Perinatal Obsessive-compulsive Disorder Research Articles

Public stigma and recognition of perinatal obsessive-compulsive disorder

Stigma is a barrier to disclosure of psychiatric symptoms and treatment seeking among perinatal patients, including those with perinatal obsessive-compulsive disorder (POCD), perinatal depression (PPD), and postpartum psychosis (PPP). This study examines the relationship between stigma, illness recognition, and familiarity with illness in six distinct postpartum experiences. In a cross-sectional online survey, participants (N = 572) were randomized to one of six postpartum vignettes: subclinical, depression, psychosis, and three subtypes of obsessive-compulsive disorder: contamination, responsibility for harm, and sexual content. Participants were asked to provide a diagnostic label of the condition and rate different aspects of stigma. Sexual content POCD, responsibility for harm content POCD, and the subclinical vignettes were less likely to be accurately recognized than PPD, contamination POCD, and PPP. A multivariate analysis of variance revealed the sexual POCD and PPP vignettes were met with the highest level of stigma, while the subclinical condition, PPD, and contamination POCD were met with the lowest levels of stigma. Significant interactions were present between accurate recognition of the condition and type of vignette on stigma variables, with recognition generally being associated with lower stigma for POCD and PPD. This demonstrates the need for comprehensive educational efforts on perinatal mental health.

Consensus recommendations for the assessment and treatment of perinatal obsessive–compulsive disorder (OCD): A Delphi study

The perinatal period is one of increased vulnerability to parents experiencing the onset of, or an increase of existing, obsessive–compulsive disorder (OCD) symptoms. Existing OCD and perinatal mental health best practice guidelines do not detail specific considerations relevant to OCD in the perinatal period (‘Perinatal OCD’). Perinatal OCD risks being undiagnosed or misdiagnosed, and subsequently untreated or mistreated, with potential negative impacts for individuals and families experiencing this problem, highlighting the importance of specific guidance. This study employed a modified Delphi survey methodology to establish recommended best practice for the assessment and treatment of perinatal OCD. A literature review identified 103 initial best practice recommendations, and participants suggested 18 further recommendations. These recommendations were rated for importance over three survey rounds by two expert panels, comprising of 15 professionals with clinical or research expertise in perinatal OCD and 14 consumers with lived experience of perinatal OCD. One-hundred and two statements were endorsed for inclusion in the final set of recommendations for clinical best practice with perinatal OCD. These recommendations inform practice across eight themes; psychoeducation, screening, assessment, differential diagnosis, case care considerations, treatment, partners & families, and culture & diversity. This novel study is the first to collate and outline a set of clinical best practice recommendations, developed using the consensus perspectives of both individuals with lived experience and professionals with relevant expertise, for supporting individuals with perinatal OCD and their families. Differences between panel perspectives, and directions for future research are also discussed.

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Special Report: Women’s Reproductive Mental Health—A Clinical Framework

Narrating Perinatal Obsessive-Compulsive Disorder Through Blogs

Abstract Purpose: To describe women's experiences of perinatal obsessive-compulsive disorder (OCD) as written in their blogs. Study Design and Method: This qualitative descriptive study examined perinatal OCD blogs identified using Google search engine. Krippendorff's thematic content analysis method for qualitative data was used. The unit of analysis included segments of the bloggers' descriptions of their perinatal OCD. Clustering and dendrograms were used to group the data into themes. Results: Forty-three different posts from women in the United Kingdom, United States, Australia, and South Africa were analyzed. Five themes were identified that described women's experiences of perinatal OCD as told in their blogs: (1) Starting to tighten its grip during pregnancy, (2) Keeping horrific secrets all to themselves, (3) Tortured with terrifying images and thoughts, (4) Driven to compulsive behaviors to protect their infants, and (5) Long difficult road to recovery but so worth it. Clinical Implications: Perinatal OCD is a hidden problem that can have negative consequences for mothers and for their infants and families if not diagnosed or if misdiagnosed. There are effective treatments for OCD, but first nurses and other health care providers need to identify the women who are struggling with this anxiety disorder. During the perinatal period nurses can screen women for OCD. Developing a trusting relationship with pregnant and postpartum women is critical for nurses so that their patients can feel safe enough to share their horrific secret thoughts.

Perinatal Obsessive-Compulsive Disorder: Epidemiology, Phenomenology, Etiology, and Treatment.

We review recent evidence concerning the epidemiology, etiology, and treatment of obsessive-compulsive disorder (OCD) in the perinatal period. We examine studies reporting on rates of both new-onset OCD and exacerbation in both pregnancy and postpartum; explore both biological and psychosocial risk factors for the disorder; and review the latest evidence concerning treatment. Evidence is limited in all areas, with rates of both OCD and subthreshold obsessive-compulsive symptoms varying widely across studies. Prevalence is likely higher in the perinatal period than in the general population. Clinical features in the perinatal period are more likely than at other times to concern harm to the child, with contamination and aggressive obsessions and cleaning and checking compulsions especially common. Research into the biological etiology is too limited at this time to be definitive. Both observational and randomized controlled trials support cognitive behavioral therapy with exposure and response prevention (CBT with ERP) as a first-line treatment, with limited evidence also supporting the use of selective serotonin reuptake inhibitors (SSRIs). Treatment considerations in the perinatal period must weigh the risks of treatment vs. the risks of untreated illness. Perinatal OCD is common and can be impairing. Clinical features differ somewhat compared to non-perinatal periods. Treatment does not differ from that used in the general population, though evidence pertaining specifically to the perinatal period is sparse.

Screening for Perinatal OCD: A Comparison of the DOCS and the EPDS.

Screening for perinatal-occurring obsessive-compulsive disorder (OCD) is rare. We sought to evaluate the Dimensional Obsessive-Compulsive Scale (DOCS) as a screening tool for perinatal OCD and compare the screening accuracy of the DOCS with the commonly recommended Edinburgh Postnatal Depression Scale (EPDS). English-speaking, pregnant individuals aged 19+ (N = 574) completed online questionnaires and diagnostic interviews to assess for OCD prenatally and twice postpartum. The DOCS total score demonstrated the highest level of accuracy. Neither the EPDS-Full nor the three-item Anxiety subscale of the EPDS (EPDS-3A) met the criteria of a sufficiently accurate screening tool for OCD at any of the assessment points. Findings provide support for the DOCS as a screening tool for perinatal OCD and indicate a need for disorder-specific screening for perinatal anxiety and their related disorders (AD). Generalizability of findings is limited to Canada only. Future research would benefit from comparisons with measures of perinatal OCD (e.g., the Perinatal Obsessive-Compulsive Scale).

Mothers’ experiences of perinatal obsessive-compulsive disorder

ABSTRACT Introduction Perinatal obsessive-compulsive disorder (POCD) is characterised by the presence of intrusive thoughts resulting in significant distress and urges to execute repeated behaviours occurring in the perinatal period. POCD is largely understudied and existing literature has mostly studied POCD quantitatively. Objective This qualitative study explores the experiences of 10 mothers randomly selected from a larger sample (N = 251; 86.8% White) who met high risk criteria based on the Postnatal Obsessive-Compulsive Scale (POCS≥16). These mothers were interviewed about their experiences with POCD retrospectively. Results Qualitative analysis of the interviews (n = 10) revealed three main themes regarding women’s experiences with POCD: 1) obsessions (i.e. safety, cleanliness), 2) compulsions (i.e. excessive checking for safety, excessive cleaning, researching information online), and 3) other emotional experiences (i.e. fear, panic, anxiety, suicidal ideation, guilt, shame, irritability/anger). Conclusion Mothers at high risk for POCD report obsessions and compulsions as well as other emotional experiences that are distressing, demonstrating the enduring impact of POCD beyond the perinatal period.

Beauty and the beast: A psychoanalytically oriented qualitative study detailing mothers' experience of perinatal obsessive‐compulsive disorder

AbstractOur understanding of mothers' experience of perinatal obsessive‐compulsive disorder (POCD) is limited. While symptoms of POCD have been documented in the literature, the wider lived experience of people with this condition has received less attention. This study used a psychoanalytically informed research method to explore mothers' experiences of POCD. Five participants each engaged in three unstructured interviews, where participants were given time and space to discuss their personal experience. Three major themes emerged from the interviews conducted: a difficult road to motherhood, which related to the challenges participants faced becoming mothers; protector/aggressor, which described the tension between participants' intrusive thoughts and their desire to protect their baby; and mothers' loss, which described participants' sense of sadness having experienced POCD at this special time in their lives. These themes are discussed in relation to their significance for our thinking about mothers' experience of POCD during pregnancy, postnatally and beyond.

Fathers' Experience of Perinatal Obsessive-Compulsive Symptoms: A Systematic Literature Review.

Perinatal Obsessive-Compulsive Disorder (pOCD) refers to the onset/exacerbation of Obsessive-Compulsive Disorder (OCD) during the perinatal period. This disorder has been studied in mothers, with limited research conducted on fathers. The aim of the current study was to conduct the first systematic review of research investigating the experience of pOCD in fathers. A systematic review was conducted via electronic searches of Scopus, ProQuest, APA PsychNet, PubMed, and EBSCOhost. There were 523 articles identified and screened for eligibility, resulting in six eligible studies included in the final review. All studies reported the presence of subclinical obsessive-compulsive symptoms in fathers during the perinatal period, with the prevalence comparable to mothers. Compared to mothers, however, fathers were found to report less intrusion-related distress. Two studies reported a correlation between dysfunctional beliefs, negative appraisal of intrusions, and pOCD symptoms. Common categories of obsessive thoughts and compulsions experienced by fathers were also identified. Fathers appear susceptible to pOCD, which is consistent with the Cognitive-Behavioral Theory of OCD. Future research is recommended, therefore, to investigate clinical prevalence and severity of pOCD in fathers, particularly relative to mothers, and further investigate the role of dysfunctional beliefs in the development of pOCD.

High Prevalence and Incidence of Obsessive-Compulsive Disorder Among Women Across Pregnancy and the Postpartum.

Objective: During the perinatal period, women are at an increased risk for the onset/exacerbation of obsessive-compulsive disorder (OCD) and may experience perinatal-specific obsessions and/or compulsions. Past research has provided preliminary findings regarding the prevalence of OCD in the perinatal period but has often reported limited metrics and ignored perinatal specific symptoms. This research aimed to assess the prevalence and incidence of maternal OCD between the third trimester in pregnancy and 6 months postpartum.Methods: An unselected sample of 763 English-speaking pregnant women and new mothers participated in a longitudinal, province-wide study between their third trimester in pregnancy and 9 months postpartum. They completed 3 online questionnaires and interviews (data collected between February 9, 2014, and February 14, 2017) and were administered a diagnostic interview to determine OCD status based on DSM-5 diagnostic criteria.Results: A weighted prenatal period prevalence of 7.8% and a postpartum period prevalence of 16.9% were found. The average, prenatal, point prevalence estimate was 2.9%, and the average, postpartum, point prevalence estimate was 7.0%. Point prevalence gradually increased over the course of pregnancy and the early postpartum, attaining a peak of close to 9% at approximately 8 weeks postpartum, with a gradual decline thereafter. The cumulative incidence of new OCD diagnoses was estimated at 9% by 6 months postpartum.Conclusions: Our study suggests that when women are encouraged to report their perinatal-specific symptoms, and current diagnostic criteria are applied, estimates for perinatal OCD may be higher than previously believed.

State of the art and future perspectives on the use of non-invasive neuromodulation in peripartum psychiatric disorders

State of the art and future perspectives on the use of non-invasive neuromodulation in peripartum psychiatric disorders

The need for inclusion of sex and age of onset variables in genetic association studies of obsessive–compulsive disorder: Overview

Obsessive–compulsive disorder (OCD) is a heterogeneous mental disorder that significantly impairs an individual's functioning. The candidate gene approach has proven to be a useful tool in investigating potential risk genes for OCD, but genetic studies have been largely inconclusive. Etiologically distinct forms of obsessive–compulsive disorder based on sex and age of onset have been identified, yet many genetic studies fail to examine the association by these subtypes. Due to the sexually dimorphic nature of the disorder, positive associations have been found with OCD in males only, suggesting the potential for identifying risk genes that contribute to OCD in women, such as perinatal OCD. This review includes a brief overview of the disorder and its subtypes, with a current update on candidate genes that may contribute to OCD using single nucleotide polymorphisms (SNPs) and genome wide association studies (GWAS).

Perinatal obsessive–compulsive disorder

I found this article by Challacombe and Roe interesting and timely.1 The idea of harming your baby can be terrifying for a new mother and the distress is aggravated by the fact that such thoughts ‘should not be felt’ by a caring …

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

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 …

Perinatale Zwangsstörungen

A perinatal obsessive-compulsive disorder (OCD) is defined as an illness exhibiting first symptoms in the context of pregnancy and the postpartal period. There are no valid data up to date concerning the incidence of OCD, which might be of multifactorial origin, in this period in which females are highly vulnerable for psychiatric diseases. From a clinical point of view, obsessions and compulsions are mainly related to the well-being of the foetus or newborn baby. Differential diagnosis of perinatal OCD including pregnancy psychosis and post-partum depression is often difficult. Concerning treatment, non-pharmacological approaches should be preferred. Administration of SSRIs should be strongly restricted. However, there are no controlled therapy studies in patients with perinatal OCD. Furthermore, current knowledge about these patients is still limited. The aim of this review article is the presentation of phenomenology, pathogenesis, differential diagnosis and treatment of perinatal OCD. The mental situation of the female patients can be improved and stabilised if early diagnosis of a perinatal OCD leads to early initiation of an adequate therapy. This will then enable a good and stable mother-child relationship to develop.

Piloting the Perinatal Obsessive-Compulsive Scale (POCS): Development and validation

Onset/worsening of obsessive-compulsive disorder (OCD) during the perinatal period are frequently seen clinically. No specific tool assessing the unique content, context, severity, and onset of perinatal OCD exists. A self-report scale of perinatal obsessions and compulsions, the Perinatal Obsessive-Compulsive Scale (POCS), was developed and validated. A total of 162 women (67 pregnant, 95 postpartum) participated in this pilot study. They completed the POCS as well as the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). The POCS has good construct validity, reflected by representative items, high internal consistency, good concurrent validity and discriminative capacity. The most common obsessions were fear of having an unhealthy baby at birth, contamination, the baby being taken away, and infant death. Behavioral compulsions such as repeating rituals, asking for reassurance, checking, and cleaning mirrored these obsessions. The POCS helps clinicians detect perinatal OCD while giving perinatal women an opportunity to openly discuss socially sensitive issues.

Gender in obsessive-compulsive disorder and obsessive-compulsive spectrum disorders

Background: There is increasing recognition that obsessive-compulsive disorder (OCD) and putative OCD spectrum disorders (OCSDs) are not homogenous entities. Gender may provide an important window onto the heterogeneity of these various disorders. Methods: A MEDLINE review of gender issues in OCD and putative OCD spectrum disorders (excluding eating disorders) was undertaken (1965–2000). These included demographic variables, clinical phenomenology, etiological factors, and treatment implications. Results: OCD differs from other anxiety disorders in having an approximately equal male:female gender ratio. OCSDs (e.g. body dysmorphic disorder) may have an equal gender ratio, may be more common in women (e.g. trichotillomania, hypochondriasis) or may be more common in men (e.g. Tourette's disorder). Etiological factors may differ across gender; an association between perinatal or early brain injury and OCD or Tourette's appears particularly important in males, while OCD and trichotillomania may also begin during pregnancy or shortly after childbirth with exacerbation of symptoms during menstruation. It is not clear that anti-androgens are effective in OCD, nor that gender predicts response to serotonin reuptake inhibitors in this disorder. Conclusion: There is a relative scarcity of literature addressing gender issues in OCD and putative OCSDs. That literature which does exist is not entirely conclusive, but raises a number of interesting questions for future research.