If you’re familiar with Obsessive-Compulsive Disorder (OCD), you know it can be a sneaky, relentless disorder. Just when you think you’ve got it under control, it finds a way to pull you back in. One of the ways OCD does this is through something called a “backdoor spike.” This might sound like something from a spy movie, but in reality, it’s just another way OCD plays tricks on the mind. Let’s break it down in an easy-to-understand way and talk about how to manage it, both for people with OCD and the therapists supporting them.
What Is a Backdoor Spike?
A backdoor spike is a flare-up of anxiety or intrusive thoughts that happens after someone feels like they’ve gotten better or conquered their OCD fears. Imagine you’ve been working hard in therapy, facing your obsessions and resisting your compulsions. Maybe you’re feeling proud, thinking, I’m doing well, I’m not as anxious, the thoughts aren’t bothering me as much and I’m managing my OCD. But then, out of nowhere, your brain goes, Wait, what if not feeling anxious means I don’t care about the thing I was obsessing over? What if I’m actually a bad person? And just like that, the fear is back, but this time it’s about not feeling anxious. To sum up, it’s feeling anxious about not being anxious.
For people with OCD, the backdoor spike is often frustrating because it feels like OCD is sneaking in through the back door just when they thought they’d locked up the front. It’s a subtle, tricky way that OCD tries to latch back on to old fears in new ways. Remember, OCD is creative, sneaky and always looking for a new trick.
How It Works
Let’s take an example to make it clearer. Say someone with POCD (pedophilic OCD) has been working really hard on their exposures, spending time around family members that are children, and tolerating being around children in public. They aren’t engaging in compulsions and after a lot of hard work, they are not feeling as anxious, feeling more calm, and not feeling the need to engage in compulsions. This is great right? This is what the person has been working toward. The predictable trick that comes next is OCD saying, Why am I not anxious? Does this mean I actually don’t care about harming children anymore? Maybe I’m going to let things get out of control and I’ll do something bad. This is the backdoor spike.
The backdoor spike preys on the idea that feeling calm or not having anxiety is somehow wrong, as if it’s a sign they’ve stopped being responsible or moral. The person might start to doubt their progress and wonder if not feeling anxious means they’ve missed something important.
Why Does It Happen?
OCD is driven by doubt and the need for certainty. People with OCD often feel like they need to be 100% sure that something bad won’t happen, or that they’re a good person. When they start to feel relief from their anxiety, OCD sees an opportunity to create new uncertainty: Why am I not worried? Shouldn’t I be worried? What if not worrying means I’m in danger or a bad person [or insert whatever fear is relevant here]?
It’s all part of OCD’s never-ending quest for certainty. Just as someone starts to move past their original fears, OCD switches gears and finds a new angle to bring the doubt back into focus.
How to Handle the Backdoor Spike
The good news? A backdoor spike is just OCD being OCD. It’s still playing the same game, just with a new twist. Here’s how to manage it:
1. Recognize It for What It Is
The first step is recognizing that the backdoor spike is just another OCD trick. Instead of getting caught up in the fear that not feeling anxious means something is wrong, remind yourself: This is just OCD trying to sneak in through a different door.
For therapists: Helping your clients label the backdoor spike as part of the OCD cycle can reduce its power. Give clients education on the backdoor spike throughout treatment and talk about how to be proactive about it when it actually happens. Explain that it’s normal for OCD to change its focus, especially when they start to make progress in treatment.
2. Resist the Urge for Reassurance
It’s natural to want to check or ruminate when a new doubt pops up. But this is just another compulsion in disguise. The same rules apply: avoid giving in to the urge to seek certainty. Just like you would resist checking or neutralizing other fears, resist the urge to “check” whether not feeling anxious means something bad. Frame this as another chance to practice ERP. Sit with the uncertainty of feeling calm. It may feel uncomfortable at first, but show yourself that you can handle it.
For therapists: Try not to get caught up in the content of OCD’s new trick, and instead focus on the process with clients. Give prompting and reminders that this sounds like an opportunity to practice ERP skills.
3. Stay Grounded in Your Values
One way OCD tries to throw you off course is by making you doubt whether your calmness means you’ve stopped caring about what’s important to you. But remember, you don’t need anxiety to be a good person, make responsible choices, or live by your values. In fact, the goal of OCD treatment is to help you live in line with your values without being ruled by fear.
For therapists: Incorporating values into ERP can help your clients stay grounded when OCD tries to shake their confidence. Help them refocus on what really matters, rather than what OCD tells them to fear.
4. Be Kind to Yourself
Backdoor spikes can feel discouraging, but they’re not a sign that you’re back at square one. In fact, experiencing a backdoor spike means you’ve made real progress. OCD has to change its tactics because the old fears don’t work as well anymore! Remind yourself that progress is not a straight line, and setbacks are part of the process.
For therapists: Encourage your clients to practice self-compassion when they encounter a backdoor spike. Progress in OCD treatment is full of ups and downs, and it’s important to celebrate the resilience it takes to keep going. Practice makes progress, not perfection!
Conclusion
The backdoor spike is one of the many ways OCD tries to keep its grip on you, but with awareness and the right tools, it can be managed just like any other OCD fear. Whether you’re a therapist helping clients through this tricky part of treatment, or someone living with OCD trying to understand your mind better, the key is to remember that you don’t have to give in to the doubt. Keep pushing forward, and don’t let OCD sneak in through the back door!
