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"

  • jRobin Craig (Mrs.)
    02/14/2021 (10:21 am)

    My daughter is 34 and was diagnosed FINALLY with Lyme disease two years ago. she has probably been sick since she was 15. She also has Bipolar 1. Her bipolar is controlled well with medication and she is treating Lyme with bee venom therapy – she has been doing that for 6 months and feels somewhat better – (20%) this is a miracle in some ways, but she still gets reactions (herxes). The challenge is mostly her neuro symptoms, especially frustration and anger. She is an extraordinary young woman, talented, generous, compassionate. I can understand her frustration, and it is hard to live with. Just sharing and hoping someone might have some coping suggestions. Patience, I know. But it’s hard. We Iive in Canada and there are few Lyme Doctors here – the ones we’ve seen, she doesn’t trust – we have spent thousands on homeopathic remedies that make her sicker. Bee venom is the only thing that seems to be helping right now. Her diet is antihistamine and she is very observant.

    • Dr. Daniel Cameron
      02/14/2021 (11:59 am)

      Your daughter’s story did not include an antibiotics for Lyme disease or other tick borne infections. Sometimes treatment for babesia has been overlooked.

  • Gilda simpkin
    10/04/2020 (7:56 pm)

    My daughter was diagnosed with Lyme after many doctors said no cause she had no sign of tick bite. She had many symptoms and was treated by holistic dr. Most symptoms were reduced but sleep disturbance, hot flashes,migraines etc.continue. She was more argumentative, aggressive by had mood swings at time of diagnosis but I presumed this was due to physical discomfort and frustration of finding treatment and her age.. she is now 21 and I notice she coninues to have unpredic table sporadic mood swings which are now making it hard to have contact with her. Where can I take her to diagnose and treat these emotional symptoms. She’s in therapy but clinician doesn’t factor lyme in and presumes her anger and rage are experience based.

    • Dr. Daniel Cameron
      10/05/2020 (6:00 am)

      I find it difficult to be sure Lyme disease has resolved. I have had adolescents and young adults with persistent psychiatric symptoms with their Lyme disease. I typically recommend a reevaluation by a doctor familiar with neuropsychiatric aspects of Lyme disease along with her psychiatrist. Call my office at 914 666 4665 if you have any questions.

      • Selena
        09/14/2022 (8:39 pm)

        My son has been diagnosed with Lymes and Bell’s palsy. He is also ADHD. After the Lymes his mood swing are terrible. He has made horrible threats he is only five. He did a round of antibiotics to treat Lymes. Does the ODD and mood swings get better?

        • Dr. Daniel Cameron
          09/15/2022 (4:55 pm)

          I have patients in my practice who have persistent OCD and mood swings who have resolved these symptoms with additional treatment or change in treatment. I also advise that they see other doctors for other conditions.

  • Kayla
    09/17/2020 (1:24 pm)

    Hi! I have a 5 year old who was diagnosed with lymes last year. Before it was diagnosed we bad multiple doctors visits, even met with a therapist because of my daughter’s out of nowhere serious freak outs. They did a month long treatment, and did not send us to infectious diseases because shes pediatric and the last western blotch test came back negative. For about a month after treatment everybody was saying my daughter was back to normal but then we started kindergarten. It’s now daily fits, refusing to log back in to class, and usually ends in me being hit, headbutted, kicked or scratched. I’m at my ends and shes at hers, but her peds doctor seems like this behavior isnt because of the lymes even tho we did not experience it until after she was bitten by a tick. I dont know where to go or what to do. Any advice would be great. Thanks!

    • Dr. Daniel Cameron
      09/17/2020 (4:48 pm)

      I have seen Lyme disease patients with similar behaviors. I have seen more problems in children than adults. I have had to refer to other doctors to rule out other causes. I do not take care of children that young.

    • Nicole harris
      07/27/2022 (7:02 pm)

      Dr minkoff in Clearwater Florida SAVED MY LIFE and my 10 year old son from Lyme babesia bartonella and Rocky Mountain spotted fever. Best clinic ever!

  • Gillian Sporn
    07/31/2020 (8:14 am)

    Do these issues accur if Lyme is caught early? Our son is 6 and is not experiencing any symptoms other than the rash. If Lyme is treated early can this be avoided?

    • Dr. Daniel Cameron
      07/31/2020 (10:15 am)

      I often have patients in my practice who do well after early treatment. I have them return for followup in month and as needed.

  • Debra Ann Carfagno
    01/27/2020 (1:56 pm)

    It i unfortunate, that over 30years have passed since I was first treated for Lyme disease. My symptoms ranged from mild to torturous.
    The unthinkable is to see a parent’s worst nightmare. Seeing their child in suffer.
    I have seen horrible symptoms displayed in children,
    many parents resigned themselves to accepting that their child would not ever recover.
    Dr. Cameron as well as a select few treating physicians, have not given up on their patients.
    Don’t accept that your child will never be the same,.
    Look forward to what they can accomplish. Many individuals look back on a life that they believe they should be experiencing.
    Life is to be lived; sometimes with major accomplishments and most of the time acknowledging baby steps.
    Believe in them, I have seen recovery after many years especially in children.

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