Can You Catch Obsessive-Compulsive Disorder?

“To suffer from obsessive-compulsive disorder, many patients say, is to ”know you are crazy.” Other forms of psychosis may envelop the sufferers until they inhabit the delusion. Part of the torture of O.C.D. is, as patients describe it, watching as if from the outside as they act out their obsessions — knowing that they are being irrational, but not being able to stop. They describe thoughts crowding their minds, nattering at them incessantly — anxious thoughts, sexual thoughts, violent thoughts, sometimes all at the same time. Is the front door locked? Are there germs on my hands? Am I a murderer if I step on an ant? And they describe increasingly elaborate rituals to assuage those thoughts — checking and rechecking door locks, washing and rewashing hands, walking carefully, slowly and in bizarre patterns to avoid stepping on anything. They feel driven to do things they know make no sense.

There are researchers who believe that some of this disturbing cacophony — specifically a subset found only in children — is caused by something familiar and common. They call it Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection, or, because every disease needs an acronym, Pandas. And they are certain it is brought on by strep throat — or more specifically, by the antibodies created to fight strep throat.

If they are right, it is a compelling breakthrough, a map of the link between bacteria and at least one subcategory of mental illness. And if bacteria can cause O.C.D., then an antibiotic might mitigate or prevent it — a Promised Land of a concept to parents who have watched their children change overnight from exuberant, confident and familiar to doubt-ridden, fear-laden strangers.” — Lisa Belkin (New York Times Magazine)

Not a promising beginning. The reason sufferers know that they are being irrational in this ‘form of psychosis’, Lisa, is that it is not a psychosis. And PANDAS does not represent a link between a bacterium and a mental illness, but rather between autoimmune-mediated brain damage and a mental illness. Despite the effort to sensationalize it as a ‘compelling breakthrough’, this is neither new news nor monumental if put in the proper context. It is often the case that injury to certain brain regions causes behavioral disturbance. The author goes on to posit a false dilemma — “do these children need penicillin or Prozac?” — although it might not be either-or but both. If the streptococcal connection is true and patients may benefit from antibiotics, they may also benefit from the medications that help control obsessional thoughts and the resultant compulsive behaviors. Besides, as I understand it, if the theory that PANDAS is mediated by an autoimmune reaction (in which antibodies raised to react against strep cross-react against some brain tissue that is misrecognized by these antibodies) is correct, it ought not respond to antibiotics at all, since the presence of the bacteria is no longer necessary to fuel the continuing immune response once the body has mistakenly recognized the brain tissue as foreign. It may be a coincidence that some cases have responded to antibiotics, continued use of which is not a benign treatment, and no one has been able to advance a consistent theory of why it should work. While I have an open mind, I think it is much more likely that, as with other psychiatric illnesses, preexisting symptoms are exacerbated by an illness. Kids with OCD symptoms frequently test positive for strep because, well, kids frequently test positive for strep. Belkin, although trying to impute ponderous import to this controversy by throwing in overblown comments about how science thrives on disagreement, etc., actually does better in the second half of the piece describing the dilemmas children, families and treaters face when premature conclusions are drawn as to whether a condition has a psychological or a physical cause. Where she should have gone with that, if she really wanted to draw ponderous conclusions, would have been to indicate that that distinction itself is a specious one.