Fear of death: Is it OCD, thanatophobia, or something else?

If you’re experiencing strong, persistent fears about death, dying, or the afterlife, it could be a sign of obsessive-compulsive disorder (OCD) or another mental health concern. In OCD, a person experiencing fears about death will have intrusive thoughts, urges, or images about the death of themselves, their loved ones, or about the process of dying. These intrusions are called obsessions; in response to their obsessions, a person with OCD will engage in compulsions, which are repetitive mental or physical acts done to alleviate obsession-induced stress or prevent feared outcomes. 

To help spread awareness, understanding, and hope, I’ve written about my experiences with OCD fears about death, to give the personal perspective of someone who has experience living with and treating the condition. I go on to offer details on the differences between OCD, phobias, and ordinary fears about death, and discuss treatment options if these fears are interfering with your life. 

My own experience with an intense fear of death

When I was five years old, I lived with my mom, dad, and two younger sisters. I spent most days walking down the street, visiting with my grandma, enjoying being spoiled with root beer candies and popcorn. My grandma was a fixture in those first five years of my life. 

One summer morning, my dad woke me up gently to tell me that my grandma had died. I tried to wrap my brain around the fact that she was gone. Was she now in heaven like my dad said? On that day, a new fear took hold of me. 

This event was the catalyst for the OCD that would follow throughout my life. I was often triggered by bodily sensations and thought they were signs that I was dying. I feared demons, the devil, and anything else that signified the afterlife, and I went to great lengths to be sure I would never encounter them. I had a stuffed animal barrier on my bed and would sleep far under the blankets, even on hot summer nights dripping sweat because of the covers. 

As I grew, my life was filled with obsessions and compulsions surrounding my core fear of death. I feared I would choke, and would only eat soft food or chew my food so much that my jaw would get sore. As a teenager, if my parents were even a few minutes late coming home, I would panic, convinced that they were dead. In my early days of marriage, I would ask my husband if he thought I was going to die of a heart attack, just to feel certain that I wouldn’t. It overwhelmed me for so long.

It wasn’t until I learned to respond to my fears in a new way, through exposure and response prevention (ERP) therapy, that I finally began to free myself from my fears.

How can I tell if it’s OCD, thanatophobia, anxiety, or something else?

While a fear of death sign can be a symptom of OCD, it’s also a fear that may strike anyone from time to time, without necessarily indicating any greater mental health concern. It may also indicate other conditions, most commonly a specific phobia called thanatophobia. So how can you tell which, if either, applies to you?

OCD vs. Phobias

Specific Phobias involve a strong, distinct fear or anxiety about particular situations, objects, or concepts. Thanatophobia is the specific fear of death or the dying process. Though individuals with OCD can have an intense fear of or intrusive thoughts about death, it manifests in different ways. Here’s how OCD with a focus on death and thanatophobia compare. 

Similarities:

As with OCD, someone with thanatophobia will be affected by their fear, which is usually not proportional to any actual threat. Someone with a specific phobia will take steps to avoid their phobic stimulus, such as never going to a funeral due to their fear of death. Similar to OCD, people with a phobia may seek reassurance about their fears. Both OCD and specific phobias can start in childhood or adulthood, and may or may not be triggered by any particular event. 

Differences:

Despite their similarities, several points distinguish OCD with a focus on death from a phobia of death. Here are some of the key differences:

#1 OCD involves obsessions

OCD involves intrusive thoughts, images, or feelings, known as obsessions—these are what lead to fear and compulsive behaviors. A person with thanatophobia may not have intrusive thoughts at all. Instead, they will experience intense anxiety or panic when directly confronting stimuli related to their fear. The graveyard, for example, is a phobic stimulus that may trigger fear in someone with thanatophobia. For someone with OCD, it may result in obsessions about getting an illness that will lead to death, or an intrusive thought like “You took a breath when you drove by the graveyard, so someone you love will die.”

#2 OCD involves compulsions

Second, individuals with OCD will perform compulsions related to their obsessions. Someone with a phobia alone won’t engage in compulsions at all, but rather avoid their phobic stimulus and related circumstances. 

#3 OCD symptoms tend to wax and wane

Another difference between the two disorders is that OCD symptoms often wax and wane from their onset. A person may spend only several months consumed by obsessions and compulsions related to death and dying, after which their intrusive thoughts and compulsive behavior may focus on another theme. In a specific phobia, one’s fears and behaviors usually remain consistent without treatment and don’t shift to another topic. 

Ordinary anxiety: Does everyone have these fears?

Many people are afraid of death to some degree or another, and it’s normal to have intrusive thoughts regarding death here and there. If your thoughts and fears around death are not interfering with your life, undermining your goals, causing intense distress, or resulting in obsessions and compulsions, then your feelings about death and dying are likely ordinary and not the result of a particular mental health condition. 

We all die. How can I get over my fear? 

What comes after death is uncertain. What one will experience while dying is uncertain. All of this can feel very scary. However, there is hope with treatment that thanatophobia and OCD focused on death and dying can be treated with exposure and response prevention (ERP) therapy.

ERP is the gold standard for both OCD and specific phobias like thanatophobia, and is backed by decades of clinical research. Most people who do ERP with a trained therapist experience a decrease in symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. 

People who struggle with OCD or a specific phobia can work with a therapist to build a hierarchy of fears and the situations that trigger then, then begin confronting one trigger at a time—all in a gradual, intentional manner, with the help of their therapist. Someone with a fear of dying may start with a low-level exercise, like looking at pictures of graves on the internet, and then work their way up to actually walking through a graveyard or touching a grave. 

When doing ERP, the goal is always response prevention. Your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions or avoiding triggers. Over time, this allows you to tolerate anxiety related to death without relying on compulsions or avoidance to feel better. 

You don’t have to live in fear

I decided to use myself as a case example for this article because I think it is important to show not only how much suffering these fears can cause, but also how much hope there is in treatment. 

My fear of death and OCD do not rule my life anymore. Two years ago, I lost my younger sister Gretchen to a rare and terrible form of lung cancer. I was with my sister to the end. I played guitar and sang with my mom and sister—it was one of the most beautiful moments in my life. 

I am so thankful that I was able to experience this without being gripped by OCD. My fears still come up but through response prevention, I am able to move on and live my life. If you’re reading this, you can too.