Can Lyme disease trigger obsessive compulsive symptoms?

A number of psychiatric disorders have been reported to occur after an infection with Lyme disease (LD). “Conditions including depression, mania, delirium, dementia, psychosis, obsessions and compulsions, and panic attacks have all been reported to occur after infection with LD,” state the authors of a new study entitled “Obsessive-compulsive symptoms in adults with Lyme disease.” [1]

 

The article published in General Hospital Psychiatry examines the temporal incidence of obsessive compulsive symptoms (OCS) among 147 subjects, ages 18 – 82, with Lyme disease. The study found that 84% of these individuals reported having “clinically significant” OCS. However, only 44% identified themselves as experiencing OCS. Their obsessions and compulsions included washing, checking, ordering, obsessing, hoarding, and neutralizing.

The onset of obsessive compulsive symptoms appeared to correlate with the individuals’ Lyme disease diagnosis. Twenty-six percent of the participants indicated the onset of obsessive compulsive symptoms occurred after their Lyme disease diagnosis, while 51% were unclear when they were diagnosed with Lyme disease but believed that their OCS was temporally related to LD.

More than 90% of the individuals reported a gradual onset (i.e., several months) of obsessive compulsive symptoms. “There was no age difference between those with sudden-onset symptoms and those with a gradual onset,” according to Johnco, lead author of the study.

The majority of participants (60%) reported a waxing and waning course of symptoms, while 40% reported a chronic and steady course of OCS. Out of the participants who were aware of their OCS, nearly 50% had taken psychotropic medications with 77% experiencing “at least partial improvement in OCS.”

“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 state.

The authors also found “those who experienced psychiatric and neurological symptoms associated with LD [Lyme disease] reported greater OCS severity.” Similarly, participants with a greater number of Lyme disease symptoms reported higher levels of OCS.

The authors offer two explanations for their findings. The OCS may be due to the “direct physiological effects of Lyme disease or associated immunologic response, a psychological response to illness, a functional somatic syndrome, or some combination of these.” More specifically, they write:

  1. “LD may play a direct or indirect role in the pathogenesis of OCS, possibly via inflammation and impact on the central nervous system via decrease in the integrity of the blood brain barrier, along with an increase in inflammatory cytokines, production of antineuronal antibodies or glutamatergic excitotoxity.”
  2. “OCS are a functional somatic response to a diagnosis of LD for some individuals. Those with greater levels of disease severity and disease-related impairment may engage in certain OCS in an attempt to manage their LD symptoms or the co-occurring emotional distress, and OCS may provide some temporary sense of control and emotional relief.”

“LD has been identified as a potential trigger for OCS and tic symptoms in children with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), with remission of symptoms following antibiotic treatment,” writes Johnco.

However, this study was limited to adults and not designed to address the question as to whether Lyme disease could be a potential infectious trigger of PANS, which is characterized, in part, by a sudden onset of obsessive compulsive behaviors and/or tics.

The authors do point out that the lack of “sudden-onset OCS” and the greater response to psychotropic medications rather than antibiotics “cast some level of doubt on the similarity to PANS presentations in the majority of respondents.”

Several limitations in the study design are highlighted including recruitment of participants from internet forums and reliance on self-reported symptoms and other medical data. But the authors emphasize the need for more studies.

“Attention to psychiatric symptoms in patients with LD has been minimal, and there is considerable scope to extend this research area in coming years,” writes Johnco.

 

Related Articles:

Suicidal behaviors in patients with Lyme and associated diseases

16-year-old boy with Lyme disease presenting as depression

7-year-old girl with Lyme disease presenting as attention deficit disorder

References:

  1. Johnco C, Kugler BB, Murphy TK, Storch EA. Obsessive-compulsive symptoms in adults with Lyme disease. Gen Hosp Psychiatry. 2018;51:85-89.

 


4 Replies to "Can Lyme disease trigger obsessive compulsive symptoms?"

  • Casey Kies
    12/22/2020 (11:06 pm)
    Reply

    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.

  • Casey K
    12/22/2020 (8:08 pm)
    Reply

    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.

  • Robin Lemieux
    07/16/2019 (4:58 pm)
    Reply

    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.

    • Dr. Daniel Cameron
      07/16/2019 (11:26 pm)
      Reply

      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.


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