It is also known as Existential OCD or Philosophical OCD and involves intrusive, distressing thoughts and worries about the nature of reality and existence. People with Metaphysical OCD often experience persistent doubts and fears about the meaning of life, death, the universe, and their own existence. These thoughts can be incredibly disruptive and distressing, and can lead to significant anxiety and fear.

The obsessions associated with Metaphysical OCD typically involve repetitive and distressing thoughts about the meaning and purpose of life, death, and the universe. For example, individuals with Metaphysical OCD may worry about the existence of an afterlife, the meaning of morality and ethics, or the nature of consciousness. These thoughts can be all-consuming and can cause significant distress and anxiety.

The compulsions associated with Metaphysical OCD may include repetitive behaviors or rituals aimed at reducing anxiety or finding relief from distressing thoughts. These behaviors can range from seeking constant reassurance from others, to engaging in repetitive thought patterns or excessive research. Compulsions may also involve self-harm, such as repetitively picking at skin or causing physical pain, in an attempt to prove one's own existence or to feel something real.