Anxiety is a major symptom of PANS and PANDAS.
See more about the PANS PANDAS Diagnostic Criteria and Symptoms.
Generalized Anxiety, particularly Separation Anxiety, a hallmark symptom of PANS PANDAS, affects not just the patient but also the entire family unit (including parents, marriages, siblings, and extended family), peer relationships, school attendance, and more. Anxiety can be absolutely debilitating, causing children to break down at the thought of being separated from a loved one or doing something against what the non-rational intrusive thoughts from OCD are telling them. The anxiety is so crippling that it is hard for anyone who has not already experienced how significantly it impacts life to understand truly.
Patients can develop generalized anxiety, separation anxiety, and anxiety resulting from intrusive thoughts as part of the OCD cycle. Per the diagnostic criteria, PANS symptoms should have a dramatic new onset or a marked increase in severity, taking a patient from a low-level baseline of worry to debilitating anxiety. So, if a patient has typically had a low level of worry, sometimes labeled as a worried child, for PANS, there must be a significant increase of anxiety above their typical worry baseline levels. Anxiety due to PANS can become increasingly worse and more disabling and consistent.
In some cases, a child may develop generalized anxiety due to PANS, causing them to worry excessively about a wide range of subjects, from friendships to the health and well-being of themselves and others. So, if they start feeling anxious about a situation, they may not want to participate in an activity as they might get hurt or cause harm.
Separation Anxiety and OCD
Separation anxiety is a hallmark symptom of PANS and is present in the majority of patients. Patients fear being alone or no longer in the presence of a preferred object or environment. As a result, we often see an inability to sleep in their room alone, cling to their parent’s side, refuse to be in public places away from their parents, and enter rooms alone like their bedroom. We also see separation anxiety manifest in the need for constant reassurance and questioning of previously routine activities. Reassurance-seeking questions are often a compulsion within the OCD cycle of intrusive thoughts and compulsions. In addition, some patients may become anxious when separated from an inanimate object, so we may see children unwilling to let go of an item or refuse to move to a different area of the house as they want to be near a specific object.
Anxiety can also center around new irrational fears and phobias due to intrusive thoughts associated with OCD. These fears often affect the patient’s ability to function in all or specific settings, like with friends, in school, or at home. For example, a patient may have an irrational, debilitating fear of going outside due to fear of being swarmed by bees and dying. Or they may fear foods or chemicals will cause harm so that they will have severely restricted eating, or they will not let someone use specific cleaning products. This fear can lead to patients thinking that only certain places or rooms are safe, thus refusing to leave that space. OCD, separation anxiety, and related anxiety can lead to an irrational fear of leaving the house and going to school.
Panic attacks can happen. Patients can have a panic-stricken look, a look of misery, dilated pupils, a racing heartbeat, shaking, and more.