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.

When Lyme disease induces extreme oppositional behavior in kids. Click To Tweet

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.

Over the past several years, researchers have found that infections and illnesses, including Lyme disease, can induce an autoimmune reaction which is characterized by a dramatic onset of neuropsychiatric symptoms. When this occurs, individuals may be diagnosed with pediatric acute-onset neuropsychiatric syndrome (PANS) or an infection-triggered autoimmune encephalopathy, which requires treatment to correct the immune dysfunction.

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.



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AnnaDr. Daniel CameronTricia BouzanM.E. MalleyJennifer r Recent comment authors
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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… Read more »

Tricia Bouzan
Tricia Bouzan

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… Read more »

M.E. Malley
M.E. Malley

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.

Jennifer r
Jennifer r

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?