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Spotlight on OCD During and After Pregnancy

written by: Debbie Roome • edited by: Diana Cooper • updated: 8/26/2011

Women thinking of motherhood may be interested in this overview of research that suggests that obsessive compulsive disorder may be brought on or worsened by pregnancy.

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    How Does OCD Present During Pregnancy?

    During pregnancy, most expectant mothers have concerns about their unborn child and may fear harming him or her by eating something bad or touching something toxic. However, these thoughts are occasional and do not cause noticeable changes in behavior. In the case of perinatal OCD or OCD that occurs during pregnancy, the woman becomes fixated on keeping her child safe and may impose strict limitations on what she eats, touches and where she goes. She may also feel compelled to wash and clean everything in an effort to make her environment safer. Family members are called upon for reassurance and the woman may demand they follow her cleaning rituals when in her home. She is generally aware that her behavior is irrational but is unable to stop herself from carrying out her rituals.

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    How Does OCD Present After Pregnancy?

    OCD after pregnancy is known as postnatal or postpartum OCD. This is characterized by the mother’s fear of illness in her child and excessive watching over him or her as they sleep. It may also incorporate thoughts of harming the child. The fear of hurting the baby can become overwhelming and in an effort to protect her child, the mother may hide any knives or sharp objects in the home. She may also withdraw from the baby, avoiding contact as far as possible in an attempt to protect him or her. If family members notice a change in a new mother’s behavior patterns or a sudden preoccupation with cleanliness or watching over the newborn, they should suggest she consults her doctor and offer to accompany her if necessary.

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    Results of a Study Conducted at the Yale OCD Clinic

    Pregnant women or those with OCD who are considering falling pregnant may find the results of the following studies interesting. Dr Ariadna Forray, of Yale University School of Medicine in New Haven, Connecticut, was lead researcher in a 2010 study that looked at OCD during and after pregnancy. The research was based on interviews with 126 women who were treated at the Yale OCD Clinic. Of these women, 78 had been pregnant at some stage of life and 24 reported that their first OCD symptoms presented during pregnancy or soon after giving birth. Here are some of the important findings listed in the study:

    • Women with pre-existing OCD, who suffered with premenstrual syndrome, were at greater risk of their OCD worsening during pregnancy. The researchers concluded that this supports the idea that there is a subtype of OCD that is hormone related.
    • Hormone-related OCD may be caused by a woman’s sensitivity to reproductive hormones meaning that pregnancy can trigger OCD in susceptible individuals.
    • The study showed that 67 percent of women with OCD that began during pregnancy had fears of contamination and of harming the baby. Only 36 percent of women with pre-existing OCD shared these fears but they had problems with different types of obsessions and compulsions.
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    A Look at a Case Study of OCD During Pregnancy

    A 2005 study presented in the Annals of General Psychiatry followed the case of a 30 year old woman from the fourth month of her pregnancy. Her story illustrates the thinking that pregnancy can bring on OCD. She had no history of psychiatric problems but developed compulsions to clean herself and items in her home. This was in response to fears of contamination and the level of the problem led to her losing her job.

    The patient was initially treated with thought-stopping behavioral therapy and when this failed, was put onto fluoxetine. This reduced her symptoms to the point where she was able to resume her employment. When eight months pregnant, she discontinued the medication and the symptoms returned. The study recorded that the obsessions and compulsions disappeared after she gave birth and five follow up visits in the first year showed no signs of OCD after pregnancy.

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    Study Results on OCD After Giving Birth

    OCD that begins or worsens during pregnancy may disappear after giving birth but in some women, it persists. A 2005 study based on data from a child and maternity hospital, and a psychiatric outpatient clinic in Turkey. Two clinical interviews were conducted with each woman on the first day after giving birth and then six weeks later. At the six week interview the incidence of postpartum OCD was 4 percent. The most common obsessions were contamination at 75 percent, aggression at 33.3 percent and symmetry at 33.3 percent. The most common compulsions were cleaning and washing at 67 percent and checking at 58.3 percent.

    The study concluded by saying that the postpartum period is a risk factor for the new onset of OCD and that women with avoidant and obsessive-compulsive personality disorders are more likely to suffer from this type of OCD.

References

  • Postpartum-onset obsessive-compulsive disorder: incidence, clinical features, and related factors. http://www.ncbi.nlm.nih.gov/pubmed/17284141
  • Treatment & Research into Postnatal OCD. http://www.postnatalocd.org/
  • Pregnancy may trigger or worsen OCD symptoms. http://www.reuters.com/article/2010/06/10/us-pregnancy-ocd-idUSTRE6593R020100610
  • Pregnancy-induced obsessive compulsive disorder: a case report. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1164400/