The idea that mental illness and psychiatric disorders are afflictions that only affect the brain is now regarded as incorrect. We know that the brain controls the body and when the brain doesn’t function properly, the body suffers the consequences, and vice-versa. A Roman poet by the name of Juvenal understood this connection when he wrote “a healthy mind in a healthy body”, echoing the fact that the body and brain are intertwined, and the health or ill-health of one can affect the other.

Psychiatric disorders, which are comprehensive in their symptomatology, are closely connected to physiological health. It might seem that obsessive compulsive disorder (OCD) is merely a psychological problem, but through more critical examination we understand this is not always the case. For example, my practice had a patient who was seeing a proctologist for gastrointestinal problems but the persistent occurrence of his physical issues, among other things, contributed to the continuation of his OCD. 

We Are as Healthy as Our Immune Systems

At the foundation of good health is a strong autoimmune system. The immune system and its hormones have a major effect on both the brain and the body. I like to think of the hormones within the system as the conductor of an orchestra and the organism as the instruments. If the conductor doesn’t function properly, the instruments go off the rails and play out of tune. With a dysfunctional autoimmune system, and subsequently fluctuating hormone levels, the entire organism goes out of whack.  

Hormonal imbalances are just one of the risk factors for the onset of OCD, along with genetics and environmental stressors such as abuse, upheavals in one’s living situation, and occupational or relationship problems. These can all affect our autoimmune systems.

Melatonin, and Cortisol, and Estrogen, Oh My

Patients with OCD are often deficient in melatonin, which is extremely important in regulating a person’s sleep cycle. If melatonin levels are off, the individual’s sleep can be affected and interfere with the person’s ability to perform daily activities. And persistent lack of sleep can lead to a weakened immune system, which is an additional detriment to both physical and mental health.

Another hormone implicated in patients with OCD is cortisol, the stress hormone. Individuals with OCD are often found to have elevated levels of cortisol, and while we can’t say that elevated cortisol levels cause OCD - mainly because OCD is a complex syndrome with many risk factors - the bidirectional connection between physical bodily symptoms and psychiatric symptoms is apparent. 

For women, the menstrual cycle, pregnancy, and postpartum are characterized by fluctuating hormones, specifically estrogen and progesterone. Estrogen plays a role in augmenting feelings of anxiety, so high levels of estrogen can increase or lead to the development of OCD symptoms. Conversely, progesterone tends to inhibit anxiety, so a deficiency in that might lead to similar effects on OCD symptomatology. 

Women and OCD

It’s no surprise then that in women, we might expect OCD symptoms to be triggered or to worsen during periods of fluctuating hormones. In fact, a study using a sample of 86,000 women found that 1.7 to 4 percent of them had their first onset of OCD after childbirth. A recurrence of existing OCD symptoms after giving birth was experienced by about 25 to 40 percent of the women in the study. 

Postpartum OCD is of particular interest, especially when we consider the interaction between physical health, such as hormonal changes, and the onset or exacerbation of mental health issues. In addition, new environmental stressors that come with having a newborn, like changes in routine, lack of sleep, and new responsibilities, might also serve to increase the risk of OCD. 

Taking into consideration hormone imbalances and environmental stressors, it makes sense that postpartum OCD symptoms can arise immediately after the baby is born but also up to 6 weeks after birth, while the adjustment period is still ongoing. It is essential that postpartum OCD be addressed,and that treatment is sought immediately.

Healthy Body, Healthy Mind and the Reverse

To illustrate the connection between hormonal changes in women and the subsequent effect on OCD symptomatology, I refer to a 33-year-old female who was diagnosed with OCD and migraines. This patient’s worsening symptoms seemed to be closely and repeatedly related to her menstrual cycle (a time when estrogen and progesterone levels often rise and fall). She was also insulin resistant, so her cortisol levels were likely affected, presumably adding to the factors which exacerbated her OCD. 

Through treatment, the severity of the patient’s OCD symptoms decreased by about 67 percent, even though her hormones continued to fluctuate during her menstrual cycle as they always had. This patient was also referred for hormone therapy to the chief of gynecology at UCLA, as well as a gastroenterologist. It is important to work on every aspect with a team and implement a multidisciplinary approach to treatment. Recognizing and understanding the connection between hormones and mental health is a critical step if we want to better support our patients. 

The Roman poet, writing in the late first century, hit the nail on the head. The mind and the body cannot be treated as separate entities. Living a life well lived requires a focus on both the physical and mental, and treating the two in tandem.