Obsessive-compulsive disorder (OCD) is a common and debilitating mental illness. Efficacious treatment options exist but treatment resistance is high, and emerging evidence suggests that biological components, particularly immune activation, may be associated with some cases of OCD. Autoimmunity has been implicated in the pathogenesis of PANDAS and PANS, but a limited number of controlled studies have investigated the association between OCD and antibodies. This article aims to provide an overview of the literature on antibody OCD.

Advantages of recombinant antibodies literature was reviewed using a PubMed search for the terms “(OCD OR obsessive-compulsive symptoms OR OCD) AND (autoantiboidies OR antineuronal antibodies OR immunoglobulins OR IgG OR IgM OR IgA).” Articles were screened independently by two raters and any discrepancies were resolved via discussion or consensus. Nine case reports/case series and six cross-sectional studies were included in the analysis.

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The current body of research on autoimmune OCD is characterized by small sample sizes and uncontrolled methodologies, making it difficult to assess the true prevalence and relationship between this disorder and autoantibodies. Furthermore, the PANS criteria are broad and not specific enough to exclude other autoimmune/inflammatory disorders, including tics, rheumatoid fever, or eating disorders with severe restricted food intake. Therefore, it is important that future clinical guidelines include a more precise definition of autoimmune OCD. A structured clinical approach with the inclusion of diagnostic red flags, interdisciplinary collaboration and advanced investigations with the use of rituximab could allow for better identification of these patients.