The role of death fears in obsessive-compulsive disorder

Death anxiety is considered to be a basic fear that may underpin a range of psychiatric conditions. The present paper proposes that the dread of death is a central driver of most presentations of obsessive–compulsive disorder (OCD). Compulsive washers often identify chronic or fatal diseases, such as HIV, as being associated with their anxiety, and with their behavioural responses to threat cues. Avoidance of perceived toxins, poisons, heavy metals, and bodily fluids of strangers is commonplace in the condition. Similarly, compulsive checkers typically report the prevention of fire, home invasion, and the subsequent death of the self and loved ones as the driving force behind their behaviours. Even the atypical compulsive cases, which may be dominated by tapping, blinking, magical numbers, and counting sequences, usually involve a stated attempt to prevent harm or death to a loved one. Therefore, the present paper explores the role of terror management theory and experimental existential psychology in understanding death anxiety. Research evidence implicating death anxiety in OCD is presented, and two illustrative cases are described. Finally, implications for treatment and future research directions are examined. It is argued that cognitive behaviour therapy outcomes in OCD could be enhanced by the addition of procedures drawn from acceptance and commitment therapy, dignity therapy, and meaning centred therapy.