The Ambiguity of Being Alive: Turning an Existential Lens to the Case of "Serena"

Abstract

Existential psychology and terror management theory suggest that death anxiety is a fundamental, transdiagnostic construct underpinning a great many psychological presentations, including Obsessive Compulsive Disorder (OCD). Alma Campiani’s (2025) pragmatic case study of "Serena" paints a nuanced and in-depth portrait of a Short Term Psychodynamic Psychotherapy (STPP) approach to OCD treatment, and represents a remarkable shift away from the prevailing behavioral and pharmacological methods that dominate the treatment of this disorder. While STPP recognizes the existential as one of many important factors to consider in treating OCD, Campiani acknowledged but did not emphasize this dimension of the work. This commentary represents an attempt to provide a deeper exploration of the existential factors at play in the development and maintenance of Serena’s OCD presentation, with a particular emphasis on Freud’s concept of dual forces of Eros, the life instinct, and Thanatos, the death instinct.  An alternate approach to treatment rooted in Irvin Yalom’s (2008) existential psychology is described and applied to Campiani’s Serena.