OCD: Keeping a lapse from becoming a relapse

OCD: Keeping a lapse from becoming a relapse: “

The way you interpret an event makes a difference in the way you end up feeling. People with OCD may make great progress with treatment yet sometimes they experience setbacks. The way you deal with that initial return of symptoms can determine whether your lapse turns into a relapse.

The following story about Jerry and Tim illustrates how two differing perspectives on a re-emergence of an obsession led to a big setback for Tim, but had relatively little impact on Jerry.

Jerry suffers from contamination OCD. He was first referred for help when his doc noticed that his hands were raw and bleeding. Jerry confesses that he often spends an hour in his shower and washes his hands hundreds of times most every day. After 10 sessions of exposure and response prevention (ERP), Jerry’s symptoms are under control. Yet, Jerry continues to have times he worries about getting contaminated. He recalls that his treatment included how to handle these occasional thoughts. He tells himself that the obsessions are normal and to be expected. He purposely waits until the thought passes and does not engage in compulsive washing. He knows that if the thoughts get worse, that he can always return to therapy for a few booster sessions. Most days Jerry feels that he is leaving OCD behind him despite his occasional lapses.

Tim also has contamination OCD. He too washes compulsively and avoids public places. His washing takes up hours of his day. Tim visits his primary care doctor to see if he can suggest something to help him. The doc talks to Tim about different kinds of treatment. Tim chooses to go on an antidepressant to see if that will help him. Tim’s doctor reminds him that the medication can take a long time to have an effect. Tim is relieved he may get better. After about 8 weeks, his symptoms seem to lesson. He doesn’t always think about contamination and has reduced his washing.

An early flu season hits and Tim comes down with the flu. He finds himself obsessing about what might have made him sick. The more he thinks about it, the more he begins to avoid places and engage in compulsive washing. Tim calls his doctor to complain that the medication is no longer working. The doctor encourages Tim to stay on the medication and consider seeing a psychotherapist for exposure and response prevention. Tim throws the pills away and hangs up the phone. Within a few weeks, Tim is back where he started with OCD controlling his life. Tim has suffered a relapse.

One reason we encourage people to seek exposure and response prevention is that when medication is stopped, symptoms usually return rather quickly. The skills you learn in psychotherapy can last a lifetime.