Rethinking OCD
Obsessive Compulsive Disorder (OCD), characterized by obsessional thinking and compulsive behaviors, has been largely attributed to psychological factors, however evidence is increasingly telling a more nuanced story. Accumulating evidence points to significant biological underpinnings, including inflammation. Inflammation has been getting a great deal of attention in the media recently, and rightfully so, as it is linked to most if not all chronic health conditions, including mental illnesses like OCD. Recent research, including a paper on the NLRP3 inflammasome, is reinforcing the hypothesis that neuroinflammation may be one of the root causes of OCD.
Inflammation in Psychiatry
The field of psychoneuroimmunology has been investigating the relationship between the immune system and mental and neurological conditions for decades. Still, conventional psychiatric providers typically do not evaluate immune function or inflammation in their patients. However, there is strong evidence that inflammation may play a critical role in the pathogenesis of various psychiatric illnesses, including mood disorders like depression and bipolar disorder, anxiety disorders like OCD, and even psychotic disorders like schizophrenia. An imbalance in pro-inflammatory and anti-inflammatory cytokines may negatively impact mental health by lowering key neurotransmitters like dopamine and serotonin, reducing neuroplasticity, and increasing excitotoxicity, among other mechanisms (Bauer & Teixeira, 2019).
OCD & Inflammation
A recent paper is shedding light on what may turn out to be a unique inflammatory “blueprint” in OCD. The NLRP3 inflammasome is a key part of the immune system that when activated, can amplify inflammation in the body. The authors found that CASP1 mRNA and pro-caspase-1 protein levels, and NEK7 mRNA levels were elevated in patients with OCD as compared to those without OCD (Tetik et al., 2023). While OCD severity did appear to correlate with elevations in these components of the NLRP3 inflammasome, the fact that many of the patients were on antidepressants muddied the waters. Still, the results provide unprecedented insight into the potential immune-inflammatory underpinnings of OCD.
In a study investigating various inflammatory cytokines in patients with comorbid OCD and neurodevelopment disorders including Autism Spectrum Disorder, ADHD, and Tourette’s Syndrome, patients with OCD were found to have lower levels of Interleukin 11, an anti-inflammatory cytokine, and higher levels of Interleukin 17A, a pro-inflammatory cytokine (Sakurai et al., 2025). In another study, patients with OCD were found to have lower levels of Interleukin 1B and elevated levels of TNFa when depression was also present. Taken together, the available evidence appears to suggest that a skewing of the immune system and resulting inflammation may contribute to the pathophysiology of OCD.
The Role of Functional Psychiatry
Functional medicine has long recognized the role of inflammation in psychiatric symptoms and conditions. While recent evidence reinforces that immune dysfunction and NLRP3 inflammasome activation may be at play in many cases of OCD, objective measurement remains relatively inaccessible for providers outside of the research setting. There is no single test or biomarker for neuroinflammation. Functional medicine practitioners evaluate a range of markers to get a sense of the inflammatory milieu, including highly sensitive C-reactive protein (hsCRP), homocysteine, and sedimentation rate (ESR) in the serum and kynurenic acid and quinolinic acid in urine via organic acids tests (OAT). While certain labs are offering more comprehensive inflammation-related panels, testing all inflammatory cytokines is currently not possible.
Fighting Inflammation with Diet and Lifestyle
Luckily, the functional medicine toolkit is chock full of therapeutic interventions that are effective in addressing the neuroinflammation that may be contributing to OCD symptomatology. It is important to note that unlike conventional medicine, which may be inclined to tackle this problem with an anti-inflammatory or immune-modulating medication, the functional medicine framework prioritizes root cause identification and resolution. Chronic inflammation doesn’t just come out of nowhere. Various root causes exist, including but not limited to metabolic dysfunction and insulin resistance, autoimmune disorders, nutrient deficiencies, gut dysbiosis and intestinal permeability, and chronic stealth infections.
Anti-Inflammatory Interventions in Practice
The following is just a sample of the evidence-based anti-inflammatory tools in the functional medicine toolbox:
- Lifestyle: sleep optimization, stress management, circadian regulation
- Movement: strength training, cardio, and mind-body exercise like yoga and Tai Chi
- Nutrition: encouraging diets high in omega-3s, dense protein, and polyphenols
- Supplements: NAC, Curcumin, Melatonin, Probiotics, Magnesium, Vitamin B6
- Gut health: addressing dysbiosis and intestinal permeability aka leaky gut
Wrapping Up
Inflammation and immune dysregulation are well-recognized factors in functional psychiatry, and emerging research has highlighted their relevance in OCD. Approaches to assessment and treatment will continue to evolve, however the priority remains a thorough investigation of underlying causes and the use of targeted anti-inflammatory nutritional, nutraceutical, and lifestyle interventions.
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References
Bauer ME, Teixeira AL. Inflammation in psychiatric disorders: what comes first?. Ann N Y Acad Sci. 2019;1437(1):57-67. doi:10.1111/nyas.13712
Sakurai M, Yamanishi K, Hata M, et al. Exploring immunological and molecular mechanisms involved in obsessive-compulsive disorder with comorbid neurodevelopmental disorders. J Psychiatr Res. 2025;184:56-64. doi:10.1016/j.jpsychires.2025.02.064
Tetik M, Direk N, Uzgan BÖ, et al. Associations Between Blood Levels of NLRP3 Inflammasome Components and Obsessive Compulsive Disorder. Noro Psikiyatr Ars. 2023;60(1):28-36. Published 2023 Feb 26. doi:10.29399/npa.28127
