Backdoor spikes are a response to your recovery and success. Those who are recovered with anxiety all of a sudden feel a SPIKE of anxiety that came out NO WHERE. It almost sneaks through the back door and says, “hello, is anywhere there….remember me.” “Let me make you doubt yourself, your diagnosis, and all your feelings.” “make you fearful that you’re going to get stuck with all these OCD and anxiety symptoms all over again.”

Introduction: Hi, my name is Nathan Peterson and in this video I want to share with you what a backdoor spike is and what to do with these nasty things. Just when you think you have it all figured out…..uhhhhhh

The “backdoor spike” is a term that is used to describe the overwhelming feelings that individuals with OCD get when they have thoughts that may make them worry that symptoms may come back. 

A backdoor spike often comes about when an individual has been doing well with their treatment plan for a few weeks or months, leading them to believe that they no longer need treatment. This could be related to the person having had some success and believing they are doing well on their own, or it could happen simply because the anxiety-provoking events of their life are naturally subsiding. But then suddenly out of nowhere comes this thought:

“Even though I haven't had any obsessions or compulsive behaviors in weeks, I still may not be able to control them if anything happens to mess up my treatment plan. What would happen if my Dad got sick? Or if my family gets into another car accident? Then these thoughts wouldn't go away and I'd never get better.” (The word “I’ll never get rid of OCD!” is often present here.) This thought can also take the form of an intuition:

Because I have the thought it must be true. It must mean something great and amazing.  It must be my intuition trying to warn me of something.

The individual struggling with a backdoor spike can spend days or even weeks trying to regain control over their thoughts and feelings as they cycle through obsessive questioning of their own sanity. 

Even after many months or years of recovery, some people with OCD may still find themselves struggling with backdoor spikes. For example, a person might not be able to "really" believe that they are not going back into full-blown OCD because of feeling so depressed without their obsessions and compulsions. Or they may feel so much shame about having had OCD in the first place that any thoughts about getting better make them feel like an impostor who doesn't deserve such good fortune.

 When symptoms start to decline. Individuals are feeling really good. I guess what, those darn intrusive thoughts don’t want to stop. So individuals can start questioning. Wait!  I’m still having all these thoughts and I’m not feeling anxious about them. This must mean something. That must mean that I was really a bad person this whole time.  Must mean the things I was thinking about is actually going to happen.


 So with these backdoor spikes what we do about it?  The answer may surprise you. Are you ready?  You do everything you’ve already doing. That’s right!  The treatment that you did which is most likely exposure and response prevention is the treatment that we continually use for backdoor spikes. Because the body and brain all of a sudden come up with a threat, tries to convince you that you’re in danger all over again and most of the time your job is to respond completely different to these threats. If you’re looking around you don’t see immediate danger we choose to leave these threats uncertain.

 Responses like yeah totally I’m going right back into that OCD what a fun ride this is going to be. I sure hope these experiences come back that would be so amazing. It will not feeling anxiety about it probably does mean I like it.  Some may choose to just stick with the uncertainty route which is those maybe maybe not statements.

 Essentially, we are not problem-solving anymore. Not trying to figure out if you’ll have symptoms again or not. Not figure out why you’re not feeling anxiety. We’re not putting any value to this anymore!   

Intuition isn’t a part of this. The brain is really tricky and make someone believe their thoughts are so powerful. Don’t fall for it. 


One thing to know about backdoor spikes is that it may make you believe that this new topic or fear that throws your way is different. It can make you believe that this is so absolutely important. Because all it wants is for you to come back in to the OCD cycle. To reattach.   They think about it, individuals may go weeks or months without anxiety, then all of a sudden comes back. We naturally are going up a lot of meaning to this.

 In here is how we can see the difference between something you need to put value to something you don’t. When anxiety hits, you might look around you, if you don’t see anything happening. The ceiling is falling down, there isn’t a lion running at you, your child’s not about to fall off the counter, It has to be see something you can physically see. Not something you “THINK” is going to happen. 

If there is nothing you can see where you would be in danger, you may choose to treat it as a false alarm and give it NOTHING. Answer a lot of fears with, Yep, maybe maybe not. Or Totally man. 

To reduce the likely hood of a backdoor spike, people do treatment, even when they’re doing well. They do treatment. They continue to face the fears they did in the past. Just to remind them that they are still the boss. 

 If you are wanting to learn treatment for yourself, check out my online self-directed course for OCD. There are 42 videos this thing.  Takes you through everything you need to know about your OCD and how to do treatment.  I’ll leave a link down in the description below. You can even check It out for free. 

 So here’s my question for you,  have you experienced these backdoor spikes?  What did it look like for you?

Imagine your child waking up one morning and they seem completely different. Not a gradual change but an immediate change. Their language may be different, the way they are talking can be different,  they are mentioning fears they’ve never mentioned before, their choosing not to eat, they are raging with anger,  their anxiety is out of control, they may be doing a lot of tics. They may even have some psychotic symptoms such as seeing or hearing things.  It may look like full-blown OCD symptoms all in one night.  These personality changes can change in an instant. 

Let's talk about PANDAS. No not that kind of panda.  You may or may not have heard of this. PANDAS stands for: are you ready for this:

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

 Say that five times fast. 

 Pandas occurs when the strep virus triggers a misdirected immune response and results in inflammation on the child’s brain.   Neurologists believe it affects the basal ganglia of the brain. It is Estimated that one and two children may be affected.

A clinical diagnosis of PANDAS is defined by the following criteria:
• Presence of significant obsessions, compulsions, and/or tics
• Abrupt onset of symptoms 
• Happens before puberty
• There is an association with a strep infection


Obviously, the strep virus is very common. Many children get step. This doesn’t mean they automatically have pandas. 

 When looking for strep, did you know that it can occur and reside in somebody’s sinuses, their ears, their gut, or in other areas of their body.  So when individuals get a throat swab,  the strep virus maybe missed.   It has been said that the majority of strep infections are missed.

Individuals may do blood work to see the amount of titers.  An elevated anti-strep titer means the child has had a strep infection sometime within the past few months, and his or her body created antibodies to fight the strep bacteria.
Some children create lots of antibodies and have very high titers (up to 2,000), while others have more modest elevations.

 One of the most common diagnostic tools I have seen individuals use is called the Cunningham panel.  This tests the likelihood of the child having PANDAS. 


 So here’s the dealio,  a lot of emails and phone calls I get regarding pandas start like this…. “do you believe that pandas exists” ---  is not such an interesting question?  People ask this because there is a lot of information  and even doctors who say that this does not exist.  While I am not a medical doctor, but in the licensed professional,  I have seen many individuals come through my office who exhibit a sudden  onset of OCD symptoms and or tics.  Sometimes mixed with rage and anger. Sometimes mixed with psychosis.  And what I mean sudden onset,  I mean sometimes literally overnight. 

  How scary and confusing this is for parents.  For me,  I absolutely believe that pandas exists,  according to research that I’ve studied as well as individual cases that I have.  Because this is what I see, an individual with all of the symptoms is going through what they call a “flare” -  where symptoms may increase and last  for typically 5 to 6 weeks and then gradually dies out.  This may be the time where they were exposed  to other viruses or the strep virus in their body is elevated. 

 This is a pattern that an  individual may go through time and time and time again. Typically these infections dictate the need of an antibiotic. Penicillin seems to be the first choice because it is well studied.  I wouldn’t believe it if I haven’t seen it with my own eyes,  but when an individual starts their antibiotics,  their symptoms start decreasing. The treatment that we are working on tends to work much better. 

Individuals may do what is called IVIG.  It essentially is an IV that injects immunoglobulin,  some say this is been able to reset the immune system.  This is made from thousands of human donors. 

So as far as the medical side goes, in individual may see an OCD therapist to take care of some of those symptoms. We use exposure and response prevention.  To teach the brain to respond completely different to the anxiety and fears that come their way.  Individuals that experience pandas will have different OCD themes. These can be seen just the same as somebody that has OCD. 

So ultimately, what I want to get you to know out of this whole video is this.   Get proper treatment if possible.  Exposure and response prevention for the OCD symptoms, CBIT for the tics and a  medical trained professional for the physical body and brain. I tend to go to the pandasnetwork.org to find a professional near you. With the information I provided, this is just scratching the surface.

Parents trying to navigate through this,  you are not alone. I hope this video is helpful for you. If your child is struggling with OCD type symptoms, please watch some of my other videos that might relate to what they are going through.

 Here’s my question for you?  What you think of pandas?  Have you or someone you know experienced this before?

Imagine getting this voicemail at the time the school bus is supposed to arrive. Anxiety provoking right? I mean I sent my 5-year-old to kindergarten. They sent emails and made comment assuring us that “our child will not get lost”. I didn’t even ask for that assurance, they just offered it freely. 

As a therapist who strives to live my life with uncertainty, I initially wasn’t worried. Like I always say, when there is a problem, we’ll solve it. 

What do you think? Is there any question in your mind that THIS IS A PROBLEM?

This is what I’ve been talking about all along. When your anxiety hits you and you’re anticipating a problem, you’re guessing a problem, you’re living your life as if there is going to be a problem……IT’S NOT A PROBLEM. 

A problem needs to slap you in the face.

You need to not have any doubt that there is a problem to be solved. If you cannot physically see or hear the problem that slapped you in the face. 
(b-roll slap face)

Then you’re feeling false anxiety and are reacting to something that isn’t really there. The body needs to learn that you ONLY react to REAL problems. 

So back to the story. The bus was supposed to arrive at 3:30….. it didn’t show.  The call was given at 3:30 – what was I to do? Problem solving kicks in, the anxiety kicks in. 

This is what it’s designed for. What would you do in this moment? When there is a real problem presented in front of us, we have to focus on what we have control over. 

I can call the school for an update.
I can get in my car and drive to the school.


There really isn’t much more I can do. Here’s the kicker. The brain automatically plays out situations in our head. These are the what if’s. and guess what? We can treat them the same as ANY OTHER PERCIEVED THREAT. Yes, I do have a real problem presented in front of me, but I practice not reacting to the guesses. 

We do this by using a lot of maybe, maybe not statements, even though it can be very scary. My brain went to the worst….
Did she get kidnapped?
Did she get on the wrong bus?
Did she think she could walk home?
Is she wondering around the school?
Did she get hit by a car?
Did she pass out somewhere?

These guesses are NOT THE PROBLEM. My perception is. I can answer each of these with a “maybe” or “possibly” --- because all I know is that they cannot find my daughter. 

Man, this is incredibly tough to do, but it’s ALL WE CAN DO. So in short, we focus on what we have control over and leave the rest uncertain. 

If I reacted to “did she get kidnapped?” what am I supposed to do? Call the police and report a possibility, just because it came to my head. Drive the neighborhoods looking?

Here is what ended up happening…….10 minutes later I got this voicemail. 

(b-roll answering the phone)

I now know a solution…get in the car and pick her up.  That’s what we did. When we got to the school, the teacher was sobbing, the school was apologetic, my daughter was well….. only sad because she didn’t get the chance to ride the bus with her brother on the first day. 

I mean, you were told to get on the wrong bus, following blindly the directions of others, taken back to the school and picked up by your parents. 

Man, kids are resilient. Here’s the deal….What we learn is that giving assurance or reassurance doesn’t work. The school sending an email assuring all the parents that everything is going to be fine is a guess. This is most assurance giving. A complete guess. We need to learn in our life to either 
1. Not give assurance unless we know 100% (something like, gravity will continue to hold us to the ground)
Or 
2. Leave things uncertain, teaching us and our kids to allow life to be and solve problems when there are problems.   

We can only prevent so much and must allow life to just be. So why am I telling you this story? 

I’m sharing this story as an example of when we need our anxiety. These moments happen rarely. I mean it. RARELY. And even with real danger anxiety, we still can practice uncertainty. 

Treatment for anxiety is uncertainty. Allowing yourself to risk the what ifs. Allowing yourself to live life regardless of the buzz reminding you of dangers. Because you don’t follow those “what if’s” anymore. 

So tell me, for the times you feel anxiety, how many of them are REAL? Meaning, How many have actually manifested the way you thought they were going to. You see, we forget about the times it didn’t happen are really good at remembering the times where the catastrophe or “bad” thing did. 

Your job when you’re feeling anxiety is to quickly look around you for immediate danger. If you don’t see any, you treat it as a false alarm by using the magic words….”maybe, maybe not.”

Stop living in the future of what ifs. Instead live and enjoy your life NOW. ​

​Man, this video is a long time coming. Derealization.  Have you ever experienced this before?  It can be so scary for the person experiencing this. They can feel so trapped like there is no other way out. Derealization  is a mental state or an individual may feel detached from their surroundings. People, objects, things around them may seem on unreal.   You are even so aware that something is wrong that this can often be an obsession on how to make it right again. How to feel attached again.   Unlike something like psychosis or delirium, individuals no that there are in an altered state that something isn’t normal.

 More than half of people will feel this disconnection from reality at least once in their lifetime.

Hi my name is Nathan Peterson…..I am the creator the online OCD and BFRB courses and release videos every week that can help give you different treatment strategies for what you’re going through. 


Derealization is similar to Depersonalization. The difference is depersonalization will experience the same thing except for adding a detachment of their own body, thoughts, and feelings. Almost as if you’re watching yourself as an outsider.  I will have a whole separate video on this.

 Derealization usually happens in different pockets of time. Meaning that these symptoms may come in they may go. Some common experiences that people have are these:
-The sounds around them can feel distorted, they can even seem too loud or too soft.
- Often individuals will feel like they are in a dream state or have some brain fog.
- The world around sees pretty lifeless, useless, what’s the point, you can seem fake that everyone is just doing their own thing every single day.
- Objects around them can look wrong. They can look different than how they actually appear. Things may seem to sharp, others may seem too small or too big. You can even seem blurry.
- Some may feel like there is something separating them from the world around them almost like an invisible wall. This wall that they cannot just break through.

 Some have experienced these for only a few minutes while others may experience this for  months at a time. Individuals often feel like they are going crazy. They recognize that something is off. And all the brain is wanting them to do this is to find a connection again.

 Many will ask me:  where does this come from?
 Guess what, every person is different. 
 Some say that common events that trigger the derealization  is emotional abuse or neglect.  Others say it’s completely random. Some say it’s only linked to anxiety or OCD.

 There is not currently a medical way to see if this is something you are experiencing or not.
 When derealization manifest as part of anxiety or OCD the treatment I typically do is exposure and response prevention.  Individuals may obsess and continually think about how to get out of these experiences. Their problem-solving is so much that they’re allowing themselves to continue being stuck in these Episodes.  With exposure and response prevention the whole idea is how can you take power away from the bodily response or thoughts that you are having. Instead of pulling away from the experience we are moving closer to it. Meaning if somebody were to go through this experience right now,  would focus on all the threats the brain comes up with an essentially answer every single one of them with either an uncertainty answer such as maybe maybe not,  or we completely agree with the threat.

 If the brain says all know what’s happening what if you don’t come out of this.  The answer is maybe I will maybe it won’t. Or I totally hope I don’t come out of this, man it be wonderful if I was stuck in this forever.  When we agree with the threat it takes the power and value away from it.

 Instead what people try to do as they had the thought oh no it’s coming but I don’t come out of this. Maybe if I sit down it will go away, maybe for drink much water it will go away. Maybe I don’t go to that event because all make it worse. Maybe for research on the Internet it will go away. If I just on that answer I can get this to go away. The brain is coming up with plenty of ideas  on how to solve this problem.

 We are no longer trying to solve this problem. We practice not doing compulsions. These are the things you are trying to do to problem solve yourself through this. You may experience the moment even mindfully. I don’t feel connected to the moment,  cool what do I experience. What do I see, what do I feel,  that it’s not to make sense of it all is to show yourself that your living life here in the specific moment.

 When people practice this exposure and response prevention every single time they go through an episode the brain finally gets it.  It learns that it’s giving you these thoughts and feelings and disconnection and when you’re not responding to it the way it wants you to learns. He learns that if it doesn’t have value then it no longer needs to bring this into your life.

 You don’t give yourself a timeline of when this is going to go away. You allow it to be there regardless of what’s happening in your life. You allowed to leave if it wants to that you are not the person that is pushing it away. A lot of acceptance is needed with derealization.  You will continue living your life the way that you want to live your life not changing anything because of this feeling of disconnection.

 Often I see derealization connected with OCD,  if you’re looking for a little extra help with your OCD I do have an online step-by-step course that takes you through treatment.  A link that down in the description below. 

 Here is my question for you. 
 Have you ever experienced derealization before?  What things of help to you what things make a worse?

 Thank you so much for watching, and I will see you next time.

 
COVID-19 and OCD.  Wow. Can you believe it’s been a little over a year since the pandemic started?  I’ve debated making this video multiple times and with multiple requests and emails I finally decided to take the plunge. I wanted to say with the disclaimer that I am not a medical doctor and I’m not giving you medical advice. I will however give you my thoughts on how somebody who struggles with OCD can  do when it comes to the fears of possibly getting the virus. Not only the virus but any sickness.

Hi, my name is Nathan Peterson! I am a specialist with OCD and anxiety related disorders and the creator of the self-directed courses for OCD and BFRBs. I create videos every single week with tips and treatment strategies for OCD, anxiety, tics and Tourette’s, hair pulling and skin picking. Make sure you’re subscribed so you do not miss any of these. 

 You probably know what COVID-19 is.  If you missed it, knock knock knock hello is anyone there. This virus in pandemic has sure set panic throughout the world. And rightfully so. When this thing first started, I made an ignorant comment. I said this is no different than getting the flu, or putting so much value and power on this thing. Boy was I wrong. With the countless lives lost, jobs lost, and mental health issues on the rise, I could never imagine what was going to happen.

 Many people have asked me. Nate and I say uhuh,  and they say so I’ve been doing treatment for my OCD, how does it now change because of the pandemic.  This has been so difficult to figure out a great guideline.  Because just like any other anxiety fear in our life, it is very uncertain.  There isn’t going to be an answer that is given that is 100% sure. 

 When it comes to contamination OCD and the fear of possibly getting sick.  Individuals felt the need to wash more, avoid more things,  Thus sending them through massive spirals where they didn’t know they were following guidelines for fear creating their own rules.

 Here is how I have been treating OCD in the midst of this pandemic.  I have people create a guideline. How many times a day I want to wash my hands. Is it before I eat, after use the bathroom, or if I come in from outside. Maybe it’s if I physically see dirt on my hand. So typically maybe is five times or less a day. 

 I then say, we will follow the guidelines of the CDC. Even if we think they are incorrect or wrong. We have to follow some type of guideline or else the rules that your OCD will create could be catastrophic.  For instance the CDC said, if you are vaccinated you no longer need to wear a mask.  So guess over going to do, no longer wear a mask. But this doesn’t mean I’m no longer wearing a mask but I’m just gonna stay inside. We are following all the guidelines. They say I can go to a restaurant, I’m going to restaurant. They say I can hang out with my other friends vaccinated, I’m hanging out with my friends.

 Here's the tricky part however, what about the things are not part of the CDC guideline. They can’t give every scenario possible that you are ever going to run into. This is where you take your best judgment. Meaning, the CDC didn’t mention if I go to my friend’s birthday party and is probably going to be 30 people there. What should I do? I say you do whatever you want to do. Sounds risky, but you do it following the CDC guidelines. They say wear a mask there’s over 20 people, I guess I’m wearing a mask.  

 I also wouldn’t want individuals to solely focus on this the rest of their life. I want individuals to live their life, sometimes feel like they are risking a lot. But knowing that the base of what I said was I want to wash my hands five times or less a day. How my going to do this.

 Typically we use exposure and response prevention. We expose ourselves to things that make us scared or nervous and respond completely different to them. A lot of people hear this and I think that sounds pretty dumb.  You want me to just go out and get myself contaminated and dirty and hug everyone I see. This is not an all or nothing approach. This means that I just went to the grocery store I got a lot of groceries other people probably touched, I’m putting them away in my pantry without washing them because the CDC did tell me I needed to. I did say however that if I come in from outside I can wash my hands.

 But did the CDC say I need to wash my hands with 5 to 10 pounds of soap? NOPE!   Did the CDC say that the water must be scalding hot? NOPE!

 You may need to create your own guideline and foundation. I wash my hands for 30 seconds, one pump of soap, and the water may be hot or not.

 Overall I want somebody’s experience to be a thoughtful one. Not in anxiety one. Meaning my decisions are based off of just general thought not my decisions are based off of my anxiety.  And if anxiety is there I might risk the rules that have created in my brain and learn to respond completely different to them. A lot of times the magic words to the things we don’t know or maybe maybe not. Meaning I’m choosing to only solve the problem when there’s a problem presented in front of me. This is so incredibly hard to do.  Because people have gone sick, people have died. 

 But we are living our life, OCD does not get to dictate what you do anymore. Because there is new value that is been placed in front of us doesn’t mean  OCD treatment goes out the window.

 A task that some choose to do is to write down all the rules are brain has created because of this pandemic. See if they match up with the CDC and the ones I don’t they may choose to do treatment with these. They feel like they’re doing a lot of risk. But without the risk there tends to not be the reward. The sound so incredibly scary,  but what I’ve seen time and time again that the brains really good at saying once I get vaccinated then I will feel anxious about it. Once this one thing happens I will be nervous anymore. Guess what happens, a person gets vaccinated and there still anxious. The brain thinks it’s problem-solving but is continuing to keep you trapped. It’s only going to know that you’re the boss if you treated that way. Sometimes going against the rules that you’ve created in your brain.

 I am in no way diminishing the effect that this virus is had on the world. I am diminishing the way OCD is making you think about the virus.  Taking power and value away from OCD. It no longer deserves your attention.

 If you’re looking for a little extra help, I’ve created a very specific course for OCD that takes you through understanding yourself, the treatment, and building your foundation for success.  I will link this down in the description below.

 Here’s my question for you. What rules are you following or are taking over your life because of this pandemic?  Also, what you can start doing differently about your behaviors?

Anxiety! Most who feel anxiety are looking for relief. I mean, that’s what the body is urging them to do. Instead of looking for the cure or falling for those “anxiety recovery in 2 weeks” scams; we do what we know works. Let me teach you how individuals finally learn to retrain their brain with their anxiety. ​

You are not special!  WAIT! Don’t don’t run away!  I needed to get your attention for a moment. If you leave now you think I’m just a big jerk.  Here’s what I mean by this! 

So here is what I mean by you not been special. First of all your special.  You matter in your feelings matter. Because you’re even watching this video right now it shows a lot of strength. 
 So what I’m really meaning is that the OCD that you are experiencing is not different.  Individuals can often think that the topic or theme that they are going through this special, it’s different,  no one understands exactly what they are going through,  its untreatable,  I hear all these videos online I see all this advice but it doesn’t apply to my theme. 

Errrrrr!  Nope!  Your OCD is not special or different.  This to me is one of OCD’s biggest lies.  If it can make you believe that you are untreatable and that you are different from what you are experiencing then it’s got you.  Individuals will often tell me that exposures they hear the specific theme just don’t apply to them.  That if people really knew all the details of everything there experiencing they would change the treatment. 

  So this is something that is important to note,  something to tell your OCD even if you think it is different than everyone else’s to remind yourself that OCD is OCD.  That follows the same route as everybody else. It’s making you doubt in question yourself and who you are as a person. It’s making you question the threats in the future and if they can come true or not.  It’s giving you an intrusive thought putting a lot of meeting on this thought making you feel anxious that’s wanting you to do something to fix it. 

 Simple as that.  When we see OCD simply becomes simple. If you see OCD is complicated,  different,  or special,  than it has the upper hand.  To take control is to see it simply. Do not see yourself as different or special.  Like I said you as a person are unique and special.  Your  OCD does not get to join this party. 

 So as you’re seeing the videos that I have, your hearing advice given,  and you think it doesn’t apply to your theme. Remember that this is a lie.  Give yourself more credit.  You can even remind your OCD that it’s not special when it’s trying to take the light.  Give yourself the opportunity to do treatment.  I know what people say, “but if you only heard what I’m going through you’d be shocked.  You would say that mine is different.”  Don’t even allow your brain to go there. Instead he focus on living life and enjoying. 
 This tactic the OCDs using is no longer going to be something you fall for.  Treatment is available if you’re looking for a specialist. 

​So here’s my question for you,  have you ever felt that your OCD is different than everyone else’s? 

Most compulsions that are done are because of a "just in case" scenario. You may not be 100% sure that the threat will happen for sure, but "just in case" you protect as to not take the risk. Let's learn what to do INSTEAD of the compulsion and avoid the "just incases". ​