What Does a Typical "Wax/Wane" OCD Cycle Look Like?

[MomWithOCDSon]

I have been participating primarily on the PANDAS forum for the last few months, as our OCD son experienced a very sharp uptick in his symptoms/behaviors about one year ago, and none of the traditional OCD treatments were assisting him. Once we found PANDAS and had his strep titer count tested, though, we found that he had high titers and decided to try treating him with antibiotics. Some of his OCD behaviors continue today . . . though to a significantly lesser degree than before the abx . . . and he continues ERP therapy and other standard OCD interventions, along with the abx.

 

He was first diagnosed with OCD at age 6, and between that age and the Wax to End All Waxes at the age of 12, we thought we experienced about 3 waxing periods, all told, though none of them was as severe as the latest one. We couldn't tie the waxing to anything interior or exterior to his life experience, though. At first, we though he'd wax at the beginning of a new school year, with new teachers and new classes, etc. But he didn't. Then we thought perhaps the waxing was tied to the seasons and, in particular, being denied more outside activity and sunlight during our heavy winters. But though his condition seemed to wax one winter, it didn't wax during the successive one.

 

Every doctor, therapist and book we've ever consulted regarding OCD acknowledges a "wax and wane" cycle, but I've never been given any sort of general expectation in terms of how long it might last, how frequently it may come around, etc.

 

Meanwhile, in the PANDAS arena, families tie "exacerbations" of behaviors (whether OCD or tics or both) to re-exposures to strep or other infectious agents, and there seems to be a concensus that the "exacerbations," especially in the case of a child who is generally medically asymptomatic for strep or another illness, can mimic the "waxing" of "typical, non-PANDAS OCD."

 

So, I'm confused, I guess. Because my son has definitely been assisted by abx, I do believe he has PANDAS. But I'm not entirely convinced that he doesn't also have some degree of "regular OCD," or perhaps will have to deal with some "regular OCD" for the remainder of his life because of some more permanent damage done to his brain/wiring as a result of having gone untreated for his hidden, asymptomatic strep issues for more than 6 years.

 

Can you help us? Can you describe what you've seen in terms of a "wax/wane period" in an OCD cycle? Is there a pattern that can be tracked from year to year, or season to season, or trigger to trigger? Does the wax/wane change as a person grows older? Any experience you might share would be really appreciated.