Perinatal obsessive compulsive disorder

Obsessive Compulsive Disorder (OCD) can occur in 2 in 100 women in the perinatal period.

The main symptoms of perinatal OCD are:

Obsessions – They are unwanted thoughts, images, urges or doubts. They occur repeatedly and can be distressing. Examples include:

  • Intense fear of contamination by germs or dirt

  • Worries about something the woman has or hasn’t done- such as sterilising baby’s bottle correctly

  • An image of a thought of harming someone

  • Perfectionism

Anxiety – Women can experience anxiety, fear, guilt or depression. They may feel better in the short term if they carry out their compulsion, but this does not last for long.

Compulsions – They are repetitive actions that are the consequence of obsessional thoughts. Examples include:

  • Rituals of washing or cleaning repetitively

  • Checking

  • Seeking reassurance

  • Avoiding feared situations or activities

Perinatal OCD can be mild or severe and can impact on the woman’s daily functioning, relationship with others and overall quality of life. It can lead to depression, difficulties in bonding with baby and on rare occasions, suicidal feelings.

The main treatment modalities include:

  • CBT (Cognitive behavioural Therapy)- specifically ERP (Exposure and Response Prevention)

  • Medications

If you require further advice, contact your local specialist perinatal mental health team or community mental health team. For further advice on medications in the perinatal period, please refer to ‘Top Tips for GPs in prescribing in the perinatal period’.

Alternatively use link below for further support in considering the risk/compulsion considerations:

Intrusive thoughts are known to occur to both men and women in the perinatal period1.

Factors to consider in risk assessment:

  • level of insight

  • Primary risk considerations in OCD: mothers with OCD are aware that their intrusive thoughts/compulsions are ego-dystonic and evidence supports that these intrusive thoughts/compulsions carry no risk that the mother would act on them, with her primary reactions being that of deep distress and an attempt to avoid any situations which the mother may feel an increase her level of anxiety or her intrusive thoughts leading to:

  • Secondary risk is the biggest risk concern related to OCD – a parent may become less responsive and emotionally available if they try to avoid anxiety provoking situations like changing a nappy or bathing the baby

View the Royal College of Psychiatrists information on perinatal OCD

Training for healthcare professionals – discussing intrusive thoughts:

Watch our videos showing an example GP appointment with a patient discussing intrusive thoughts.

References

1. Howard et al Lancet series on Perinatal Mental Health (2014) Non-psychotic mental disorders in the perinatal period.

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2 2Seas

PATH – PerinAtal menTal Health – is part of the Interreg VA 2Seas programme and receives funding from the European Regional Development Fund.

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