Thursday, 10 July 2008

Is Ocd An Autoimmune Disease

Is Ocd An Autoimmune Disease
ZZ Ward Put The Gun Down (right click to open in new window, ad at the beginning, my apologies, but song is rad.)

I haven't done much on OCD for this blog, which is silly. I mean, ask any psychiatrist about "organic" mental health disorders and OCD will top the list. It is highly inherited, and there are forms of it that, like rheumatic heart disease, even start after a bacterial infection. Is OCD an autoimmune disease? A fair question.

OCD by definition: Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unreasonable thoughts and fears (obsessions) that lead you to do repetitive behaviors (compulsions). With obsessive-compulsive disorder, you may realize that your obsessions aren't reasonable, and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings.Clinical OCD is not the same as just liking all your stuff neat or writing notes in rainbow order with colored pens. OCD is a terrible burden. It means an hour long shower just so everything is done in the right order. Countless hidden routines and intrusive thoughts. Nasty, negative, sexual or homicidal intrisive thoughts that are so far from who you are that you are tortured by them. The disorder tends to start in childhood, so it becomes a part of who the person is.

There are certain cases of OCD that begin with a strep infection. These are thought to be due to PANDAS (pediatric autoimmine neuropsychiatric disorders associated with streptococcus infection.) Many childhood cases of OCD involve tics and other movement disorders as well. David Sedaris has a personal take on the experience.

PANDAS strike with obsessive-compulsions and tics, also increased urinary incontinence, hyperactivity, and a deterioration in handwriting. The strep autoantibodies seem to be attacking the basal ganglia. Straight-up non PANDAS OCD doesn't seem to have these characreristics. So not every case of OCD is a PANDA.

Classic therapy for OCD involves behavior therapy and SSRIs. And I have patients with OCD on clean paleo diets who still need SSRIs for symptom remission. A rather famous "paleo" character from Robb Wolf's site, "Squatchy" (or Chris Williams) came forward to me with his history of OCD. He said I could share his story. It was horrible for him. He tried doctors, pharmaceticals, everything, for years. Managing his lifestyle for good sleep and exercise and a paleo diet has helped him tremendously.

It would make sense from a pathologic standpoint that some cases might have inflammatory dietary components that, if removed, would diminish the symptoms of OCD. This fact will not be true for all cases. In Chris' case, multiple factors were at play.

I started having problems with OCD, and Tourette's in about 1st grade. It would get especially bad during the summer. I was miserable, going to bed as early as possible so I wouldn't have to be awake, not wanting to be alive, etc. I had "good" number and "bad" numbers, and even some "good" and "bad" words, and would have to touch everything a certain number of times, usually while thinking certain thoughts when I did so. At times I even had to have some people around me, like my mom, do things a certain number of times, or say a certain word a specific number of times. To say that all of this was incredibly annoying would be a severe understatement. With the Tourette's I had head tics where I would nod my head forward quickly, vocal tics where I would make a sound that I could feel in the back of my throat, blinking, etc....After some time I ended up transitioning into a paleo diet from my previous "healthy diet". Eventually I also stopped running as much, and started doing more strength and HIIT work. I noticed after a while that my OCD seemed to be a lot less prevalent than it used to. Eventually it got the point where it wasn't even noticeable most of the time. I would go through the day, touching things, closing doors, turning off light switches, and not even have OCD type thoughts. Now I would say it's not a problem or even something I do most of the time. In times of stress or if I'm more worried about something in particular, I notice a few OCD thoughts coming back here and there, but even then it's less than it used to be at baseline

More about the pathology of OCD in the next article.