My daughter, Megan, is twenty-one and has a diagnosis of both autism and autoimmunity. One of the main behavioral symptoms that Megan began to exhibit nineteen years ago was obsessive compulsive disorder (OCD). It is not an easy life by any means as OCD can dominate too many of her days. Meg regressed after each vaccine as a toddler but had a profound change in health and behaviors after her MMR vaccine. She developed a full body rash, fever, stopped eating, had numerous, daily episodes of green diarrhea, lost eye contact, became isolative,--- and then obsessed with holding a magnetic letter in each hand 24/7. More medical issues developed for example, chronic constipation, Gastroesophageal reflux disease (GERD), and seizures over these past years. Megan has been nonverbal since that regression. Many with an autism diagnosis have OCD and similar health issues. The immune system continues to be unraveled more as the big player in an autism diagnosis yet some still habitually describe autism as a genetic misfit. OCD is a factor in much of this. There seem to be patterns that need to be examined:
Obsessive-compulsive disorder (OCD) occurs worldwide, with common features across diverse ethnic groups and cultures. It affects approximately 2% of the population and is associated with substantial social, personal, and work impairment.1,2……Moreover, a number of other psychiatric and neurologic disorders have similar phenomenological features, can be comorbid with OCD, or are sometimes even conceptualized as uncommon presentations of OCD. These include the obsessive preoccupations and repetitive behaviors found in body dysmorphic disorder, hypochondriasis, Tourette syndrome, Parkinson's disease, catatonia, autism, and in some individuals with eating disorders (eg, anorexia nervosa).4-1……three to five symptom dimensions,19 with the most commonly identified solution including four factors: (i) contamination obsessions and cleaning compulsions; (ii) aggressive, sexual, religious, and somatic obsessions with checking-related compulsions; (iii) obsessions regarding symmetry, exactness, and the need for things to be "just right" paired with compulsions relating to ordering, arranging, and counting, and (iv) hoarding obsessions and compulsions.
Kanner Unfortunately Missed the Immune Dysfunction
Dr. Leo Kanner met those first eleven children, born in the 1930’s , that he would then diagnose in his 1943 paper, AUTISTIC DISTURBANCES OF AFFECTIVE CONTACT . Being a psychiatrist may have clouded his ability to recognize any of the medical issues that those children had vs the psychiatric issues that he loved to study. We here at Age of Autism continue to point out those health issues as we believe they lead both to causation and cures. Kanner did not see the connections that are so clear today but instead used Freudian logic to blame the parents. It is important to get the clues that Kanner missed in his own writings about those first eleven, such as these, describing obsessions and compulsions:
- Usually he winds up with an obsessed interest in the things he was afraid of.
- Most of his actions were repetitions carried out in exactly the same way in which they had been performed originally.
- There were also innumerable verbal rituals recurring all day long.
- He immediately proceeded to turn the lights on and off.
- At 4 years, 11 months, his first move in entering the office (or any other room) was to turn the lights on and off.
- His boarding mother reported a number of observations that indicated compulsive behavior.
- All these and many other things were not only repetitions but recurred day after day with almost photographic sameness.
- Repetitious as a baby, and obsessive now: holds things in hands, takes things to bed with her, repeats phrases, gets stuck on an idea, game, etc., and rides it hard.
- But he himself liked to pull blinds up and down, to tear cardboard boxes into small pieces and play with them for hours, and to close and open the wings of doors.
- …he gently stroked his mother's leg and touched it with his lips. He very frequently brought blocks and other objects to his lips. There was an almost photographic likeness of his behavior during the two visits.
- He has gradually shown a marked tendency toward developing one special interest which will completely dominate his day's activities.
- Yesterday, when looking at a picture, he said many times, "Some cows standing in the water." We counted fifty repetitions, then he stopped after several more and then began over and over.
- He immediately spotted a train in the toy cabinet, took it out, and connected and disconnected the cars in a slow, monotonous manner. He kept saying many times, "More train-more train-more train." He repeatedly "counted" the car windows..
- ..obsessive questions about darkness and light.
- When he is interested in a thing, you cannot change it.
- He developed an obsession about feces,
- The whole performance was very repetitious.
- Mild obsessive trends were reported, such as pushing aside the first spoonful of every dish.
- There was very marked obsessiveness. Daily routine must be adhered to rigidly; any slightest change of the pattern called forth outbursts of panic. There was endless repetition of sentences.
- She insists on the repetition of the same routine always. Interruption of the routine is one of the most frequent occasions for her outbursts. Her own activities are simple and repetitious.
Since autism has been historically and still today, often diagnosed solely on behaviors, it is important that we stress the many GI issues that children can have as they may not be CO-MORBID but instead could be THE EPICENTER of autism and also the OCD that manifests. .
The word REPETITIVE has been one of the triad symptoms diagnosing autism but I would like to challenge that word as OCD may be a better fit for what we are actually seeing. Here is an example of that:
Gut woes may accompany repetitive behaviors in autism -
Although children with autism frequently complain of gastrointestinal (GI) problems, the link between gut health and autism is not entirely clear. Researchers have now begun to trace a connection between the two.
Children with autism who have constipation are often also plagued by compulsive or repetitive behaviors, a core feature of autism, finds a study published 29 November in the Journal of Autism and Developmental Disorders….The researchers initially noticed that many of the children with autism who have GI problems are also prone to compulsive behaviors….The researchers' hunch proved right. Children who have more than one GI symptom are more likely than the controls to show compulsive or repetitive behavior, have a diagnosis of obsessive-compulsive disorder (OCD) or engage in ritualistic behaviors such as flipping on a light switch a specific number of times…Further analysis showed that children with constipation alone have nearly double the odds of being diagnosed with OCD….
..It's possible that constipation might somehow trigger these compulsive behaviors or, conversely, that attempts to toilet-train a child with repetitive behaviors might result in the child becoming constipated…It's possible that children who cannot speak have trouble indicating when they need to relieve themselves, triggering some of these symptoms.
Really? “ That constipation might somehow trigger these compulsive behaviors” or that “It's possible that children who cannot speak have trouble indicating when they need to relieve themselves, triggering some of these symptoms,” sounds pretty flimsy and kind of ridiculous.
I think there is plenty of evidence to show that the gut in each of these children harbors an array of microbes that are most likely causing the symptoms of OCD. The constipation is not the cause but the effect. The children and young adults, like Megan, are victims to a microbial, toxic stew, some pathogenic and causing infection, some inducing autoimmune features via antibodies and toxins.
OCD: Autism and Much More
Could this phenomenon of microbiome-induced OCD also be affecting others? Studies do show that vaccines are capable of changing the microbiome and also can cause molecular mimicry, two mechanisms that can affect the immune system and tilt it. Is this how AUTISM, PANDAS/ PANS and most likely many others, have the shared symptoms of OCD and are connected? Here’s what the research says:
That veil is only very recently being lifted with respect to a potential role for autoimmunity in neuropsychiatric disorders. This shift has occurred as evidence accumulates to support the idea that dysregulated cross-talk between the brain and the immune system is an important contributor to the pathogenesis of conditions as diverse as schizophrenia, mood disorders, autism spectrum disorders (ASDs), obsessive-compulsive disorder (OCD), Tourette syndrome and other tic disorders, attention-deficit hyperactivity disorder (ADHD), anorexia nervosa, narcolepsy, posttraumatic stress disorder and myalgic encephalomyelitis/chronic fatigue syndrome (CFS).[4,5] In addition, intriguing new evidence lends support to the possibility that not only the microbes associated with infectious episodes but also the bacteria of the gut microbiome can foster the production of brain-reactive autoantibodies, and that these microbe-induced antibodies provide the critical link between infection and neuropsychiatric disorders.
That's quite a list and quite a profound scientific reality. Add to that the fact that Narcolepsy, mentioned in that list, has been implicated as a result of vaccine injury.
Mercury in Vaccines and Pesticides - The Age of Autism
Mercury and pesticides also seem to mess with the microbiome in a very negative way. Many will point a sole finger to antibiotics as the bad guy here but too much evidence is making that choice just wrong. Mercury, all by itself, can do this- “bacterial exposure to metals such as mercury can contribute to antimicrobial resistance because many transferrable plasmids carry genes for multiple types resistance. In other words, in the process of developing metal resistance, a bacterium may also become resistant to an antibiotic it hasn’t even encountered.”
It is important to also look at the timing of autism, something Mark Blaxill and Dan Olmsted have done in their superior book, "The Age of Autism: Mercury, Medicine, and a Man-Made Epidemic." Autism made its debut when mercury in vaccines (Thimerosal) and pesticides/fungicides became part of the American landscape. Toxic chemicals have only multiplied since then and that is a huge concern. Our children who regressed into autism are the canaries of a toxic world. Are some of these other disorders with immune issues and OCD not far behind?
So it seems OCD is overlapping in some DSM diagnoses and the newest edition made a shift in 2012 to reflect some of this:
According to the American Psychiatric Association (APA), the publisher of the DSM-5, the major change for obsessive-compulsive disorder is the fact that it and related disorders now have their own chapter. They are no longer considered “anxiety disorders.” This is due to increasing research evidence demonstrating common threads running through a number of OCD-related disorders — obsessive thoughts and/or repetitive behaviors. Disorders in this chapter include obsessive-compulsive disorder, body dysmorphic disorder and trichotillomania (hair-pulling disorder), as well as two new disorders: hoarding disorder and excoriation (skin-picking) disorder.
From DSM To Your TV
Watching television shows often reminds us of how “all the world is a stage.” For example, daily on TV, we can watch different shows that have the common theme of OCD. This seems to be a newer development in the past years. Could it be on the increase?
The Big Bang Theory-The show follows a group of twentysomething genius scientists who also adhere to the textbook definition of “geeks.” Led by the egocentric Sheldon Cooper and nice-guy Leonard Hofstadter, they deal with life, love and awkward social situation with the help of next-door-neighbor Penny, the attractive and semi-normal object of Leonard’s affections.
A favorite of mine as I like all of the characters a lot and am fascinated by Sheldon’s OCD and brilliant mind, yet saddened by his lack of social skills. It has been written in articles that Sheldon DOES NOT have Asperger’s syndrome yet many still wonder about that. My title above, regarding Sheldon’s now famous knock, an OCD triple knock with a call out to “Penny” after each one, is an entertaining and humorous look at the oddness of OCD, but in real life, OCD is more often difficult and painful.
Monk- Though the series ended, the reruns continue about Monk, “a renowned former homicide detective for the San Francisco Police Department. Monk suffers from obsessive-compulsive disorder (OCD) and multiple phobias, all of which intensified after the murder of his wife Trudy,”
This description, about OCD, is on the USA Network, Information courtesy of the Anxiety Disorders Association of America .
Although a fictional character, Monk's plight is a reality for nearly 6 million Americans who suffer from OCD. These obsessions are recurring thoughts or impulses that are intrusive or inappropriate and cause the sufferer anxiety. Some common obsessions are:
•Thoughts about contamination. For example, when an individual fears coming into contact with dirt, germs or "unclean" objects.
•Persistent doubts. For example, whether or not one has turned off the iron or stove, locked the door or turned on the answering machine.
•Extreme need for orderliness.
•Aggressive impulses or thoughts. For example, being overcome with the urge to yell 'fire' in a crowded theater.
Only when the OCD sufferer performs their obsessive rituals will their anxiety subside. But relief is only temporary and so these rituals must be incorporated into the person's daily routine. Some of the most common compulsions are:
•Cleaning - Sufferers concerned with germs and contamination tend to clean constantly, either repeatedly washing their hands, showering, or constantly cleaning their home.
•Checking - Individuals may check several or even hundreds of times to make sure that stoves are turned off and doors are locked.
•Repeating - Some repeat a name, phrase or action over and over.
•Slowness - Some individuals may take an excessively slow and methodical approach to daily activities. They may spend hours organizing and arranging objects.
•Hoarding - Hoarders are unable to throw away useless items, such as old newspapers, junk mail, even broken appliances. Sometimes the hoarding reaches the point that whole rooms are filled with saved items.
Which brings us to the hoarding television shows:
Hoarders: was a US documentary series on A&E, which depicted the real-life struggles and treatment of people who suffer from compulsive hoarding. The series premiered on August 17, 2009, and concluded on February 4, 2013.
Hoarding: Buried Alive: is an American documentary television series that premiered on TLC on March 14, 2010. The show follows hoarders through their life experiences and helps them learn to manage their illness.
The fascination with hoarding is not exclusive to the USA:
And back to the States:
A favorite among Generation Y and one that I have found interesting is the HBO show:
"It's Back" is the title of last night's episode of Girls. It refers most obviously to the reappearance of Hannah's OCD, which she faced as a high school student in a pretty paralyzing form. We start the show out with Hannah counting: Counting trees, counting door-slams, counting potato chips, counting chews, everything in numbers of 8. It's back for Hannah because of the stress of writing her book, and maybe, too, because she's never really dealt with what happened with Adam. Because in life there are triggers, and often they cause us to revert back to old patterns or behaviors, even though we think we've outgrown them, treated them, or simply successfully blocked them for a while…..With Hannah, it's not just the OCD that's back. It's also her parents, who are in town and bring their own ways of relating to their daughter that have existed, presumably, for much of her life. Her dad, forgiving and ready to make excuses for her lateness; her mom, calling her on her bullshit, knowing when something's wrong. At the dinner table at The Carlyle as they wait to see Judy Collins sing, her mom notices right away, "You’re counting to 8." A second later, she defends her parenting: "We don’t know why you had OCD. It’s not our fault.” Hannah responds, "It's the ultimate your fault; it's genetic."
In Part II, we’ll look at genetics, some famous people, and an OCD sufferer reported as cured.
Teresa Conrick is Contributing Editor for Age of Autism.