A hidden problem: consequences of the misdiagnosis of perinatal obsessive–compulsive disorder

Abstract

Obsessive–compulsive disorder (OCD) is characterised by: recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and that cause marked anxiety or distress; and compulsions, which are behaviours or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation. Avoidance can also feature prominently. In women, OCD commonly starts in the early 20s, and is often chronic; thus it coincides with the typical childbearing years for many women and pregnancy and/or birth is a consistently cited triggering factor.1 Perinatal OCD is OCD that occurs in pregnancy or postnatally. It may be a new and sudden onset in those with no previous history or an exacerbation of existing OCD. Symptoms commonly orientate around the baby and caregiving. Pregnancy onset has been more associated with fears of accidentally harming the baby by contamination (for example, ‘my hands may be contaminated’), with related compulsions including excessive washing, restriction of diet and, postnatally, avoidance of activities and contact with others such as playgroups, and minimal child handling, reducing mother–child interaction. Postnatal onset has been more associated with fears of deliberately harming the baby (for example, ‘I could touch my baby inappropriately’), associated with avoidance of …