Kristen Taylor-Ladd, MA, LMFT, of the OCD Center of Los Angeles discusses the common OCD experience of the backdoor spike: what is it, what it can look like, and how it can be treated.

As a therapist who specializes in Obsessive-Compulsive Disorder and anxiety, I often help clients navigate the confusing and difficult territory of intrusive thoughts, compulsions, and the all-consuming doubt that OCD provides us. One particularly sneaky form of OCD that tends to catch clients off-guard and that is not talked about nearly enough is what we call a “backdoor spike.”

Say you’re someone who has been progressing in Exposure and Response Prevention (ERP) treatment, maybe even finally beginning to experience some relief from your OCD theme(s), but suddenly you find yourself spiraling again in a new and disorientating way – you may be experiencing your first backdoor spike.

What is a Backdoor Spike?

A backdoor spike is a type of obsessive intrusive thought that emerges subtly, often after an initial obsession has been addressed and is starting to feel less intense. This is your brain’s attempt at sneaking OCD in through the “back door” when the “front door” seems to be closed due to all your excellent ERP work. Sometimes I like to call it OCD about OCD.

It typically doesn’t come with the same loud, repetitive anxiety you might be used to with your primary OCD theme(s). Instead, it can feel more like an unsettling “what if?” about your OCD itself that lingers in the background and refuses to leave. Think about it this way, when our brain is so used to worrying, and now we’ve taken some of the compulsive fuel away from the anxiety, our brain may try to fill that space with a worry about our lack of worry.

Examples of Backdoor Spikes

Let’s say a person has been struggling with Relationship OCD, obsessing specifically over whether they truly love their partner or not. They’ve done a lot of great work with ERP, and their anxiety and intrusive thoughts have started to subside, yay! Then one day, a new thought appears: “If you’re not feeling anxious anymore, maybe that means you actually don’t love your partner, and this has all been a lie.”

Another example: Through ERP treatment, a person with Harm OCD has successfully worked on managing intrusive thoughts about harming someone. They no longer feel the same fear when the thoughts come up. Then one day, a new thought appears: “If you no longer feel afraid, maybe that means you’re actually okay with the idea of harming someone and your thoughts are real.” Cue the doubt and the anxiety spiral.

Backdoor spike thoughts can also take a meta approach, which sometimes can look like the below examples:

“What if the thoughts I had before weren’t really OCD?”

“What if I haven’t actually gotten any better?”

“What if this is the real me and I’ve just been lying to everyone, including myself?”

“What if I’ve been faking it this whole time and I don’t have anxiety or OCD at all?”

If any of this sounds familiar, please know you’re not alone. Backdoor spikes can be a common part of the OCD healing journey. I like to think of backdoor spikes as a sneaky OCD compliment, because they often only pop up when we are making good progress – so congratulations on your hard work!

Now you might be wondering what we can do about backdoor spikes. If you’ve been working on your OCD with ERP treatment, the good news is that you’re already on the right track and have the proper foundation to tackle these kinds of intrusive thoughts, too. The first step is to recognize the pattern of backdoor spikes and the different ways these may show up for you. Secondly, we want to keep an eye out for mental compulsions (reassurance seeking, mental checking, self-punishment, etc.), as these tend to be difficult to catch without awareness. And finally, continue implementing your ERP tools and practicing acceptance. Treating backdoor spikes is very similar to treating our initial, more direct, intrusive thoughts – just in a different font.

Although frustrating, experiencing a backdoor spike doesn’t negate all the hard work you’ve put into your treatment journey; it’s just another opportunity to use your skillset. And take the twisted backdoor spike compliment! It’s here because you’re doing great.

•Kristen Taylor-Ladd, MA, LMFT, is a psychotherapist at the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related anxiety based conditions.  In addition to individual therapy, the center offers nine weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment.  To contact the OCD Center of Los Angeles, click here.