OCD Resurgence – What first?

[Robin S]

Hey Natasha – I hope you and your kids are doing well and enjoying the summer together.  Maggie has really missed participating in this month and last month’s Zoom calls. We’ve just had other commitments on those days :(.  Anyway, Maggie’s OCD has been a thing for 3 years now, and we’re all super informed as you know (since you informed us! :). Maggie’s intrusive thoughts/obsessions/compulsions have always ebbed and flowed, but this summer we are seeing a bigger-than-usual increase. Her intrusive thoughts are around fear of throwing up, and she connects that to what she eats.  The thoughts make her question how much she ate (especially sweets), and even “measures” it for her.  Reassurance-seeking has been the biggest compulsion along with face scrunching (we do not reassure her).  She has also started having panic attacks, which she hasn’t had in a couple years.  I’m just feeling really unfocused and overwhelmed, wondering where to start tackling all of this – do we increase her exposures, target the intrusive thoughts, etc?  Medication-wise, she has been on 100 mg of Sertraline for quite some time now (no negative side-effects), has also added Guanfacine to address negative thoughts in the past few months, and finally has started taking Hydroxozine at times where she finds her intrusive-thought-related nausea to be unbearable – this can be up to twice a day currently.  Just for reference, she has had access to the Hydroxozine for a couple of years now but never really felt she needed to take it.  Maggie is working with a NOCD therapist that we like every other week.  I could look at increasing that to weekly?  Please let me know your thoughts. We did make a new exposure menu together, but I’m just questioning whether to start someplace else, and admittedly we don’t do exposures daily.  She was doing so well that we got out of that routine.

Any input you have is appreciated. Thanks!  ~Robin

[Natasha]

Hi Robin,
So sorry to hear about the increase in symptoms. If possible, I would definitely move her to weekly with her therapist. It sounds like doing more ERP around the fear of throw up would be good. Also eating sweets as an exposure might be helpful?

I would also work on how she reacts when feeling nauseous. It can help to learn how to relax the body and not fight the nausea, as that tends to make it worse. This youtube video speaks about that: https://youtu.be/N64tVmsfwYQ

[Robin S]

Thank you so much for your response!

[Author]

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