Oppositional behavior in children with Lyme disease

Several studies have found that children and adolescents infected with Borrelia burgdorferi, the causative agent of Lyme disease, can, in some instances, develop extreme neuropsychiatric symptoms, including sudden, abrupt mood swings, aggressiveness, explosive anger, depression, panic disorder, neuropathy and even homicidality. [1]

As Dr. Richard Bransfield explains in Neuropsychiatric Disease Treatment, “Lyme disease and the immune, biochemical, neurotransmitter, and the neural circuit reactions to [Lyme disease] can cause impairments associated with violence.” [1]

Children with serologic evidence of a tick-borne illness can also develop severe oppositional defiant behaviors, according to Dr. Rosalie Greenberg, a child and adolescent psychiatrist, who runs a private practice in New Jersey.

[bctt tweet=”Lyme disease can trigger extreme oppositional behavior in kids. ” username=”DrDanielCameron”]

Out of 69 youths evaluated at Dr. Greenberg’s practice, 49 (or 2/3) were positive by blood tests for one or more tick-borne illnesses including Lyme disease, Bartonella, Babesia, Ehrlichia and Anaplasmosis.

“I have seen a number of children and adolescents who exhibit significant acute or gradual onset of highly oppositional behaviors often both at home and at school,” she says.

Several examples include:

  • Refusal to do class work or homework
  • Heightened paranoia or feeling rejected by others
  • Increased irritability
  • Extreme temper tantrums
  • Problems concentrating
  • Elevated impulsivity
  • Sensory hypersensitivity (sound, touch, smell, taste and/or light)
  • Intense emotional lability

Patients also exhibited bouts of rage. “During periods of intense anger over minimal issues, they can appear menacing and threaten to kill a sibling, parent or a friend or state that they want to die themselves,” Greenberg says.

The onset or presentation of the oppositional behavior varied. “Parents describe these behaviors as either a sudden change or a period of worsening of a previous condition, such as attention-deficit hyperactivity disorder or mood Lyme Hangout: Rage, extreme irritabilitydisorder,” she explains.

In some cases, infections including Borrelia burgdorferi, the bacterial pathogen causing Lyme disease, can induce an immune dysfunction and a condition known as Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). An abnormal immune response triggers various neuropsychiatric symptoms including OCD-like behaviors, tics, mood changes, bouts of rage and aggression.

Dr. Bransfield’s and Dr. Greenberg’s observations will need to be studied further to prove a direct correlation between tick-borne illnesses and aggression and oppositional behaviors. Until then, it would be reasonable to consider a tick-borne illness as a potential underlying cause of extreme oppositional behaviors.

Editor’s note: I have treated both middle and high school students with Lyme disease who exhibited severe oppositional behavior.


Related Articles:

Suicidal behaviors in patients with Lyme and associated diseases

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

Video: Is Lyme disease an autoimmune disease?



  1. Bransfield RC. Aggressiveness, violence, homicidality, homicide, and Lyme disease. Neuropsychiatr Dis Treat. 2018;14:693-713.
  2. Greenberg R. Aggressiveness, violence, homicidality, homicide, and Lyme disease. Neuropsychiatr Dis Treat. 2018;14:1253-1254.

36 Replies to "Oppositional behavior in children with Lyme disease"

  • Erin Schaaf
    01/08/2020 (8:48 pm)

    Hi-my son was almost 6yo when he was treated for Lyme this past summer. Is there any connection between time of suspected exposure to tick-borne illness and drastic shifts in mood/reactive behavior? I had attributed this shift to his age however they happened at the same time. Or is the behavior something that occurs much later and this is more of a coincidence? Thank you for your research and time.

    • Dr. Daniel Cameron
      01/09/2020 (10:34 am)

      I find mood/behavior issues can occur quite early in my Lyme disease patients.

  • Anna
    08/18/2019 (4:27 pm)

    We started Lyme treatment 2 years ago with a Lyme specialist for our 9 year old child with Lyme-induced PANS, and saw great improvement on many fronts. However, the rage episodes you are describing here (extreme to the point of looking neuropsychiatric) are still happening sometimes and seem to be coming back periodically. It is very discouraging to witness, and very difficult to deal with. Which makes us think the 2 year treatment didn’t touch them the root cause of these rages at all. Is it safe to assume so? Do you believe such rages can be fully eradicated with the correct treatment? Many thanks

    • Hannah
      03/24/2022 (12:59 pm)

      HI Anna – when researching for my 10 year told, your message is exactly what we experience with our daughter (She has babesia, bartonella and Lyme) We are one year into lyme treatment but the rages periodically, come back some days are worse than others. I was just wondering how your child is doing and if you have any experiences you can share? I’m sorry you are going through this too, it’s so hard.

  • Tricia Bouzan
    12/22/2018 (12:13 pm)

    My son was treated for lyme 3 years ago. It was a struggle for anyone to believe he was not cured or better. He had sever headaches and sever stomach pain, complained of numbness, his memory became horrible and lost so much of what he had learned in school. We fought for him to see infectious disease at Mass General Hosp. and he was treated with a longer period of antibiotics. My son started to do much better but still had symptoms about every 6 weeks. Last spring he was put on a preventative for headaches which has also helped a great deal. One of our remaining problem is “His attitude/ittatibility” when he is corrected–for example if something is wrong on his homework and I try to help him correct it, or a teacher tells him something is wrong in school. He feels like the world is against him. People think it is his 12 year attitude but this began when his lyme started at the age of 8. Any thoughts of ways to help him with this.

    • Dr. Daniel Cameron
      12/22/2018 (11:58 pm)

      Doctors are divided on how to approach children with continued issues after treatment. It would be reasonable to include another doctor with experience treating tick borne illness to see if there might be an infection or co-infection.

    • Christine
      03/08/2022 (10:48 pm)


  • M.E. Malley
    08/04/2018 (1:29 am)

    Dr. Greenberg is my son’s doc and quite frankly a superstar! She returned him to us. Her suspicions of tick borne infections were right on. I shudder to think of where we would be now if we hadn’t decided to seek her help. I am thankful every day that we crossed paths because now we are finally treating the CAUSE of this behavior and seeing some improvement.

    • Matthew Waite
      08/08/2021 (1:36 am)

      Can you specify what sr greengergs name is and where she practices? Thanks. Looking for my 5 year old son.

  • Jennifer r
    08/02/2018 (11:12 pm)

    This is EXACTY what we are dealing with after 3 years of Lyme treatment with abx. The past 3 years since treatment ceased we have gotten to the point where we are considering residential placement. HOW do we help him? Before someone gets seriously hurt and it’s too late?

    • Dr. Daniel Cameron
      08/03/2018 (12:34 am)

      I am sorry to hear your child remains ill. It sounds like your child is worse again. It is important to follow with doctors to rule other issues. It is also to know if a tick borne illness was adequately treated.

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