Expect lapses and beware of relapse—especially upon making progress! What’s the difference between the two? Only a world of difference! Lapses are accompanied by a relatively minor uptick in OCD symptoms, are usually short or limited in duration, and almost always occur during a period of short-term life stress or transition. Getting married, divorced, changing jobs, the birth of a child, a move to a new location/community, illness in the family—both happy events and unwanted events—can be associated with a short-term lapse in your recovery from OCD. They are completely normal and should be expected as part of the normal waxing and waning of OCD symptoms throughout your life. Your previous recovery should be fully intact when the outside situational stressors subside.

Relapse, on the other hand, is a much rarer, severe regression back to pretreatment levels of symptoms. It is usually associated with some significant life stressor or disruption in social support, plus additional factors such as alcohol or drug abuse, and in almost all cases, having gone off of your prescribed anti-OCD medication. The sooner you face the issues of lapse and relapse and learn some tools to both prevent them and manage them when they occur, the better.

The following suggestions can help you:

1. After several weeks or months, you may feel you have it made. You may even think that you are cured! Don’t be fooled! OCD is sneaky and persistent. It will give you a “sucker punch” when you least suspect it. In fact, we believe that recovery without having experienced and successfully endured a lapse in OCD symptoms is only partial recovery! Successfully managing lapses is a skill that will help you throughout your life with OCD.


2. Even when you are doing very well, you will get spikes of anxiety on occasion. Don’t be alarmed, and be aware that this is normal. Try the following metaphor and view the OCD-related discomfort like an unwanted houseguest:
   This is a houseguest who thinks he can drop by any time he wants, when you least expect him, and at the most inconvenient time. He’s big, ugly, stinky, scary, and intimidating—much bigger than you are. When he visits, he plops himself down in your living room, takes his smelly shoes off, watches your TV, eats all of your food, reads your magazines, and just takes up a lot of your precious time. Before you began treatment, he’d scare the daylights out of you, and you’d do anything to get rid of him. You would get awfully upset, even terrified by these visits. You’d scream at him to leave, pound your fists, stomp around the floor, and agonize over every minute that went by until the moment he decided to exit on his own. And you’d live in constant fear and dread of his next visit. All of your commotion would only cause the houseguest to stay even longer, entrenching himself ever more stubbornly in your living room. He’d gain enormous strength and power by just feeding off of your desires to get rid of him.
   Now, after you’ve been helped with medication and CBT, he still looks really scary, but now you know he’s really just annoying but essentially safe and harmless! You have come to learn that it’s how you react to him that determines how long he stays! So now, you take the attitude of calm, tolerant acceptance of his presence. You know that trying to get rid of him doesn’t work and only makes it worse. So you just go about your business around the house without paying much, if any, attention to him. With none of your commotion to feed off of, he gets bored and decides to leave after a while on his own. Over time, his stays get shorter and shorter, and eventually he decides your home isn’t even worth a visit, though he may decide to drop in on you by surprise sometime in the future when you least expect it.


3. Lapses and relapses are not signs of failure. They are opportunities to further refine the skills you’ve learned in the Self-Directed Program and fine-tune your recovery from OCD. Be honest with yourself. When you slip up and perform a compulsion, admit it and make plans for how you can resist the compulsion in the future. Get back on track and don’t get down on yourself—people with OCD are so very self-critical! If possible, immediately expose yourself to the feared situation again, and move on.


4. Pay attention to small symptoms before they grow into big ones. As you break free from your major compulsive rituals, you may find yourself doing smaller, less intrusive compulsive rituals. These may seem like harmless behaviors, but they aren’t. They reinforce your belief that you need your rituals to ward off harm. Some examples of smaller rituals are touching the wall as you pass through doorways or checking the stove before you go to bed, even though you may not have used the stove at all that day. These may be new rituals, or they may be old ones you overlooked when the major compulsive rituals overshadowed them. Make a list of any “little” OCD symptoms you may still need to work on.


5. Don’t compare yourself with others—with or without OCD. Your OCD problem is uniquely your own; therefore, your path to recovery will be uniquely your own!


6. It is not uncommon for those who make significant progress with their OCD in a relatively short time to go through a phase of feeling depressed. It is almost a state of bereavement—mourning for the years that were lost to OCD and the devastating toll it has taken. There may be a period of deep sadness and regret about what your life might have looked like had you recovered sooner. Forgive yourself and others for mistakes of the past! No life is ever perfect. Remember that without all of those blind alleys, you would never have gotten to the point you are at today. They were an inevitable part of your recovery. Use the painful past to further safeguard and solidify the recovery you have achieved now.


7. The goal of this book is progress with your OCD, not a perfect cure. Be realistic in your expectations for recovery from OCD. Recovery is a lifelong process with many ups and downs—and with OCD under good control, hopefully, many more ups!


8. Sometimes it will be just plain hard. When you are working hard at maintaining your previous gains, you may become discouraged and frustrated, as if you’ve accomplished nothing at all! It is at these times that you must not lose sight of the real progress you’ve made. Even at difficult times, find compassion for yourself, realize your self-worth, and give yourself a pat on the back for how far you’ve come! Keep moving forward!


9. Appreciate your small victories against OCD. Daily, even minor improvements eventually, over time, add up to larger gains.


10. Never go off of your medications without first consulting your physician. Many patients make the mistake of stopping medications because they are feeling well, only to discover later that they were feeling well only because they were taking the medication!


11. While medication can make a big difference in your OCD symptoms, do not overly rely upon medication to help you. The fact is, you cannot medicate away all your OCD symptoms! Sometimes the best “medicine” for nagging, residual OCD symptoms is a stronger effort with exposure and response prevention.

excerpt from The OCD Workbook: Your Guide to Breaking Free from Obsessive-Compulsive Disorder by Bruce M. Hyman, Cherlene Pedrick RN