Sudden Onset of Obsessive-Compulsive Disorder and Other Mental Health Conditions in Children: An Overview of PANS/PANDAS

Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) are conditions that many health-care providers are unfamiliar with, yet they can have profound implications for childhood mental health. These disorders present with abrupt-onset neuropsychiatric symptoms, often leaving families and clinicians confused and searching for answers. While conventional medicine has traditionally overlooked these conditions and their immune-related underpinnings, the tide is turning, with PANS/PANDAS centers opening at major institutions, including Stanford University and Massachusetts General Hospital. An integrative and functional medicine approach offers a broader framework for understanding and addressing these often disabling conditions.

What Are PANS and PANDAS?

PANS is a clinical syndrome characterized by the sudden onset of obsessive-compulsive behaviors, severe anxiety, emotional dysregulation, and other neuropsychiatric symptoms. It is thought to result from an immune-mediated attack on the brain, often triggered by infections, environmental factors, or metabolic dysfunction (Gagliano et al., 2023).

PANDAS is considered a subset of PANS, specifically linked to streptococcal infections. The theory behind PANDAS is that strep bacteria provoke an abnormal immune response, leading to neuroinflammation and dysfunction in brain regions associated with mood, behavior, and movement (Dop et al., 2021).

Recognizing the Symptoms

Unlike typical childhood-onset obsessive-compulsive disorder (OCD), anxiety, or eating disorders, PANS/PANDAS symptoms appear abruptly—sometimes overnight. Parents often describe their child as “a different person” within a short timeframe. Symptoms can include:

• Intense OCD-like rituals or intrusive thoughts
• Sudden, severe separation anxiety
• Emotional instability, irritability, or aggression
• Tics or involuntary movements
• Cognitive dysfunction (brain fog, memory problems)
• Sleep disturbances
• Restrictive eating behaviors

These symptoms can fluctuate in severity, often worsening with infections (including upper respiratory tract infections) or immune system activation. Often misdiagnosed as primary psychiatric disorders, children are typically placed on medications that don’t address the underlying cause.

Why Are These Pediatric Disorders Often Misunderstood?

One challenge in diagnosing PANS/PANDAS is its overlap with conventional psychiatric conditions. Many children initially receive diagnoses such as OCD, generalized anxiety disorder, Tourette’s, anorexia nervosa, or even bipolar disorder. However, the sudden onset and waxing-waning nature of symptoms set PANS and PANDAS apart. As emphasized by Prato et al. (2021), PANS and PANDAS are diagnoses of exclusion; other causes must be ruled out before a diagnosis is made. While expert clinicians have their own sets of diagnostic tools, it is important to remember that these are clinical diagnoses and that there is no validated testing that fully confirms the presence of PANS/PANDAS.

Another barrier is the medical system’s traditional separation of psychiatry from immunology and infectious disease. Since PANS/PANDAS involve immune dysfunction affecting the brain, these conditions don’t fit neatly into existing psychiatric models. Many providers remain unaware of these disorders, and some dismiss them due to historical controversies surrounding their etiology.

Treatment Approaches for PANS/PANDAS

There are many treatment options for PANS/PANDAS, depending on the cause of the immune dysfunction. Common treatments include antibiotics, anti-inflammatory medications like NSAIDs or corticosteroids, and even intravenous immunoglobulins in severe cases (Sigra et al., 2018).  Functional medicine providers tend to augment these more conventional treatments with other treatments to modulate the immune system, optimize gut health, and support mitochondrial function. While more research is needed, behavioral interventions like cognitive-behavioral therapy (CBT) and exposure/response prevention (ERP) can be particularly effective in managing OCD symptoms in patients receiving treatment for PANS/PANDAS (Thienemann et al., 2017).

The Road Ahead

Early recognition of PANS/PANDAS is crucial. When properly identified and treated, many children can make full recoveries. However, misdiagnosis or delays in care can lead to prolonged neuropsychiatric challenges. As awareness grows, functional psychiatry has an opportunity to bridge the gap between mental health and immunology, providing a more comprehensive approach to pediatric neuroinflammatory conditions.