Obsessions and
Compulsions
Increasing evidence suggests that in a subset of patients, an abnormal immune response, often caused by an infection, can trigger obsessive compulsive behaviors that may be misdiagnosed as OCD.

Infections and treatment resistant OCD

Obsessive compulsive symptoms are treated primarily with standard medications and psychotherapy. But studies indicate that these medications don’t work for 1 in 3 people with OCD. 1 Other studies report that 40 to 60% of patients with OCD do not show an adequate response to first-line treatments. 2

Patients with treatment resistant OCD can suffer terribly with little relief. “Some people suggest that the level of functioning in someone with treatment resistant OCD is about the level of functioning of a patient with schizophrenia.” 2

The outlook for children is just as sobering. Bloch et al. found that over 46% of children diagnosed with OCD did not achieve a remission. “Children with OCD symptoms that do not respond to evidence-based treatments are among the most challenging and difficult patients with OCD to treat.” 3

It is unknown why some patients with treatment resistant OCD don’t respond to standard medications. There may be multiple factors at play.

Autoimmune induced OCD

New research indicates that some patients with OCD, who do not respond to standard treatment or whose symptoms worsen with these medications, may have a form of autoimmune encephalitis, known as basal ganglia encephalitis, prompting their OCD-like behaviors.

Various infections, including strep, mycoplasma pneumonia and coxsackie virus, can trigger the immune system to produce antibodies that mistakenly target a specific region of the brain, leading to basal ganglia encephalitis.

This dysfunctional autoimmune response can cause brain inflammation and trigger neurologic and psychiatric symptoms, including behaviors that mimic OCD. One study reports, “a strong relationship between brain inflammation and OCD, particularly in the parts of the brain known to function differently in OCD.” 4

For instance, strep infections can trigger neuropsychiatric symptoms, including obsessive compulsive behaviors, in a subset of children. An estimated 1 in 200 children in the U.S. are believed to suffer from PANDAS, pediatric autoimmune neuropsychiatric disorders associated with strep infections. 5

Additionally, Orlovska et al. found that “individuals with a streptococcal throat infection had elevated risks of mental disorders, particularly OCD and tic disorders.” 6

Other infectious agents have been linked with obsessive compulsive behaviors. People with toxoplasmosis had 2.5 times higher odds of developing OCD, according to one study. 7 And herpes simplex virus, mycoplasma pneumoniae, measles, chicken pox, cytomegalovirus, mumps 8 and Borrelia burgdorferi, the bacteria which causes Lyme disease 9 have all been associated with the onset of OCD-like symptoms.

  1. Flegr, J. et al. Toxoplasma-infected subjects report an Obsessive-Compulsive Disorder diagnosis more often and score higher in Obsessive-Compulsive Inventory. European Psychiatry. Volume 40, 82-87. https://www.ncbi.nlm.nih.gov/pubmed/27992837
  2. Hollander, E. Interview: Developing Guidelines for Treatment-Resistant OCD. Medscape. https://www.medscape.org/viewarticle/507104
  3. Bloch MH, Storch EA. Assessment and management of treatment-refractory obsessive-compulsive disorder in children. J Am Acad Child Adolesc Psychiatry. 2015;54(4):251–262. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460245
  4. 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
  5. PANDAS Network, Statistics. http://pandasnetwork.org/statistics/
  6. Orlovska S, Vestergaard CH, Bech BH, Nordentoft M, Vestergaard M, Benros ME. Association of Streptococcal Throat Infection With Mental Disorders: Testing Key Aspects of the PANDAS Hypothesis in a Nationwide Study [published online May 24, 2017]. JAMA Psychiatry. 2017; doi: 10.1001/jamapsychiatry.2017.0995. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2629065
  7. Lamothe H, Baleyte JM, Smith P, Pelissolo A, Mallet L. Individualized Immunological Data for Precise Classification of OCD Patients. Brain Sci. 2018;8(8):149.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6119917
  8. Khanna S, Ravi V, Shenoy PK, Chandramukhi A, Channabasavanna SM. Viral antibodies in blood in obsessive compulsive disorder. Indian J Psychiatry. 1997;39(3):190–195. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2967113
  9. Carly Johnco, Brittany B. Kugler, Tanya K. Murphy, Eric A. Storch, Obsessive-compulsive symptoms in adults with Lyme disease. General Hospital Psychiatry. Volume 51, 2018, Pages 85-89. https://www.ncbi.nlm.nih.gov/pubmed/29408088
strong relationship between brain inflammation and OCD

Study shows a “strong relationship between brain inflammation and OCD…” 8

Infections may result in developing OCD
How can an infection make a person develop OCD symptoms?

Learn more about how infections can trigger neuropsychiatric symptoms

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

Cunningham Panel™ helps identify an autoimmune disorder in 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

The 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. 

B. Robert Mozayeni, MD

Medical and Clinical Advisor

B. Robert Mozayeni MD

Dr. B. Robert Mozayeni was trained in Internal Medicine and Rheumatology at Yale and at NIH. He has had pre- and post-doctoral Fellowships in Molecular Biophysics and Biochemistry at Yale, and also at NIH where he was a Howard Hughes Research Scholar at LMB/DCBD/NCI and later, Senior Staff Fellow at LMMB/NHLBI/NIH. Editorial board of Infectious Diseases – Surveillance, Prevention and Treatment. Past President of the International Lyme and Associated Diseases Society (ILADS).

He is an expert in Translational Medicine, the science and art of advancing medical science safely and efficiently. He is a Fellow of the non-profit Think Lead Innovate Foundation and is a co-founder of the Foundation for the Study of Inflammatory Diseases. He is a Founder of the Foundation for the Study of Inflammatory Diseases to crowd-source medical solutions for complex conditions using existing knowledge, diagnostic methods, and therapies to meet patient needs immediately. He is the Chief Medical Officer of Galaxy Diagnostics, LLC. He is a Board member of the Human-Kind Alliance. Dr. Mozayeni has held admitting privileges (since 1994) on the clinical staff of Suburban Hospital, a member of Johns Hopkins Medicine and an affiliate of the National Institutes of Health Clinical Center.

Safedin Sajo Beqaj, PhD, HCLD, CC (ABB)

Moleculera Labs, Clinical Laboratory Advisor
Medical Database, Inc., President and CEO

Sajo Baqaj, PhD

Dr. Sajo Beqaj is board certified in molecular pathology and genetics and licensed as a Bioanalyst and High Complexity Laboratory Director. He has been practicing as a laboratory director since 2005.

Dr. Beqaj served as a technical director and was part of the initial management team for several well-known laboratories in the clinical lab industry including PathGroup, Nashville, TN; DCL Medical Laboratories, Indianapolis, IN, and Pathology, Inc, Torrance, CA. He is currently serving as off-side CLIA laboratory director for BioCorp Clinical Laboratory, Whittier, CA and Health360 Labs, Garden Grove, CA.

Dr. Beqaj received his Ph.D. in Pathology from Wayne State University Medical School, Detroit, Michigan. He performed his post-doctoral fellowship at Abbott Laboratories from 2001-2003 and with Children’s Hospital and Northwestern University from 2003-2005.

Dr. Beqaj has taught in several academic institutions and has published numerous medical textbook chapters and journal articles. He has served as a principal investigator in clinical trials for several well-known pharmaceutical and diagnostic companies such as Roche HPV Athena, Merck HPV vaccine, BD vaginitis panel, Roche (Vantana) CINtec® Histology clinical trials, and has presented various scientific clinical abstracts and presentations.

He is a member of several medical and scientific associations including the Association of Molecular Pathology, American Association of Clinical Chemistry and the Pan Am Society for Clinical Virology. He has served on a number of clinical laboratory regulatory and scientific committees, and has assisted several laboratories and physicians as a Clinical Laboratory Consultant.