She came in with a diagnosis of obsessive-compulsive disorder—but nothing was working. Her symptoms had escalated quickly: racing thoughts, compulsions, insomnia, and sensory overload. She’d tried multiple psychiatric medications without relief. The turning point? We discovered it was Lyme disease misdiagnosed as OCD—a diagnosis no one had considered until now.

Lyme Disease Misdiagnosed as OCD: A Growing Concern

In my practice, I’ve seen Lyme disease misdiagnosed as OCD more often than most expect—especially when psychiatric symptoms are the most visible.

Lyme and tick-borne infections like Bartonella can affect the brain and trigger:

1. Obsessive thoughts and compulsive behaviors
2. Mood swings and rage
3. Sensory hypersensitivity
4. Panic, insomnia, and suicidality

In children, this may be diagnosed as PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) or PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections).

In adults, it’s often labeled as primary OCD or anxiety disorder—and Lyme disease is not considered.

But it should be.

Psychiatric Lyme Symptoms Are Underrecognized

The list of psychiatric symptoms due to Lyme disease includes:

1. Depression
2. Anxiety and panic attacks
3. Emotional volatility
4. OCD-like behaviors
5. Sleep disturbance
6. Dissociation or derealization

Bartonella, a common co-infection, is particularly associated with psychiatric symptoms—including rage, paranoia, and obsessive thoughts. This pathogen can cross the blood-brain barrier and lead to neuroinflammation, especially in younger patients.

These symptoms are often mistaken as purely psychiatric issues. When, in fact, they may be signs of a neuroinvasive infection.

A Case for Reconsidering the Diagnosis

A patient was tested for Bartonella. Her antibodies were elevated.
Her Lyme Western blot showed multiple reactive bands.
We started treatment—with antibiotics, not SSRIs.

And slowly, the obsessive thoughts faded.
She began to feel like herself again.

The diagnosis wasn’t just delayed. It was wrong—because Lyme disease was never considered.

How to Avoid Lyme Disease Misdiagnosed as OCD

As clinicians, here’s what we must ask ourselves when evaluating psychiatric symptoms:

1. Did the symptoms come on suddenly or after an illness?

2. Are there physical symptoms—fatigue, dizziness, night sweats?

3. Has the patient spent time outdoors or in a Lyme-endemic area?

4. Are they resistant to conventional psychiatric medications?

5. Could we be missing an infection?

A normal screening lab doesn’t rule out Lyme. A psychiatric label doesn’t mean a deeper cause isn’t at play.

The Cost of a Missed Lyme Diagnosis

When Lyme disease is misdiagnosed as OCD, patients lose more than time.
They lose hope. They lose trust. They sometimes lose years of their lives.

The label might look right—until you ask better questions.

If your patient has sudden OCD or isn’t responding to treatment, pause and reconsider:
What if it isn’t just OCD? What if it’s Lyme disease?

🔗Can Lyme disease trigger obsessive compulsive symptoms?
🔗Obsessive-compulsive symptoms in adults with Lyme disease
🔗 Neuropsychiatric Lyme Cases