Backdoor Spikes: How to deal with sudden OCD episodes

So, you’ve been diligently following your OCD treatment plan: exposure and response prevention (ERP), perhaps bringing in other methods like acceptance and commitment therapy (ACT) or prescribed medication. And it’s paying off! Your symptoms are easing up. And then out of nowhere, you’re hit by a wave of obsessions, anxiety, and the overwhelming urge to return to compulsions. 

You’re experiencing what Tracie Ibrahim, LMFT, CS, a licensed therapist with NOCD calls a “backdoor spike.” And it can leave you feeling overwhelmed and doubting your progress. So what is a backdoor spike? She describes it as an invisible force covertly making its way back into your life, as if to say, Hey! Remember me?! And it rekindles fears and compulsive behaviors you believed you had under control.

This anxiety can emerge after months of stability, casting shadows of doubt on your healing journey—and maybe even your diagnosis of OCD. You might find yourself questioning whether your progress was real, or fearing a slide back into deeper OCD patterns. This internal turmoil can be distressing, even leading to feelings of despair, or the impression that you’re an impostor in your own recovery.

If these thoughts resonate with you, know that you’re not navigating this path alone. This unsettling phase is a twist in the recovery narrative that many don’t anticipate, but that many people who recover from OCD—even most of them—experience. (Let that sit for a second: It’s normal.) And not only that, but accepting this fact can be your first step toward regaining control.

“It’s important to remember that experiencing a backdoor spike doesn’t undo all the hard work you’ve put into your recovery. It’s not a regression, nor does it negate your progress. It’s simply another layer of the complex OCD journey,” Ibrahim explains. The path you’re on may not have a definitive conclusion or a one-size-fits-all approach, but it’s filled with hope, nonetheless. 

We’re here to explore the nature of backdoor spikes and strategies to help you manage these episodes, so you keep moving forward. Remember, each step forward, no matter how small, is a victory in the broader battle against OCD.

Why won’t my OCD go away? 

Living with OCD often feels like hosting an unruly guest in your mind, constantly demanding your attention and sowing seeds of doubt. If you have OCD, your days are likely burdened by unwanted thoughts and a deep need for absolute certainty. 

Now, if you’re reading this, chances are you’re feeling a bit defeated, wondering why, despite giving it your all, your OCD is still stubbornly hanging around. Here’s something really important you need to know: OCD is a chronic condition. Ibrahim explains that, “Treatment is not about trying to totally eradicate your symptoms. OCD can’t technically be cured. But you can manage your symptoms. It might show up now and then, but it doesn’t have to rule your life.” 

The ebb and flow of your OCD can be influenced by a bunch of factors: the unique wiring of your brain, life’s inevitable stresses, and changes in your environment. Yet, if you’re armed with the right tools—like ERP therapy and perhaps medication—you can dial down the intensity of your obsessions and compulsions. But your symptoms are not an indication of failure in any way. Often, that’s simply part of living with OCD.

What triggers an OCD backdoor spike?

Now, you’re likely wondering what might cause a backdoor spike. Many factors could be at play here. Things like stress, changes in your routine (even positive events!), skipping treatment sessions, or medication issues could all contribute to a flare in OCD symptoms.

Ibrahim explains that these spikes can be insidious and unexpected. You may be navigating your treatment smoothly, and suddenly—wham!—a new compulsion emerges. Often, she says, with a backdoor spike, you might not realize that you’re engaging in a new compulsion, or it may not immediately dawn on you that you may be inadvertently fueling your OCD.

Take, for example, Ibrahim’s own experience. She’s been an OCD therapist for 20 years, and has 45 years of personal experience with the condition. She considers herself well-versed in managing her OCD with ERP skills, and has reached a point where she coexists comfortably with her OCD. Yet, she admits that backdoor spikes still surprise her every few years. 

These can come in new and unexpected forms. One time, when Tracie felt like she was doing well in her recovery, she was blindsided by an olfactory hallucination—believing that everything smelled like turmeric. Her compulsion led her to constantly think about this scent, and then incessantly checking her clothes, hair, breath, and even her urine. After seeking reassurance from her husband, she had an epiphany. This was, once again, her OCD making a covert return, reminding her of its presence.

These episodes can cause past fears to re-emerge or spawn new anxieties, even after a period of calm. This cycle just goes to show that backdoor spikes are yet another dimension of OCD. They sneak in silently and unnoticed, causing a resurgence of stress and self-doubt, and challenging your sense of progress. 

In fact, those who’ve been effectively managing their symptoms are more susceptible to these spikes, precisely because the sensation of reduced symptoms feels so foreign. This newfound sense of calm and control can trigger doubts and fears leading to a resurgence of symptoms. Essentially, a lessening of your symptoms can make you interpret the quiet of your mind for a looming threat, reigniting the cycle of OCD. But this is just another challenge that comes with truly regaining control over your life on the way to recovery—and you can overcome it.

A backdoor spike can also amplify your fears about handling future stresses or changes. This kind of doubt can act as a trigger in itself, fostering a loop of anxiety and uncertainty about your resilience. 

What should I do if I experience a backdoor spike?

“Begin by acknowledging the intrusive thought, then dive straight back into ERP,” advises Ibrahim. See your thoughts and feelings for what they truly are: manifestations of your OCD, not reflections of your personal value.

How did Ibrahim react to her backdoor spike? She bought a bottle of turmeric, faced her new intrusive concern, and tackled it immediately through exposure. She embraced the notion that everything seemed to smell like turmeric, and by directly smelling the spice, she confronted her obsession: “This is the scent of turmeric; this is my present reality. So what?” she says. And that helped empower herself over the obsession, asserting control and integrating ERP into her daily life as a recovery strategy. 

Here’s another example. Ibrahim combats her contamination OCD by counteracting the anxiety triggered when her phone touches an unsanitary surface. Her bold response? She actually licks her phone as a direct confrontation to the intrusive thoughts, essentially challenging them. “It’s like I’m saying, Oh, you think you can intimidate me? Well, I’ll show you! You don’t own me.’” 

The most important thing to know is that getting help from a clinician who truly specializes in treating OCD is crucial to prevent compulsions due to backdoor spikes from solidifying. Remember, OCD is a severe condition that works differently in everyone, so even experienced therapists need to have specialized training in order to effectively treat the condition with ERP. 

As you go through your journey, Ibrahim recommends, try to regard every spike not as a defeat but as an opportunity to fine-tune your coping mechanisms for OCD. Each hurdle conquered is a step towards enhancing your resilience and your self-awareness.

4 strategies to get back on track in your OCD recovery journey

Navigating all of the complexities of OCD can be challenging, especially when you find yourself veering off the path to recovery. But remember to acknowledge the hard work and progress you’ve already achieved through therapy. Recognizing your efforts is the first step toward regaining stability, even when the journey seems fraught with obstacles.

As you work through the fluctuations of OCD, incorporating these specific strategies can significantly reduce the power of compulsions and improve your overall mental health. Note that these techniques are most effective under the guidance of a licensed mental health professional who has specialized training in OCD treatment.

1. Accept the spike and commit to recovery.

“First and foremost, accept your thoughts and commit to getting back on track,” advises Ibrahim. Acceptance doesn’t mean resignation, but rather recognizing your current state without judgment, which is the foundation for effective treatment.

2. Get back on track with your ERP

You’re likely already very familiar with ERP and know that it’s the gold standard of therapy for OCD. Staying consistent in your practice of ERP is the best thing you can do to gradually diminish the frequency of your compulsive urges. That’s why it’s so important to get right back into therapy. ERP is something you’ll need to continue long term to keep your symptoms at bay and smooth out any spikes that arise along the way.

Just like Ibrahim and her turmeric, consistent practice of ERP can gradually diminish the intensity and frequency of your compulsive urges.

3. Focus on your values

Ibrahim notes that it’s important to choose behaviors that align with your values instead of yielding to OCD’s demands. (Whether that means licking your phone, sniffing turmeric, or something else that combats your fears.) “Opting for meaningful activities can significantly aid your recovery, unlike succumbing to compulsions,” she notes. Engaging in valuable behaviors encourages a positive shift in focus and reinforces your commitment to recovery.

4. Develop healthy lifestyle strategies

• Manage your stress. Stress can exacerbate your OCD symptoms, so incorporating relaxation techniques and stress-reduction activities into your routine is essential. This could include regular exercise, adequate rest, balanced nutrition, or engaging in activities that you enjoy.
• Build a support network. Surround yourself with people who understand and support your journey with OCD. This could be friends, family, or others who are navigating similar challenges. Support groups, whether in-person or online, can provide understanding and camaraderie.
• Give yourself a routine and structure. A consistent daily schedule can add stability and predictability into your life, helping to manage the uncertainties that come with OCD. As long as you’re not using these routines or activities to avoid or escape your triggers and fears, they can help you improve your overall mental well-being.
• Face your fears. Avoiding triggers may seem like a temporary solution, but it ultimately reinforces OCD. Gradually confronting your fears and reducing avoidance behaviors is crucial for long-term improvement.
• Practice self-care. Prioritize activities that nurture and refresh your spirit, such as socializing, pursuing hobbies, exercising or engaging in mindfulness and relaxation techniques.

Lastly, If you find yourself struggling, remember, seeking help is a strength, not a weakness. A therapist with expert training in treating OCD can collaborate with you to craft a personalized treatment approach to deal with your backdoor spike.

Navigating the twists and turns of OCD is undeniably tough, but the effort you pour into managing your condition is invaluable. So while facing sudden OCD symptoms can be daunting, they don’t determine your journey’s value—or your personal worth. Armed with the right strategies and support, you can move through these backdoor spikes and continue advancing toward recovery.