In Review
Postpartum Obsessive‐Compulsive Disorder

https://doi.org/10.1111/j.1552-6909.2011.01294.xGet rights and content

ABSTRACT

Objective

To synthesize the extant literature on the prevalence, phenomenology, etiology and treatment of postpartum obsessive‐compulsive disorder (OCD). A discussion of differential diagnosis between postpartum OCD and other postpartum psychiatric conditions (e.g., depression, psychosis) and nonpostpartum‐onset OCD is provided.

Data Sources, Study Selection and Data extraction

All studies addressing postpartum OCD between the years 1950 and 2011 were reviewed. Data from all pertinent studies was explored as it related to postpartum OCD.

Data Synthesis

Studies were organized based on their empirical technique (e.g., retrospective, prospective), population studied (e.g., clinical OCD, nonclinical populations, males), and etiological or treatment theory (e.g., cognitive‐behavioral).

Conclusion

The prevalence, phenomenology, etiology, and treatment of postpartum OCD are reviewed. The limited data on treatment approaches and outcomes for postpartum OCD are highlighted with a discussion of the role of nurses in the prevention and identification of postpartum OCD.

Section snippets

Prevalence

Estimates of the prevalence of perinatal OCD vary widely. Anywhere from 25% to 70% of women with OCD report that pregnancy and/or childbirth was the precipitating life stressor in the development or significant worsening of their symptoms (Buttolph, [13]; Ingram, [27]; Pollitt, [42]). Reasons for the wide range in estimates include reliance on notoriously unreliable retrospective self reports, different types of study samples, and different definitions of obsessive‐compulsive symptoms.

Etiology

Several etiological theories have been proposed to explain the presence of obsessive‐compulsive symptoms in pregnancy and the postpartum including cognitive‐behavioral, biological, evolutionary/sociobiological, and psychosocial stressor theories. Theories of postpartum OCD should account for several postpartum specific features including rapid symptom onset, symptom content focused on harming the infant, and the emergence of obsessive‐compulsive symptoms in fathers (Abramowitz, Schwartz, Moore,

Phenomenology

The presentation of postpartum obsessive‐compulsive symptoms varies widely (Brockington et al., [12]). During pregnancy and the postpartum period, women's obsessions often concern fears of intentionally or accidentally causing harm to the baby (Buttolph, [13]; Labad et al., [31]; Ross & McLean, [45]). Other obsessional themes experienced in postpartum OCD have included contamination, symmetry/exactness (e.g., obsessing over the proper symmetrical positioning of the infant's blanket), aggression

Treatment

Treatment for postpartum OCD should involve similar approaches as used in treatment for OCD occurring at other times in life (for a review see Abramowitz, [2]), namely cognitive‐behavioral therapy (CBT) and serotonin reuptake inhibitor (SRI) medication. The primary treatment components of CBT involve helping the patient confront feared stimuli—including situations and thoughts (i.e., exposure)—while refraining from performing compensatory rituals (response prevention); this is referred to as

Implications and Future Directions

We highlight empirical and clinical findings on postpartum OCD. Although encouraging, there remain several areas within research and clinical work that warrant further consideration. First, prospective research is needed with clinical and nonclinical samples of women throughout their pregnancy and postpartum. Though informative, retrospective studies are limited by self‐report and recall bias, whereas case series highlight phenomenology but have limited generality and methodological rigor.

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