Can anyone offer some advice for existential OCD? It's the theme that has gotten to me the most and is the only one I'm dealing with currently. I'm in therapy now with someone who understands OCD and ERP, so I'm treating it in the proper ways. I'm struggling a bit and would love to hear what has helped some others.

It's hard to offer good advice without a specific question. You say you are doing ERP. What's going well, and what is a struggle?

Ruminating on the fear of cutting off your hand would sound like "arghh!!! I hate that thought. I'd never do that... Would I? Remember that time as a kid at camp when I burned myself on a smore, maybe that was intentional and I've just tricked myself into believing it was an accident. How can I know for sure? I'd better think some more. I had that dream about my arms falling off, maybe that's a sign. But I hate gory movies... How could I want to chop my hand off if blood disgusts me. That's good, I probably won't do it. NO I WONT do it!.... But maybe I should hide the knives just in case. My therapist says this is OCD. She's really knowledgeable, but I still have a niggling doubt. Better start googling to see if people have similar symptoms. How horrible would it be if I did ERP and then actually DID cut my hand off. Has anyone's OCD fear actually come true? Let's ask people.... I'm going to imagine it again to see if I was really scared. OH GOD!!! MY HEART DIDN'T RACE THIS TIME! that must mean it doesn't scare me. I'm gonna do it, I just know it! But I don't want to! I'll let my husband do all the cooking from now on. And do some more googling to see if the fear comes true...."

Well, I'm still experiencing obsessive thoughts even though I've gotten through my entire heirarchy. My obsessions involve a story that was very triggering to my OCD and my therapist has been trying to get me to view it as not mattering whether or not it's true. I find this helpful sometimes, but sometimes even that still causes anxiety. I had stopped doing my exposures as much because I was originally improving, but after my session with my therapist this week, we realized my obsessions were still lingering and that I needed to work on exposures more regularly again. I'm trying to use some acceptance techniques and do some exposures, but the exposures my therapist and I have come up with aren't activating my anxiety anymore. I texted my therapist and am hoping she'll get back with me soon, I'm wondering if we need to come up with some new exposures. I guess I'm feeling a little stuck right now since my exposures don't seem to be working like they did previously, and I'm not entirely sure where to go from here. I feel like I never find a lot of info on existential OCD, so I wanted to see if there was anyone else who maybe had some some useful advice when it comes to recovery and if anyone has felt stuck like this in their recovery.

I don't have a detailed response prevention plan, but I also don't really have any outward exposures. The only thing I really do physically that I'm aware of is researching and asking for reassurance, but for the most part I have that under control and they don't seem to be big issues for me. Those are things I really only do once in a while. Mentally, I'm sure I do some ruminating if you count that as a compulsion, although for me that seems to be difficult to differentiate from the obsession. When I do exposures I pretty much just sit with whatever I'm doing (now it's mostly scripts that I repeat to myself because that was at the top of my hierarchy) and carry out the exposure until I'm bored or it doesn't make me as anxious. My level of discomfort lately hasn't been going past a 3 much, unless I'm just having a bad day.

Ruminating does count as a compulsion because it's an active process in response to a spontaneous thought that causes distress. If you'd like an example, I can copy and paste in an example of ruminating vs obsession. Your anxiety not spiking past a 3 is a sign that the erp is working. Remember, the goal of therapy isn't to eliminate unwanted thoughts or to get rid of all anxiety. It's to be able to have all kinds of thoughts and feelings without getting stuck in them or using repetitive behaviors to cope

An example would be great actually. I'm not expecting therapy to completely get rid of my unwanted thoughts, I fully expect them to still be there but I'm hoping they'll be easier to dismiss and not completely throw me off. My therapist and I actually did a severity test the other day and my obsessions actually increased from last month, so I'm hoping I can still find a way to manage them better.

Thank you, that helps put some things into perspective for me. I mainly want to switch to distraction to keep from ruminating, not necessarily avoid the thought when it comes up. I really want to get to the point where if the bothersome thought comes up, it doesn't matter and doesn't bother me like it has been. I've been trying to keep up with things I need to do and want to do, and admittedly it is sometimes a lot harder when my OCD is stronger, but I am still trying my best. I may talk to my therapist about the ruminating and see what she has to say about it.