An Adolescent with PANDAS - Healing with Homeopathy - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections

Townsend Letter for Doctors and Patients,  April, 2002  by Judyth Reichenberg-Ullman,  Robert Ullman

• E-mail
• Print
• Link

Jim was a clean-cut 16 year-old from the Midwest sporting a crew cut. Suffering from a deathly fear of getting dirty, especially around his own house, he explained: "I feel like I'm not clean and I want to wash my hands. Almost every day my anxiety goes up. My stomach tightens a little and I get kind of nervous. I tell myself that nothing is really dirty. I try to convince myself that nothing is wrong. It builds up inside and I feel like I have to wash. I feel quite uncomfortable until I can wash. After a while, it may go down without washing. I used to wash a lot more. Now I've lowered the amount of time I wash. Sometimes I can wash for a while, then I get frustrated and it gets worse. Sometimes I can wash and feel clean, but sometimes I have to wash twice. I wash once and it doesn't feel right, so I have to wash again. It feels like my hands are dirty and my stomach feels funny - it tightens up and the tightness goes into my chest, like a butterfly feeling. I feel quite a lot of anxiety if the thing I touch is dirty. In my house, the stuff upstairs and in the basement is dirtier. I used to caddy for the golf course. The stuff I used then feels dirtier."

Jim continued his story, "What set the whole thing off was that me and my friend were riding our bikes home from caddying. On the side of the road was a page of advertising from a dirty magazine. My friend stopped, picked it up, put it in his pocket and brought it to my room. That's how my room came to be dirty. He set it down on a shelf in my closet., Then he threw it away. I remember a couple days later my anxiety was bad, and I started washing more. I had a sore throat at the time, but it went away."

Jim's mom continued the story. "He was washing his hands hundreds of times a day. After several months, a round of antibiotics stopped the acceleration of the OCD (obsessive-compulsive disorder). Any kind of infection exacerbates it, which is difficult since he gets an infection every four to six weeks. He won't go in his room. He will hardly touch anything in the house. He won't even touch suitcases. Just knowing he was really dirty would make him wash a lot."

When asked what seemed dirty to him, Jim explained that "germs and bacteria and stuff" were especially dirty. His anxiety became worse whenever he had an infection. "If I get sick, it is hard to shorten things, and I may wash more. I tell myself to get out of the bathroom, but my anxiety overrides it. Whenever I get sick, I get frustrated because the anxiety is worse."

When questioned about dreams, Jim replied that he did not dream very frequently, but that when he did, the dreams were mostly about being with friends or occasionally dreams of being chased by someone trying to kill him. According to his mom, Jim talked of fighting dreams - he and a friend against the bad guys. In another dream Jim was sitting in his biology class and there was a big, pink snake in his desk that he feared would bite him. The substitute teacher would not listen to Jim. The snake escaped, Jim .attempted to to hide it, but finally the teacher caught the snake and placed it in a fish tank.

A year ago Jim slept regularly 13 or 14 hours a night; recently it was less. Jim was not very cooperative and refused to dress himself. His mom, a nurse, explained, "He panics if he takes his toothbrush into the bathroom." When dressing, Jim felt compelled to touch a wash cloth before touching each piece of clothing. The wash cloth apparently symbolized washing for Jim, so that the clothing seemed clean to him. It became clear, as the case unfolded, that Jim's obsessiveness was quite extreme. Jim insisted that his parents turn the water on and off for him when he washed. He would literally not touch anything in the house but two chairs. Jim washed whenever the family dog touched him. Various places in the house were either clean, partially clean or dirty according to Jim and he considered only two places to be absolutely clean. The place where he did his homework luckily remained clean to him. Jim's rituals all centered around the issue of cleanliness. Before bed Jim would leave his shoes in the kitchen and h is clothes in his mom's room. His mom would have to hand him things. if things were not done exactly right, Jim would accuse, "You just made me dirty!" Very argumentative, Jim blamed her relentlessly.

When we asked what 'clean' meant to him, Jim replied that in order for something to be clean it could not have any dirty bacteria or dirt on it. To 'wash' meant "when you wash your hands with soap and water and dry them off, and your hands are clean." Jim could use a wash cloth or a spray bottle if he wanted to wash quickly.

As a younger child, Jim used to wash his hands normally. His mom described him as a very happy, beautiful child until kindergarten. Developmentally slow, Jim had difficulty with numbers and the alphabet, and had an "I don't know and I don't care attitude." Artistic and creative, Jim easily entertained himself. Even before the OCD, Jim had been a perfectionist. As a young child, he would not even attempt to put together a puzzle unless he could do it perfectly. If he took a test, he demanded of himself a perfect score. Jim felt much less inclined to engage in compulsive handwashing outside the house, although he did mention some contamination issues at school.