PANS, PANDAS, or OCD? Understanding the Difference and Why it Matters

At GroundWork CBT in Orlando, we provide evidence-based care for OCD, PANS and PANDAS.

When a child suddenly begins to display alarming changes in their behavior, such as developing intense fears, repetitive actions, or severe anxiety, parents are often left feeling confused and desperate for answers. These abrupt shifts can be signs of several conditions, including Obsessive-Compulsive Disorder (OCD), Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS).

While these conditions can present with similar symptoms, they have distinct underlying causes and require different treatment approaches. Untangling the nuances between PANS, PANDAS, and OCD is not just an academic exercise; it is a critical step toward securing an accurate diagnosis and creating an effective treatment plan for your child.

This guide will explore the definitions, symptoms, and key differences of each condition. Understanding these distinctions will empower you to advocate for your child, ask the right questions, and find the specialized care they need to start their journey toward healing.

What is PANS (Pediatric Acute-onset Neuropsychiatric Syndrome)?

PANS is a clinical diagnosis characterized by the sudden and dramatic onset of neuropsychiatric symptoms, most notably obsessive-compulsive behaviors or severe eating restrictions. Unlike OCD, which typically develops gradually, PANS symptoms can appear seemingly overnight, causing significant distress and disruption to a child’s life.

A key feature of PANS is its connection to an underlying inflammatory or infectious trigger. While the exact cause can vary, the syndrome is believed to be a misdirected immune response that targets the brain, leading to inflammation and the resulting behavioral and emotional changes.

Potential Triggers and Diagnostic Criteria for PANS

PANS is an umbrella term, and the trigger is not always identifiable. However, common infectious agents associated with PANS include:

• Mycoplasma pneumonia (walking pneumonia)
• Influenza (the flu)
• Lyme disease
• Varicella (chickenpox)
• COVID

The diagnostic criteria for PANS require the abrupt onset of OCD or eating restrictions, along with at least two of the following seven symptoms:

1. Anxiety (often separation anxiety)
2. Emotional lability or depression
3. Irritability, aggression, or oppositional behaviors
4. Behavioral regression (acting younger than their age)
5. Deterioration in school performance
6. Sensory or motor abnormalities (including tics)
7. Somatic signs and symptoms, such as sleep disturbances or urinary frequency

Because PANS is a clinical diagnosis based on these criteria, it is essential to work with a knowledgeable provider who can rule out other potential causes for the symptoms.

What is PANDAS?

PANDAS is a specific subset of PANS. The acronym stands for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. As the name suggests, PANDAS is directly linked to a Group A Streptococcus (strep) infection, such as strep throat, scarlet fever, or perianal strep.

The mechanism behind PANDAS is believed to involve a process called molecular mimicry. The antibodies produced by the body to fight the strep bacteria mistakenly cross-react with and attack healthy tissues in the brain, particularly in the basal ganglia. This brain region is responsible for movement, habit formation, and emotion, and inflammation here can trigger the sudden onset of OCD, tics, and other neuropsychiatric symptoms.

Onset and Symptoms Related to Strep

The hallmark of PANDAS is the acute onset or dramatic worsening of symptoms following a strep infection. This connection can be very clear, with symptoms appearing within days or weeks of a positive strep test. In some cases, the strep infection may have been mild or asymptomatic, making the link harder to identify without specific testing.

Like PANS, the primary symptoms are the sudden appearance of OCD or tics. Children with PANDAS often experience a similar range of accompanying symptoms as those with PANS, including severe anxiety, mood swings, and developmental regression. The episodic nature of PANDAS is also notable, with symptoms often flaring up with subsequent strep exposures.

Understanding OCD (Obsessive-Compulsive Disorder)

Obsessive-Compulsive Disorder (OCD) is a mental health condition characterized by a cycle of obsessions and compulsions. Unlike PANS/PANDAS, traditional OCD is not typically triggered by an infection and usually has a more gradual onset, often developing over months or even years.

Working with a skilled therapist is crucial for managing OCD. A qualified professional can collaborate with other providers, evaluate the nuances between different diagnoses, and help guide parents through the complexities of treatment. Even when OCD symptoms are part of a PANS/PANDAS diagnosis, Exposure and Response Prevention (ERP) therapy remains a cornerstone of treatment, though it may be adapted to account for the inflammatory “flares” associated with these conditions.

The Role of Obsessions and Compulsions

OCD operates in a debilitating cycle:

• Obsessions are unwanted, intrusive, and persistent thoughts, images, or urges that cause significant anxiety and distress. Common obsessions in children include fears of contamination, concerns about harm to themselves or others, a need for symmetry, or religious/moral anxieties.
• Compulsions are repetitive behaviors or mental acts that the child feels driven to perform in response to an obsession. The goal of a compulsion is to reduce the anxiety caused by the obsession or to prevent a feared outcome. Examples include excessive handwashing, checking, counting, or seeking reassurance.

While these compulsions might offer temporary relief, they ultimately reinforce the obsessive-compulsive cycle, making the condition more entrenched over time.

Key Differences Between PANS, PANDAS, and OCD

Distinguishing between these conditions can be challenging, but understanding their core differences is vital for accurate diagnosis and treatment.

Feature	PANS	PANDAS	OCD (Traditional)
Onset	Abrupt and dramatic, often described as “overnight.”	Abrupt and dramatic, closely following a strep infection.	Typically gradual, developing over months or years.
Primary Trigger	Associated with various infections or inflammatory processes (e.g., flu, mycoplasma). Trigger may be unknown.	Specifically linked to a Group A streptococcal infection.	No definitive infectious trigger; linked to genetics, brain structure, and environment.
Core Symptoms	Sudden onset of OCD and/or severe eating restrictions.	Sudden onset of OCD and/or motor/vocal tics.	A recurring cycle of obsessions and compulsions.
Associated Symptoms	A wide range of neuropsychiatric symptoms, including anxiety, mood swings, regression, and urinary issues.	Similar to PANS, with a strong emphasis on symptoms appearing after strep exposure.	Primarily involves obsessions and compulsions; other symptoms are secondary.
Course of Illness	Relapsing-remitting pattern, with “flares” often linked to new infections or inflammation.	Relapsing-remitting, with symptom exacerbations tied to new strep infections.	Can be chronic and constant or wax and wane in intensity over time.

The presence of widespread inflammation and infection is a central differentiator for PANS and PANDAS compared to traditional OCD. The sudden, multi-symptom presentation in PANS/PANDAS is a direct result of this underlying neuroinflammation.

Why Accurate Diagnosis Matters

Receiving the correct diagnosis—whether it’s PANS, PANDAS, or OCD—is the most critical step in helping a child recover. A misdiagnosis can lead to ineffective treatment, prolonged suffering, and immense frustration for both the child and their family.

For example, treating PANS/PANDAS as solely a psychiatric disorder without addressing the underlying infection or inflammation will likely yield poor results. The child’s immune system will continue to attack the brain, and behavioral therapies alone may be insufficient to manage the severe, biologically-driven symptoms. Conversely, prescribing antibiotics for a child with traditional OCD would be inappropriate and ineffective.

An accurate diagnosis guides the entire treatment strategy, ensuring that interventions target the root cause of the problem.

Treatment Approaches for PANS, PANDAS, and OCD

Because these conditions have different origins, their treatment plans must be tailored accordingly. A multidisciplinary approach involving pediatricians, immunologists, neurologists, and mental health professionals is often necessary, especially for PANS/PANDAS.

Treating PANS and PANDAS

The primary goal is to address the underlying infection and inflammation while managing the neuropsychiatric symptoms.

• Treating the Infection: For PANDAS, this involves a course of antibiotics to eliminate the strep bacteria. For PANS, the specific antimicrobial will depend on the identified trigger.
• Managing Inflammation: Anti-inflammatory medications, such as NSAIDs (like ibuprofen) or corticosteroids, may be used to reduce brain inflammation during acute flares.
• Immunomodulatory Therapies: In severe or persistent cases, treatments like Intravenous Immunoglobulin (IVIG) or plasmapheresis may be considered to help reset the immune system.
• Behavioral Therapy: Exposure and Response Prevention (ERP) is crucial for managing the OCD symptoms. However, a therapist skilled in PANS/PANDAS will know to adjust the therapy’s intensity based on the child’s inflammatory state. During a severe flare, a child may be too unwell for intensive ERP.

Treating OCD

For traditional OCD, the gold-standard treatment is psychotherapy.

• Exposure and Response Prevention (ERP): This form of Cognitive Behavioral Therapy (CBT) is the most effective psychological treatment for OCD. It involves gradually exposing the child to their fears (obsessions) while helping them resist the urge to perform compulsions.

Your Path to Expert Support

Navigating the complexities of PANS, PANDAS, and OCD requires a team of knowledgeable and compassionate professionals. If you are a parent in the Orlando area and suspect your child may have one of these conditions, seeking an evaluation from a specialist is paramount. A skilled therapist aware of the nuances between PANS, PANDAS, or OCD can be an invaluable guide, helping you connect with the right medical experts and implementing the appropriate therapeutic strategies.

You don’t have to face this journey alone. With an accurate diagnosis and a comprehensive treatment plan, your child can find relief from their symptoms and reclaim their life. Contact our Orlando office today to connect with a PANDAS and OCD specialist who can provide the expert care and guided support your family deserves.

At GroundWork CBT Orlando, our team of compassionate OCD therapists and specialists is dedicated to providing expert care and evidence-based treatment for children struggling with PANS/PANDAS and OCD. Led by Courtney Hubscher, LMHC, a BTTI-trained ERP therapist for OCD and PANS/PANDAS and a Diplomate of CBT, we are committed to helping your child achieve relief and lasting recovery. Contact us today to learn more about our personalized treatment plans and how we can support your family on the path to healing.