Can Lyme Disease Trigger Obsessive Compulsive Symptoms?
Obsessive compulsive symptoms may occur in Lyme disease
Neuropsychiatric symptoms may overlap in neurologic Lyme disease
Careful evaluation may help identify contributing factors
Obsessive compulsive symptoms have been reported in some patients with Lyme disease, particularly in individuals with neurologic and psychiatric manifestations. Researchers have explored whether neuroinflammation, immune dysregulation, blood-brain barrier disruption, or the psychological burden of chronic illness may contribute to obsessive compulsive symptoms in susceptible individuals.
The article published in General Hospital Psychiatry examined the temporal incidence of obsessive compulsive symptoms (OCS) among 147 subjects, ages 18 to 82, with Lyme disease.
The study found that 84% of these individuals reported having “clinically significant” obsessive compulsive symptoms. However, only 44% identified themselves as experiencing obsessive compulsive symptoms. 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 symptoms were temporally related to Lyme disease.
More than 90% of the individuals reported a gradual onset of obsessive compulsive symptoms over several months. “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 reported a waxing and waning course of symptoms, while others described a chronic and steady course of obsessive compulsive symptoms.
Out of the participants who were aware of their obsessive compulsive symptoms, nearly half had taken psychotropic medications, with 77% experiencing 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 stated.
Neuropsychiatric Symptoms and Lyme Disease
The authors also found that individuals who experienced psychiatric and neurologic symptoms associated with Lyme disease reported greater obsessive compulsive symptom severity. Similarly, participants with a greater number of Lyme disease symptoms reported higher levels of obsessive compulsive symptoms.
The authors offered two possible explanations for their findings. Obsessive compulsive symptoms may reflect direct physiologic effects of Lyme disease or associated immune responses, or they may represent a psychological response to chronic illness and disease-related distress.
- “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.”
- “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.”
Johnco also noted that Lyme disease has been discussed as a potential trigger for obsessive compulsive symptoms and tic disorders in children with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS).
However, the authors emphasized that this adult study was not designed to determine whether Lyme disease directly triggers PANS presentations characterized by sudden-onset obsessive compulsive behaviors or tics.
The lack of sudden-onset obsessive compulsive symptoms and the greater response to psychotropic medications than antibiotics “cast some level of doubt on the similarity to PANS presentations in the majority of respondents,” according to the study.
Several limitations in the study design were highlighted, including recruitment from internet forums and reliance on self-reported symptoms and medical data. Still, the authors emphasized the need for additional research into psychiatric symptoms associated with Lyme disease.
“Attention to psychiatric symptoms in patients with LD has been minimal, and there is considerable scope to extend this research area in coming years,” Johnco wrote.
Frequently Asked Questions
Can Lyme disease cause obsessive compulsive symptoms?
Some studies have reported obsessive compulsive symptoms in patients with Lyme disease, particularly among individuals with neurologic or psychiatric manifestations. More research is needed to better understand the relationship.
What obsessive compulsive symptoms were reported in Lyme disease patients?
Reported symptoms included washing, checking, ordering, obsessing, hoarding, and neutralizing behaviors.
Can neuroinflammation contribute to psychiatric symptoms in Lyme disease?
Researchers have explored whether neuroinflammation, immune dysregulation, inflammatory cytokines, or blood-brain barrier disruption may contribute to psychiatric and neurologic symptoms in some patients.
Did patients improve with treatment?
Some participants reported improvement with psychotropic medications, while others reported at least partial improvement following antibiotic treatment.
Is Lyme disease considered a proven cause of OCD?
No. The study identified an association between Lyme disease and obsessive compulsive symptoms but did not establish direct causation.
Clinical Takeaway
Obsessive compulsive symptoms may occur in some patients with Lyme disease, particularly among individuals with neurologic and psychiatric manifestations. Current evidence suggests an association rather than proven causation, and several biologic and psychological mechanisms have been proposed.
Patients with new psychiatric or cognitive symptoms may benefit from a careful medical and neuropsychiatric evaluation when Lyme disease is part of the clinical picture.
Related Articles
These related articles explore neuropsychiatric symptoms, pediatric presentations, cognitive dysfunction, and overlapping neurologic manifestations associated with Lyme disease.
Neurologic Lyme Disease
PANDAS and Lyme Disease in Children
Lyme Disease Symptoms Guide
Lyme Disease Presenting as Depression
Delayed Lyme Disease Diagnosis
References
- Johnco C, Kugler BB, Murphy TK, Storch EA. Obsessive-compulsive symptoms in adults with Lyme disease. Gen Hosp Psychiatry. 2018;51:85-89.
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.