time or occurs as a reaction to some stressor or trigger. This isn’t to say that it’s not traumatic or terrible, but it’s not a lifelong disorder perpetuated by an underlying disease.

Perhaps the most notable deviating factor has to do with the compulsions that make OCD, OCD. Existential OCD sufferers – as a rule – engage in neutralizing rituals to control their thoughts. Those suffering from an existential crisis typically do not.

Factors that Influence OCD’s Development

OCD is most common in adults, but it does appear in children too. Most often, sufferers first show symptoms around late adolescence (19 or 20) though they may also experience symptoms earlier in the years during puberty. It’s rare, though not unheard of, for OCD to first appear after the age of 50.

While genetics can, somewhat, lay a foundation of who gets OCD (and when), a predisposition doesn’t guarantee OCD development (just as having no predisposition doesn’t guarantee OCD will never develop).

Sometimes, OCD appears out of the blue; sufferers may describe it as a light switch flipping on for the very first time – no rhyme, no reason, no trigger. Other times, OCD first appears after something happens (even when this “something” is happy). Emotional or physical trauma can play a part in its debut as well.

Different Focuses inside the Same Illness

People with OCD describe an illness where sufferers experience the same intensity and the same anxiety but with differing thoughts. One person with OCD may obsess about asymmetry while another obsesses about their brother dying because they walked by a cemetery.

It’s unclear exactly why one person develops Existential OCD and the other develops Contamination OCD or another type. But the way OCD works is rather simple: It attacks the sufferer’s values. For instance, someone who is a parent to a child with a compromised immune system makes excellent fodder for Contamination OCD as they fear the germs that could cause their child to get sick. Or someone who is surrounded by successful and powerful people may feel insignificant, inadvertently setting the stage for Existential OCD.

It’s difficult to know exactly why one flavor sticks to one person and not others but it’s not absolute, either. People can experience thoughts that involve several types of OCD.

Someone with Relationship OCD, for example, may also have elements of Harm OCD. Their compulsions may revolve around things like asking their spouse for reassurance as well as making sure they don’t stab their spouse at the dinner table.

Regardless of the flavor, OCD is really about uncertainty. It’s about doubt, the what if, and second guessing everything. All sufferers, independent of the specifics of their thoughts, share that in common: OCD tells them that they have to know.

Dysfunctional Beliefs: Why They’re So Powerful

Sufferers of Existential OCD, like all sufferers of OCD, experience powerful and highly dysfunctional beliefs. These beliefs give OCD its power and encourage the sufferer to engage in their compulsions.

According to the Obsessive-Compulsive Cognitions Working Group, there are six types of dysfunctional beliefs found inside the OCD mind. And these include:

• Responsibility: In many ways, the OCD sufferer sees it as their responsibility to save the world. They don’t perceive this because of an inflated sense of self-importance, but rather they do it because of fear and guilt. If they don’t do something (whatever that something OCD tells them) and then something bad happens, they feel like they won’t be able to live with themselves.

In Existential OCD, this may manifest as someone feeling as if it’s up to them to discover the meaning of life. When they can’t (and of course they can’t) this causes great anxiety.

• Magical Thinking: One of the most important aspects of truly understanding OCD is understanding the component of magical thinking. This is sometimes referred to as “thought action fusion” and it is the phenomenon where sufferers believe thinking about something (or engaging in specified action) will cause it to happen.

In Existential OCD, this may manifest as someone feeling as though they must avoid stepping on crack on a sidewalk, believing that doing so will remove any purpose they have from life.

• Control: OCD is highly focused on control as well. Sufferers repeatedly attempt to control their thoughts and – in some instances- they’re instructed by misguided therapists to engage in thought-stopping. But OCD sufferers cannot control their thoughts (nor can anyone else) and any attempt worsens the disorder.

In Existential OCD, this may manifest as someone attempting to repress thoughts that question reality. The more they attempt to repress these thoughts, the louder the thoughts become. It’s a guarantee of psychology: Whenever we try not to think about something, we automatically do.

• Over-evaluation of Thoughts: As previously discussed, OCD sufferers are unable to identify their intrusive thoughts as the nonsense they are. Instead, they take them seriously and react accordingly.

In Existential OCD, the sufferer labels their wonderment as highly problematic. People without OCD, on the other hand, are likely to acknowledge the unknown, shrug their shoulders, and move on.

• Perfectionistic Behavior: While it’s possible to be a perfectionist and not suffer from OCD, perfectionism generally impacts those with this disorder. In general, OCD sufferers – regardless of type – are extraordinarily hard on themselves and believe they must be perfect in order to keep bad things from happening.

In Existential OCD, sufferers may believe that any imperfection or any personal flaw translates to a meaningless life.

• Intolerance of Uncertainty: As demonstrated throughout this article, uncertainty is a major part of OCD. We could argue that the only thing that OCD sufferers are indeed certain of is that they hate uncertainty.

In Existential OCD, this hatred of uncertainty is especially potent. The questions that invade the OCD sufferer’s mind are unsolvable by nature. And this forces the existential OCD sufferer into a game they can’t possibly win.

What Doesn’t Cause Existential OCD?

• The way a child is potty trained: Once upon a time, potty training technique was linked to OCD, especially when the technique involved domineering or overreaching actions. Now, we know this isn’t true. Parents, outside of the genetics they pass down, don’t cause OCD.
• Stress: Stress worsens OCD and makes symptoms more prominent, but it won’t cause OCD in people who don’t have it already. Stress can, however, cause OCD to reappear after a period of relative dormancy.
• Living environment: Living environment, like stress, can make OCD worse but it won’t cause its development in the first place. Living with roommates or family members who shame the OCD sufferer (or do the opposite and help them with their compulsions) can compound an already-existing disorder.
• Diet: Gluten, high-fat, sugar, and caffeine don’t cause OCD, either. But any diet that involves food choices that decrease overall health can worsen everyday stress, worsening OCD in addition.
• Lack of exercise: Just like eating poorly, a lack of exercise can increase OCD symptoms. Sufferers are encouraged to work out not only for the physical health benefits but as a way to control their anxiety. Exercise releases endorphins, which act like natural anti-depressants.

Misconceptions About Existential OCD

The most common misconceptions about Existential OCD are aligned with the common misconceptions about OCD itself. Including:

• OCD isn’t that bad or no big deal
• Everyone has a little bit of OCD
• OCD is a neurotic or quirky personality trait
• People with OCD are choosing their thoughts and can turn them off by choosing to think of something else
• People with OCD can just “get over it”
• People with OCD are anal-retentive, picky, or particular
• OCD always manifests as a preoccupation with order, organization, and cleanliness
• People who claim to be “so OCD” actually have it

Treatment for Existential OCD

Overall, OCD treatment is the same regardless of the OCD type. The specifics do change, however, to reflect the individual’s thoughts and fears. Several common methods and medications used in treatment, include:

CBT with ERP: Cognitive behavioral therapy (CBT) is the first line of treatment and gold standard choice. Exposure and response prevention (ERP) is a type of CBT that is used when treating sufferers. During ERP exercises, patients expose themselves to their intrusive thoughts and then refrain from engaging in any neutralizing compulsions.

For example, the Existential OCD sufferer may be asked to expose themselves to the idea that life is meaningless. Then they’ll be instructed to refrain from asking others for reassurance or rushing off to the library to check out that extra thick philosophy book.

Other examples of Existential OCD treatment include:

• Asking the sufferer to refrain from analyzing their thoughts or questioning their thoughts
• Asking the sufferer to refrain from arguing with others about things like the meaning of life
• Asking the sufferer to refrain from reading or engaging in study involving topics that align with their obsessions
• Asking the sufferer to refrain from seeking assurance from themselves or others
• Asking the sufferer to remind themselves that they have OCD

When discussed matter-of-factly, ERP comes across as simple. But, to the sufferer, refraining from the compulsions is the hardest part of OCD treatment. Because sufferers generally believe something bad will happen if they don’t engage in their rituals, ERP forces them to sit in their anxiety and accept uncertainty. And this is extraordinarily difficult.

Because ERP is so hard, treatment is usually gradual. Sufferers are not asked to expose themselves to their scariest or most fear provoking thought; instead, they are asked to expose themselves to thoughts that are more tolerable. Then, after practice, they work their way up to the more challenging ideas.

The goal of ERP is to not engage in any sort of compulsion, regardless of how much anxiety that lack of engagement causes. Most people who do ERP find that they don’t bat .1000; some days they’re able to do the exercises successfully and some days the anxiety wins. That’s why they require practice: The more people practice, the more they learn how to sit with anxiety and the more confident they become that they can.

Medication: The vast majority of OCD sufferers benefit from some sort of medication: All in all, about 70% of people respond. But the medications used for OCD don’t eliminate OCD the way aspirin eliminates a toothache. The intent of medication is to make the thoughts less powerful and make the ERPs easier; the goal is not to get rid of the thoughts entirely (though OCD sufferers would certainly welcome that!). The magic of OCD treatment truly lies in ERP; Medication acts as the sidekick, but ERP is the superhero.

Sometimes, finding the right medication is a challenge because of side effects, pre-existing conditions, or contraindicated prescriptions. Age is a factor as well – children, teens, and young adults are at greater risk of suicide when taking some brands of antidepressants.

Overall, the most common medications involved in OCD treatment are Serotonin Specific Reuptake Inhibitors (SSRIs), antidepressants that increase serotonin. These meds include:

• Lexapro
• Celexa
• Prozac
• Luvox
• Paxil
• Zoloft

Tricyclic antidepressants are used as well, with Anafranil (or Clomipramine) the most common. Anafranil appears especially effective in treating symptoms of OCD, but it can come with more serious-than-average side effects, making it inappropriate for some sufferers.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs which are close related to SSRIs) are also used as they increase serotonin and norepinephrine in the brain. The most commonly ones prescribed include:

• Effexor
• Cymbalta

Several of the off-label medications may prove effective for OCD symptoms, ether as standalone treatment or supplements. A handful of those commonly used include:

• Risperdal
• Haldol
• Zyprexa
• Seroquel
• Abilify
• Xanax
• Valium
• Buspar
• NAC
• Namenda
• Pristiq
• Ketamine
• Tramadol
• St. John’s Wort

Many of these medications can’t be taken together. For example, St. John’s Wort should never be taken with anything that increases serotonin as it puts the consumer at risk for too much serotonin inside the body.

ACT Therapy: Well ERP typically serves as the initial treatment, acceptance and commitment therapy (otherwise known as ACT) is becoming a more commonly accepted form of treatment. ACT focuses on accepting intrusive thoughts and ideas rather than reacting to them or paying them attention.

The OCD sufferer learns to see their thoughts simply as thoughts and then they learn to accept those thoughts any way they can. Sometimes, they may use mental tricks or clever imagery or personal mantras in order to help facilitate this acceptance.

The idea behind ACT is that, when we see thoughts as thoughts, they lose their power. ACT relies on mindfulness, self-compassion, and psychological adaptability. But mostly it relies on non-judgement of any thought that pops into the sufferer’s head.

In existential OCD, this acceptance is especially key. Once the sufferer learns to accept that they don’t have the answers to the meaning of life or to the purpose of man, they begin to heal.

Lifestyle: OCD is not a condition largely dictated by lifestyle – this is to say, what sufferers eat, drink, or do on a daily basis won’t make OCD go away or bring it on. But, because lifestyle affects overall health (both mental health and physical) OCD sufferers should:

• Maintain a diet of fruits, vegetables, low-fat, and high fiber
• Reduce consumption or red meat and fatty foods
• Exercise every day (even if it’s a walk around the block)
• Practice mindfulness, meditation, or yoga (again, daily is the ideal)
• Limit coffee to one or two cups (or none, but that’s not realistic for many)
• See a therapist weekly
• Participate in support groups
• Foster social relationships and speak openly about OCD
• Limit the use of nicotine, tobacco, and alcohol

TMS: Transcranial Magnetic Stimulation (TMS) is commonly used to help people with major depressive disorder, but it’s under investigation for OCD too (and some providers are already using it). It may eventually serve as an alterative to those who can’t find relief with more conventional means.

TMS is not brain surgery but rather a non-invasive process that uses magnets to regulate the deep parts of the brain associated with OCD.

TMS required a short-term commitment (four-six weeks of one hour of treatment a day) as well as a maintenance program. Unfortunately, most major insurance companies don’t cover TMS for OCD (although they do cover it for major depressive disorder). This should change as more studies are conducted on its efficiency.

Finding an OCD Therapist

OCD sufferers are encouraged to seek out clinicians who have specialized training via conventions, conferences, and intensive programs. The International OCD Foundation provides a list of health care providers with this criteria. OCD sufferers can use this directory to find someone nearby or someone who works with patients through teletherapy.

References:

https://beyondocd.org/ocd-facts

https://www.madeofmillions.com/articles/are-intrusive-thoughts-normal

https://theocdstories.com/stories/ocd-existential-questions-and-treatment/

https://iocdf.org/about-ocd/what-causes-ocd/

https://iocdf.org/about-ocd/what-causes-ocd/

https://beyondocd.org/information-for-parents/helping-a-child-who-has-ocd/causes-of-ocd-in-children

https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/breast-cancer-risk-factors-you-cannot-change.html

https://pubmed.ncbi.nlm.nih.gov/9193129/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143776/

https://www.health.harvard.edu/blog/transcranial-magnetic-stimulation-for-depression-2018022313335

https://iocdf.org/ocd-finding-help/find-help/