OCD is treatable

Written by Stella Chadwick for the Autism Eye Magazine. Issue 35, Autumn 2019.

It was the spring of 2006, and my son and I had travelled to visit my parents for the weekend, leaving my daughter and my husband together back home. Only a day after arriving at our destination I received a call from my husband telling me that my daughter had woken up that morning with a temperature of 104 and was covered in a red rash. He had taken her to A&E, where she had been diagnosed with Scarlet Fever.

Life changed completely for our family on that day. My daughter developed anxiety, OCD, irrational fears, intense rage, and extreme sensory processing difficulties. There were some very long and dark days for our family, and it would be many years, having left a trail of specialists and rabbit holes behind us, before our daughter would be diagnosed with PANDAS by a doctor in the USA.

PANS and PANDAS

PANDAS stands for Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infection. Since going through that time personally, we have seen hundreds of children coming to our Brainstorm Health® clinic wrongly diagnosed with behavioural disorders where, in fact, these children have an immune system issue which is affecting their brain.

It is now understood that streptococcal infection is only one of the infections that can cause these symptoms and the wider umbrella term, PANS is more commonly being used:  Paediatric Acute-onset Neuropsychiatric Syndrome, covering a number of other potential pathogenic triggers. If you want to learn more about PANS and PANDAS, look at www.panspandasuk.org – it is the best resource to investigate more about it.

OCD is a key feature of these conditions

One of the key features of these conditions is Obsessive Compulsive Disorders (OCD) – characterised by repetitive thoughts and behaviours, impulses or obsessions or compulsions – with the tendency to perform acts in a habitual or stereotyped manner. There is little control on the urge to perform a specific behaviour, with a significant reduction in the ability to inhibit those thoughts or behaviours.

Typically, OCD behaviours are first observed in late childhood or early adolescence. In children with autism, the onset tends to be much earlier, manifesting before age 3. Drugs used to reduce these symptoms work only in 40% of cases. The remaining 60% don’t respond and are left to cope with this debilitating symptom.

OCD and autistic children

Many children with autism don’t tend to get a separate diagnosis of OCD as these compulsions are seen as part of “autism”. Many professionals assume that OCD is mainly about repetitive hand-washing but some children suffer from extreme OCD and anxiety around perceived contamination and around everyday common activities such as eating and drinking and, in some extreme cases, fears around even swallowing their own saliva. Table 1 outlines the most common obsessions and compulsions that have been observed.

With children who don’t have an autism diagnosis, a sudden personality change can be much easier to identify. A child with autism, on the other hand, may also develop OCD fairly abruptly, but it can be dismissed as part of the “condition”.

What is of the utmost importance to convey is that when we start digging deeper into these children’s health, we find some key similarities in the biochemistry of both groups of children regardless of whether or not there is an autism diagnosis.

Both groups of children have dysregulated immune systems and tend to have signs of underlying infections, including streptococcal infection, CMV, EBV, HHV-6, and Coxsackie. The herpes viruses tend to be key players, including chickenpox (varicella zoster) and shingles. All of these viruses are neurotropic and can affect brain function.

There are also significant markers suggestive of a compromised immune system, with raised CD3, lowered CD57, and raised inflammatory markers.  Often, the same children will be prone to UTIs (urinary tract infections), excessive urination, conjunctivitis, mouth ulcers, sleep issues and gut problems. One key point to make is that over the years, through clinical practice, we have found that the onset of symptoms like severe OCD doesn’t need to come on abruptly.

Some children drift into this state over a few months.  The more common triggers tend to be illnesses like Scarlet Fever or chickenpox. Still, other common triggers exist, such as other viruses, exposure to mould,  food poisoning or an intense course of antibiotics. Sometimes the trigger can be emotional trauma, such as a divorce or the death of a loved one.

A study in March 2019, published in the Journal of Child and Adolescent Psychopharmacology, highlighted the potential connection between low IgA levels in serum and OCD, which mirrors what we see in clinical practice. IgA is the first line of defence against harmful microbes and is crucial for maintaining immune tolerance.  IgA is found primarily in the gut, urogenital areas, saliva, tears and the respiratory system.

When considering the health of the gut, it is important to point out that more than half the children we see in our clinics with OCD were born via C-section and had at least one course of antibiotics in the first year of life, often immediately after birth. Given over 70% of our immune system is in the gut, it is not surprising that poor “seeding” with bacteria due to C-sections and the loss of microbial balance due to antibiotics can predispose children to immune dysfunction.

If your child has debilitating OCD

Here are some things to consider if your child has debilitating OCD:

• It is important to rule out psychological reasons. Seeing an appropriate specialist like a psychologist or psychiatrist is a must for some children. If therapy and medication do not work for your child, consider looking at your child’s biochemistry using lab tests.
• If you identify underlying pathogens – you must remove them using either pharmaceuticals or natural compounds or a combination. Please see Table 2 for our favourite natural compounds. (Whenever you use anything to remove pathogens, make sure that bowels are opening daily and that you support the liver and gallbladder as well as the kidneys and lymphatic system.)
• Once you have removed, the pathogens work on balancing the immune system through gut support, including using enzymes like Trienza by Houston Enzymes and probiotics such as saccharomyces boulardii (beneficial yeast), and those containing lactobacillus reuteri, lactobacillus casei and bifidobacterium bifidum. Probiotic foods should ideally feature daily in the diet through foods and drinks like sauerkraut, kefir and beet kvass. You can find recipes on our website. Use prebiotics like inulin, resistant starch, and beta-glucans- always use caution, start with a tiny pinch, and build up slowly. The use of probiotics and prebiotics needs to be handled carefully, as not only is it important to introduce them at the right time in the protocol, but it is also crucial to use the correct strains of bacteria.
• It is also essential to use anti-inflammatories like Enhansa (or other curcumin extracts), PEA (palmitoylethanolamide), skullcap, feverfew, Omega 3 fatty acids and many others.
• Always check iron levels and vitamin D levels of children with OCD as sometimes by simply correcting those levels, you can see a significant improvement.

Look at the underlying biochemistry

Conditions like OCD are often symptoms of disturbed underlying biochemistry and should be investigated using thorough case-taking and laboratory analysis before administering long-term psychiatric medication. Children on the autism spectrum are particularly vulnerable as it may be very easy to lump all of their symptoms under the ASD diagnosis.

My daughter is now 17 years old, and a picture of health and is thriving. I am acutely aware that had we not approached things with steely determination, the outcome could have been very different.

Interested in finding out whether our approach would work for your child? Please do get in contact to arrange a private, no-obligation conversation with me.

 

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APPENDIX

TABLE 1

Source: www.pandasppn.org

For a full description of OCD, please see the International OCD Foundation website (www.iocdf.org) and the Y-BOCS Symptom Checklist, which includes a comprehensive list of 67 types of obsessions and compulsions. Here is a short list of the more common ones observed:

• Contamination obsessions (germs, bodily secretions or waste, poisons, animals, environmental contaminants like tobacco, cleansers or any substance). Often, the obsession leads to compulsive washing or cleaning rituals; but, in some cases, the symptoms cause the child to avoid the feared contaminant. In severe cases, even a loving parent may be a contaminant because of “exposure” to the dirty object, and the child will develop complex rituals to avoid contact with the exposed parent.
• Sexual or religious obsessions (fear that God hates them or that they have done something morally offensive)
• Aggressive obsessions of harm to oneself or others
• Repeating compulsions (examples: going in and out of a doorway; switching on/off appliances or light switches; re-reading pages over and over)
• Symmetry and exactness obsessions (examples: books and papers must be properly aligned; every action has to be done exactly the same on the right and left side; the child has to walk exactly in the centre of a hallway)
• Ordering / arranging compulsions (example: suddenly placing bathroom items in a particular order and extreme anxiety if they are moved)
• Counting compulsions (examples: having to count ceiling tiles, books, or words spoken)
• Checking compulsions and requests for reassurance (examples: repeatedly asking a parent “is this okay?” or “did I do that right?”)
• Need to touch, tap, or rub (examples: rubbing the back of one’s hand across the table in a certain way, urge to touch rough surfaces)
• Intrusive images, words, music or nonsense sounds (examples: unwanted images, words, or music appear in the mind that do not stop)
• Need to tell, ask, or confess (examples: child needs to tell parent every perceived mistake or sin that day in school; excessive guilt)
• Colours, numbers, or words with special significance (examples: the colour black is equated with death and anything black triggers obsessional fears; the number 3 is “lucky” and things have to be repeated three times or 3X3X3 times)
• Ritualized eating behaviours (examples: eating according to a strict ritual; not being able to eat until an exact time)
• Hoarding behaviours (Obsessional concerns about losing something important generalize to the point where nothing can be thrown away, or useless items take on special significance and cannot be discarded.)

TABLE 2

Natural Compounds for Pathogens

Viruses responds well to;

Olive leaf extract, cat’s claw, garlic, astragalus root, ginger, elderberry, echinacea, licorice root

Bacteria respond well to;

Garlic, berberine, plant tannins, oregano, grapeseed extract

Yeast respond well to;

Grapefruit seed extract, oregano oil, caprylic acid, garlic, pau d’arco

Parasites respond well to;

Black walnut, wormwood, garlic, cloves, thyme, fennel, cayenne, ginger, gentian, mimosa pudica