Can Lyme Disease Trigger Obsessive Compulsive Symptoms?
Obsessive compulsive symptoms have been reported in some patients with Lyme disease, raising questions about whether infection or immune activation could contribute to psychiatric symptoms.
Obsessive compulsive symptoms in Lyme disease may reflect neurologic involvement, immune activation, or the psychological burden of chronic illness.
The CDC notes that Lyme disease can affect the nervous system, which may contribute to neurologic or psychiatric symptoms in some individuals.
Study Examines Obsessive Compulsive Symptoms in Lyme Disease
The study published in General Hospital Psychiatry examined obsessive compulsive symptoms (OCS) among 147 adults with Lyme disease. The authors found that 84% of participants reported “clinically significant” OCS, although only 44% identified themselves as having these symptoms.
Reported symptoms included washing, checking, ordering, obsessing, hoarding, and neutralizing behaviors.
The onset of obsessive compulsive symptoms appeared temporally related to Lyme disease in many participants. Twenty-six percent reported onset after their Lyme diagnosis, while 51% were uncertain of timing but believed the symptoms were related.
More than 90% described a gradual onset over several months. There was no difference between those with gradual versus sudden onset.
Sixty percent reported a waxing and waning course, while 40% described persistent symptoms. Among those aware of their symptoms, nearly half had used psychotropic medications, with 77% reporting at least partial improvement.
“Most patients who sought mental health treatment for OCS experienced improvement of symptoms, and around half also reported improvement in OCS following antibiotic treatment,” the authors note.
Why Obsessive Compulsive Symptoms May Occur
The authors propose several possible mechanisms. Obsessive compulsive symptoms may reflect direct effects of infection or immune activation on the central nervous system, including inflammation, cytokine activity, and potential disruption of the blood-brain barrier.
Alternatively, these symptoms may represent a psychological or functional response to chronic illness, particularly in patients with more severe or persistent Lyme disease symptoms.
- Direct or indirect neurologic effects, including inflammation, cytokines, and possible antineuronal antibodies.
- Behavioral or psychological responses to illness-related stress, providing temporary relief or a sense of control.
Patients with more severe neurologic and psychiatric symptoms reported greater OCS severity.
Relationship to PANS
Lyme disease has been proposed as a potential trigger for Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), which involves sudden onset of obsessive compulsive symptoms and/or tics.
However, this study focused on adults and did not establish Lyme disease as a trigger for PANS. The gradual onset and response to psychiatric treatment in many participants differed from classic PANS presentations.
Study Limitations
The study relied on self-reported data and recruited participants from internet forums, which may introduce bias. The authors emphasize the need for further research into psychiatric manifestations of Lyme disease.
Psychiatric and neurologic symptoms are discussed further in the Lyme disease symptoms guide.
Clinical Perspective
This study highlights the potential overlap between infection, immune response, and psychiatric symptoms. While causality remains uncertain, obsessive compulsive symptoms may be part of the broader neurologic and psychiatric spectrum seen in some patients with Lyme disease.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
My son was diagnosed with LD in 2009. Missed high school. After years of treatment went on to finish HS. Graduated from community college and started at a university. End of his junior year he started with severe OCD and paranoia. He was placed in a psych ward, where they almost killed him. He went cationic and was in a Boston hospital for months on a feeding tube, etc. Psych meds did not work and they would not listen to my about Lyme and his co-infections and treatments. Finally we agreed to try ECT. It brought him out of the catonia, Infectious Disease would not listen, even after present them with new positive bloodwork and many research articles. He has LD, babeosis, Bartonella, ehrlicia and RMSF. He has been on treatment for a year now. Started IVIG 7 months ago and IV Rocephin 3 months ago with other combinations of ABX. He has made remarkable improvements. The OCD which has greatly improved still stands in the way of his recovery. I’m really not sure if the psych meds he is on even help. I have met you several times at LDA and ILADS. I value your opinion. Thank you for listening and all the work and research you have done.
I am happy to hear your son is improving. Hopefully, the OCD will respond. I have patients that meet the PANDAS and PANS criteria as well as Lyme disease.
I have been chronically ill since 2016 age 21. Symptoms started with severe migraines and body weakness a few times a month around my menstrual cycle, to becoming chronically in pain everyday where I had to loose my job and be completely debilitated with an unknown illness. Had daily debilitating migraines, body pain, weakness, fatigue, dizziness, nausea, short of breath, fast heart rate, horrible digestive issues, gnarly hand rashes, pain deep to the bone to the point where I could not walk or stand up on my own on some days. Could not work or exercise, went 6 months without being able to drive a car. Before I so suddenly got sick I was able to work out 1-3 hours 5 times a week so this was a shock to me. I then started becoming very scared of germs and getting sick because I felt so weak and vulnerable and so out of control. Everyday was unexpected and unknown to me for what my body was to do to me each day. Long story short I developed OCD within a year of being chronically ill and without a diagnosis. In 2019 I have been diagnosed with Lyme Disease. I’ve tried many antibiotic and herbal treatments with no improvement except sometimes sporadically I get a week or two of feeling good then i’m deathly sick every day again. My OCD is still very severe, it’s a battle every day with my OCD and physical pain but I do notices both my Lyme symptoms and OCD get extra worse before my menstrual cycle. The rare days I feel good, my OCD symptoms improve but both are short lived. This pandemic has been especially hard for my OCD but I keep fighting and continue to seek a treatment that can hopefully help me get my life back! Thank you for this article.
I have been chronically ill since 2016 age 21. Symptoms started with severe migraines and body weakness a few times a month around my menstrual cycle, to becoming chronically in pain everyday where I had to loose my job and be completely debilitated with an unknown illness. Had daily debilitating migraines, body pain, weakness, fatigue, dizziness, nausea, short of breath, fast heart rate, horrible digestive issues, gnarly hand rashes, extremely painful swollen lymph nodes, pain deep to the bone to the point where I could not walk or stand up on my own on some days. Could not work or exercise, went 6 months without being able to drive a car. Before I so suddenly got sick I was able to work out 1-3 hours 5 times a week so this was a shock to me. I then started becoming very scared of germs and getting sick because I felt so weak and vulnerable and so out of control. Everyday was unexpected and unknown to me for what my body was to do to me each day. Long story short I developed OCD within a year of being chronically ill and without a diagnosis. In 2019 I have been diagnosed with Lyme Disease. I’ve tried many antibiotic and herbal treatments with no improvement except sometimes sporadically I get a week or two of feeling good then i’m deathly sick every day again. So going on 4 years of feeling horrible every day all day and I get my hopes up every time I try a new treatment but nothing seems to work or relieve any of my symptoms or severity. My OCD is still very severe, it’s a battle every day with my contamination OCD and physical pain level but I do notices both my Lyme symptoms and OCD get extra worse before my menstrual cycle. The rare days I feel good, my OCD symptoms improve but both are short lived. This pandemic has been especially hard for my OCD and feeling extra vulnerable with Lyme but I keep fighting and continue to seek a doctor and new treatment that can hopefully help me get my life back! Thank you for this article.