Could your OCD symptoms be caused by a dysregulated immune system?

Researchers are increasingly recognizing autoimmunity as a potential root cause of OCD – but it’s not being talked about enough.

In this article, we’ll dive deep into the connection between the immune system and the brain, and why addressing potential autoimmunity may be more effective than standard OCD therapies (which roughly half of patients don’t respond to). (1)

And every case of OCD is unique, so I’ll break down for you some of the signs that your OCD may be related to autoimmunity, a few other potential triggers and causes, and what to do next.

Let’s get started.

Autoimmunity as a Root Cause of OCD

Autoimmunity has always been one of my primary clinical focuses – mostly because it’s so common and a root cause of so many different symptoms, conditions, and health concerns.

Inflammation and immune system dysregulation can disrupt the whole body (and mind), and this looks different for everyone. As I write about in The Inflammation Spectrum, beyond the 100+ autoimmune diseases that are currently recognized, so many people are experiencing health problems that can be linked back to unrecognized autoimmunity and/or inflammation.

Which brings me to OCD.

When you run a Google search on what causes OCD, as with the vast majority of chronic illnesses, you’ll read that there is “no known cause” of OCD.

Usually when the conventional paradigm says there’s no known cause of something, what they mean is that there’s no single cause of something. There isn’t one single genetic marker of OCD. There isn’t one single environmental trigger of OCD. There isn’t one single cause.

That’s because our bodies and our minds and our environments are complex. OCD is a multifactorial condition, likely brought on by a combination of factors that are different for every individual, including the interaction between our unique environment and our unique genetic makeup.

Brain Inflammation and the Immune System

Brain inflammation is significantly higher in those with OCD than in healthy individuals. And inflammation is a product of the immune system, created when the body detects a threat or an intruder. (2)

Many different things can trigger an immune system response and inflammation, including viruses, bacteria, environmental toxins, and foods we’re sensitive to. In the case of autoimmunity, the immune system erroneously attacks the self – our own cells and tissues.

When an autoimmune response affects the brain (the immune system attacks cells or tissues in the brain), we may experience cognitive, mental health, and/or psychiatric symptoms, like obsessive and/or compulsive behaviors.

The PANDAS Example

One of the first connections to be made between OCD and autoimmunity was the emergence of the condition PANDAS in the late 1990s. (3)

PANDAS, which stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, occurs when a child has an autoimmune response to a strep infection. This autoimmune response affects a specific part of the brain called the basal ganglia and often leads to OCD-like symptoms, tics, and other emotional and cognitive changes. (You can read my deep dive into PANDAS here).

In 2001, in response to the emergence of PANDAS, a research paper titled “Is Obsessive Compulsive Disorder an Autoimmune Disease?” was published in the Canadian Medical Association Journal. (4)

Around a decade later, the related syndrome PANS was first described in the scientific literature. (5) PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) may be diagnosed when a child has the same kind of autoimmune response as in PANDAS, but in response to a different (non-strep) infection.

PANDAS and PANS are generally thought to affect children between 3 and 12, but that doesn’t mean adolescents or adults can’t experience a similar autoimmune, neuropsychiatric response to an infection – it just may show up more subtly, more gradually, or may be harder to identify.

There are also several other things besides infections that can trigger autoimmunity, including leaky gut, dysbiosis, and unresolved trauma or emotional stress.

How Autoimmunity Can Trigger OCD

Almost 30 years after PANDAS was first described, OCD has now been linked to several different kinds of autoimmune responses and conditions in adults. (1) In some cases this is a combination of infectious and autoimmune processes. (6) In other cases, different triggers may prompt an autoimmune response that ends up leading to obsessive compulsive symptoms.

The general process is similar – a trigger (or, more commonly, a combination of triggers) leads to autoimmunity and inflammation which begin to affect parts of the brain associated with mental health, behavior, and OCD.

Researchers have observed that patients with OCD often have high levels of proinflammatory cytokines, markers of neuroinflammation, and autoantibodies against parts of the brain including the basal ganglia (thought to play a prominent role in OCD). (7, 8)

OCD has also been linked to autoimmune CNS (central nervous system) disorders including multiple sclerosis (MS), and to systemic autoimmune diseases including systemic lupus erythematosus. (9)

LISTEN: Autoimmune-Inflammation: Top Causes, Functional Medicine Labs, Diet + Lifestyle Factors, The Nervous System Component & Exactly How To Heal 

Is Your OCD Actually Autoimmune? How to Know

Autoimmunity can trigger OCD, but not all cases of OCD are necessarily autoimmune related. So how do you know if the autoimmunity connection applies to you?

Researchers have suggested a few “red flag” signs for autoimmune OCD, which may include: (1)

• Subacute or rapid onset
• Accompanying neurological symptoms (such as tics or movement disorders)
• Accompanying neurocognitive symptoms (such as difficulty concentrating or memory loss)
• Symptoms that start after an infection
• Having an existing autoimmune condition/diagnosis
• Not responding to conventional treatments
• Increased levels of autoantibodies (antibodies against the self), especially targeting the basal ganglia, or inflammation in the basal ganglia

At our functional medicine telehealth clinic, we would want to look at various markers of inflammation and autoimmunity, including (but not limited to) C-reactive protein (CRP) and homocysteine.

We would thoroughly investigate your symptoms, health history, and any signs of inflammation and autoimmunity, and likely suggest more specialized testing to try to get to the root cause of your OCD symptoms.

It’s worth underscoring that even if autoimmunity is identified, we still need to figure out what is causing your autoimmunity. Especially outside of cases where there’s a clear infectious trigger (as in the case of PANDAS), we’ll want to look at things like toxin exposure, gut health imbalances, and food sensitivities.

Specialized stool testing can tell us a ton about what’s going on in your gut microbiome, including the presence of viruses, parasites, and other pathogens, the makeup of bacteria and fungi, markers of inflammation and immune function, and more.

Other Causes of OCD

Other potential causes or risk factors behind the development of OCD may include genetic variations, neurotransmitter imbalances, history of trauma or emotional stress, physical traumas such as traumatic brain injury (TBI), food allergies or sensitivities, parasitic infections, toxin exposure, and more.

Whether or not these overlap with autoimmunity for you, we’ll want to explore whether any of them may be influencing your condition, so that we can tackle your triggers at the source.

Autoimmune OCD: What To Do Next

If you know or suspect your OCD may be autoimmune in nature, what can you do to calm your body’s immune response and reduce your symptoms?

The conventional medicine approach to OCD typically involves antidepressant medications including SSRIs (selective serotonin reuptake inhibitors) or tricyclic antidepressants, and psychotherapy or behavioral therapy.

CBT (cognitive behavioral therapy) and other forms of behavioral or psychotherapy can certainly be important to include within an OCD protocol, but we should also be addressing the autoimmunity that may be triggering the condition.

There are several holistic and functional medicine approaches to autoimmunity and OCD that may be helpful. Working with a knowledgeable practitioner can help you customize your approach to your specific case. Here are a few of my top tools and strategies overall.

Identify Food Sensitivities With an Elimination Diet

Food is one of the biggest triggers of autoimmunity and often the best place to start. Some of the most common triggers include gluten and non-gluten grains, dairy products, industrial seed oils, and added sugar. (10) Try eliminating these and other potentially inflammatory foods for 30-60 days to start and see how you feel.

Harness the Power of Food

Eliminating food triggers is essential – but don’t sleep on the foods that can heal and support your immune system and nervous system.

Some of the most powerful foods for autoimmune OCD are those rich in omega-3 fatty acids, which have been shown to both reduce inflammation and support brain function. Wild-caught salmon, seaweed, avocado, nuts, and seeds are a few of the best options.

Also include leafy greens rich in mood and brain supporting B vitamins (and tons of other nutrients), anti-inflammatory superstars like turmeric, ginger, and green tea, and prebiotic and probiotic foods to support your gut.

Restore Your Gut Health

Specialized testing can help us determine exactly what’s going on in your gut so that we know what to do next. Leaky gut is very common among those with autoimmunity, and many patients also have a bacterial imbalance such as SIBO, a parasitic infection, and/or a yeast issue.

The gut-brain connection is also major for OCD overall (for example, did you know that 95% of mood-regulating serotonin is produced in the gut?). (11)

Address Emotional Stress

Unresolved emotional trauma, unprocessed emotions, and chronic stress can all contribute to both autoimmunity and OCD. Often, when I work with patients who have been doing all of the “right” things in terms of nutrition, lifestyle, and supplements, but who are still experiencing a lot of autoimmune flare-ups, emotional stress is the piece that has been missed.

Daily practices like meditation, yoga, and breathwork are great for reducing stress, and to go a bit deeper, therapies like mindfulness-based cognitive therapy (MBCT) may help.

Incorporate Targeted Herbs & Supplements

Some of the best supplements for reducing inflammation include curcumin, fish oil, and ginger.

For additional nervous system support and stress reduction, adaptogenic herbs like ashwagandha can play an important role and have been shown to significantly reduce symptoms of OCD. (11)

Zinc and N-acetylcysteine (NAC) may also help with OCD by regulating the glutamatergic system which is involved in the condition. (12)

A Whole Body Approach to Obsessive Compulsive Disorder

When we look further into the potential causes of OCD, it’s clear that a holistic, whole body approach is the best way to get back to balance.

If you’re interested in working with our telehealth clinic to get to the root of your own OCD, please consider booking a consultation.

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.