Obsessions and
Compulsions
Increasing evidence suggests that in a subset of patients, an abnormal immune response, often triggered by an infection, can cause obsessive compulsive behaviors.

Obsessions and Compulsions
Many people engage in obsessive compulsive behaviors at some point in their life, but these behaviors typically don’t affect their daily functioning. Most of these individuals don’t necessarily develop OCD, as it’s clinically defined. On the other hand, people with clinically defined OCD develop symptoms that bring enormous distress and are, at times, disabling.
While the exact etiology of OCD is unknown, it is believed to be caused by a number of factors, including genetics, neurologic abnormalities, and environmental influences. Researchers have also discovered that common infections, such as strep, can trigger an abnormal autoimmune response which produces behaviors that mimic OCD.

Can you develop OCD?

Individuals who develop OCD suffer from persistent, intrusive thoughts and feelings (obsessions) so extreme that it drives them to perform obsessive behaviors (compulsions) to alleviate their anxiety. The behaviors can wax and wane in severity and present differently in every individual. However, the behaviors tend to revolve around several themes, including: contamination and cleanliness concerns; fear of being harmed or someone else being hurt; having items in symmetrical order or performing rituals; hoarding behaviors and having bad or “taboo” thoughts.

Obsessive compulsive behaviors may be driven by irrational fears, upsetting thoughts, or disturbing images. In most cases, OCD will develop gradually. Patients who develop an abrupt, and sudden onset of symptoms, may have an underlying organic cause, such as an infection, triggering OCD-like behaviors.

Abrupt onset of OCD

These individuals experience an almost overnight eruption of obsessions and/or compulsions which, on the surface, appears to be OCD but may also be an infection-triggered autoimmune encephalopathy.

OCD typically appears in children around age 10 or in young adults. 1 Older individuals or very young children rarely develop OCD. 2 In fact, one study found that out of 1,000 OCD patients, only 5 had their initial symptoms develop later in life. 3

“The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology.” 2

Additionally, toddlers or very young children who develop a sudden onset of OCD-like behaviors, along with other neuropsychiatric symptoms following an infection may suffer from PANS or PANDAS, a manifestation of basal ganglia encephalitis.

Autoimmune dysfunction mimics OCD

Individuals with infection-triggered autoimmune encephalitis or basal ganglia encephalitis may exhibit one or more neurologic and/or psychiatric symptoms which mimic a mental disorder.

For example, in some people, common infections can trigger an autoimmune response which results in antineuronal antibodies attacking the basal ganglia region of the brain. These infections may include: strep, influenza, mycoplasma pneumonia, Lyme disease, herpes virus, mononucleosis and Coxsackie virus.

This autoimmune response targeting the basal ganglia can cause brain inflammation and the onset of neuropsychiatric symptoms, including OCD-like behaviors.

“In some subset of OCD patients, autoimmunity is likely triggered by specific bacterial, viral, or parasitic agents…” writes Gerentes et al. 4

Meanwhile, another study discovered that brain inflammation is “significantly elevated, more than 30% higher” in people with OCD. “This study is the strongest evidence to date for inflammation in the brain in OCD.” 5

  1. Barry Sarvet. Childhood Obsessive-Compulsive Disorder. Pediatrics in Review. Jan 2013, 34 (1) 19-28. http://pedsinreview.aappublications.org/content/34/1/19
  2. Tonna, M., Ottoni, R., Ossola, P. et al. Late-onset obsessive-compulsive disorder associated with left cerebellar lesion. Cerebellum. (2014) 13: 531. https://www.ncbi.nlm.nih.gov/pubmed/24771488
  3. Anthony P. Weiss, M.D., and Michael A. Jenike, M.D. Late-Onset Obsessive-Compulsive Disorder. The Journal of Neuropsychiatry and Clinical Neurosciences. 1 May 2000. https://www.ncbi.nlm.nih.gov/pubmed/11001607
  4. Gerentes, M., Pelissolo, A., Rajagopal, K. et al. Obsessive-Compulsive Disorder: Autoimmunity and Neuroinflammation. Current Psychiatry Report. (2019) 21: 78. https://link.springer.com/article/10.1007%2Fs11920-019-1062-8
  5. Attwells S, Setiawan E, Wilson AA, et al. Inflammation in the Neurocircuitry of Obsessive-Compulsive Disorder. JAMA Psychiatry. 2017;74(8):833–840. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2631893
Can you develop OCD from brain inflammation?

People with OCD had more brain inflammation (32% higher) than healthy subjects, study finds.

Infections may result in developing OCD
Can you develop OCD from an infection?

Learn more about how infections can trigger neuropsychiatric symptoms

Cunningham Panel helps identify an autoimmune disorder in child initially diagnosed with schizophrenia

The Cunningham Panel™ helped identify an underlying autoimmune disorder in a child initially diagnosed with schizophrenia.

Researchers describe a complex case involving a 15-year-old girl, who abruptly developed multiple neurologic and psychiatric symptoms.

The association between streptococcus pyogenes and tics/OCD

Association between streptococcus pyogenes and tics/OCD

In this book chapter, Dr. Madeleine Cunningham explains the association between Group A strep and the onset of tics and/or OCD and their clinical manifestations in children with the autoimmune neuropsychiatric disorder, PANDAS.

Childhood infections can increase risk of mental illness in kidss

Childhood infections can increase risk of mental illness in kids

Nationwide study finds both mild and severe infections can increase risk of mental disorders in children and adolescents.

  • Test Order Process
    The Cunningham Panel™ – Antibody testing that helps determine whether an autoimmune response may be triggering neurologic and/or psychiatric symptoms.

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