There is no clear statistics on how many women experience Obsessive-Compulsive Disorders during pregnancy, since obsessions and compulsions can appear separately or in conjunction with the diagnosis of Major Depression and/or Panic Disorders. The Reproductive Mental Health Program believe very few women, less than one per cent experience Obsessive-Compulsive Disorders during pregnancy.
There is no clear statistics on how many women experience Obsessive-Compulsive Disorders during the postpartum period, since obsessions and compulsions can appear separately or in conjunction with the diagnosis of Major Depression, and/or Panic Disorders. The Reproductive Mental Health Program believe few women, two to three per cent, experience Obsessive-Compulsive Disorders without a co-morbid mood or anxiety disorder in the postpartum period.

What is an Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorders are characterized by obsessions and compulsions.

What are the signs and symptoms of an Obsessive-Compulsive Disorder?

Obsessions - recurrent thoughts, impulses or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and cause marker anxiety and distress.

Some women are bothered by recurrent thoughts or impulses that seem inappropriate or do not make sense, but keep repeating over and over and are difficult to get out of their minds
the thoughts, impulses or images are not simply excessive worries about real-life problems
the woman attempts to ignore or suppress such thoughts, impulses or images or to neutralize them with some other thoughts or actions
the woman recognizes that the obsessional thoughts, impulses or images are a product of her own mind. Also referred to as thought insertion, where a person believes someone is putting thoughts into their mind.

Compulsions are urges that women experience to lessen their anxiety, discomfort, dysphoria, or feelings of disgust that usually results from obsessions.

Compulsions typically lead to performance of repetitive purposeful, intentional behaviors called rituals. Rituals - reduce discomforts form obsessions but the cost is that the behavior is done in excess. For example:

washing/cleaning- reduces concern about contamination
avoiding objects of aggression - reduces anxiety about aggression
straightening and ordering- reduces discomfort from disorder
hoarding (collecting items) - counteracts fears of losing things of importance

At some point during the course of the disorder, the woman recognizes that the obsessions and compulsions are excessive or unreasonable.

Some of the obsessional thoughts and compulsive behaviours reported in the literature for postpartum women are obsessional fears of:

the baby’s bottles being contaminated, resulting in compulsively sterilizing the bottles
putting the baby in the microwave
drowning the baby, especially during bath time
stabbing the baby
throwing the baby down the stairs or over the railing, or in the garbage

Obsessional thoughts are highly correlated to checking compulsions - where the mother feels compelled to frequently check on her baby because she is stricken with fear that something bad will happen.

Obsession-Compulsive Disorders:

cause marked distress
are time-consuming (take more than an hour a day) and
significantly interfere with the woman’s normal routine, work, studies, social activities or relationships.

top

What are the risk factors for Obsessive-Compulsive Disorders?

Women are at greater risk of experiencing Obsessive-Compulsive Disorders if they have a:

Previous history of Obsessive-Compulsive Disorder (e.g. women who have an Obsessive- Compulsive Disorder prior to pregnancy continue to have the disorder throughout the pregnancy and postpartum period).
Family history of an Obsessive-Compulsive Disorder
A woman with Obsessive-Compulsive Disorder during pregnancy is twice as likely to experience Postpartum Depression.

Why should women with Obsessive-Compulsive Disorders seek treatment in pregnancy or postpartum?

A woman with untreated Obsessive-Compulsive Disorder in pregnancy is at a higher risk of developing Postpartum Depression.
Treating women with Obsessive-Compulsive Disorders increases their coping skills during pregnancy and in the postpartum period.
A woman with untreated Obsessive-Compulsive Disorder in the postpartum period may minimize her interactions with her baby for fears she may harm him/her. Treating the woman promptly may help her normalize her fears, increase her interactions with the child and therefore promote the bonding between mother and child.
Use of anti-obsessional medication in the postpartum period has been shown to decrease symptoms in some women.
Untreated Obsessive-Compulsive Disorders may affect the mother-child relationship and the woman’s ability to cope in the postpartum period.

top

What are the treatments options for women with Obsessive Compulsive Disorders?

Psycho education: Involve the significant other, friends and family supports. Teach coping strategies and how to build social networks and supports. ( Link to the Self-Care Program)
Supportive Psychotherapy - offers support, reassurance and education for women with postpartum depression.
Cognitive Behaviour Therapy (CBT) - is based on the fact that, the way we think affects the way we behave. Depressed women may experience a lot of negative thoughts. Cognitive Behavior Therapy helps women identify these thoughts, teaches them to challenge them and replace them with positive thoughts. The resulting thought patterns changes from their earlier ones. In cognitive therapy, the therapist helps the woman: identify her distorted thinking patterns, patterns, challenge these distortions and replace the thoughts with more realistic thoughts.

Some examples of Cognitive Disorders:

All-or-nothing thinking: You look at things in absolute, black-and-white categories.
Overgeneralization: You view a negative event as a never-ending pattern of defeat.
Mental filter: You dwell on the negatives and ignore the positives.
Discounting the positives: You insist that you accomplishments or positive qualities "don’t count".
Jumping to conclusions: Mind reading – you assume that people are reacting negatively to you when there’s no definite evidence for this.
Fortune-telling - you arbitrarily predict that things will turn out badly.
Magnification or minimizing: You blow things way up out of proportion or you shrink their importance inappropriately.
Emotional reasoning: You reason from how you feel: "I feel like an idiot, so I really must be one". Or "I don’t feel like doing this, so I’ll put it off"."
Should statements": "You criticize yourself or other people with "shoulds" or "shouldn’ts". "Musts", "oughts" and "have tos" are similar offenders.
Labeling: You identify with your shortcomings. Instead of saying "I made a mistake", you tell yourself, "I’m a jerk", or "a loser".
Personalization and blame: You blame yourself for something you weren’t entirely responsible for, or you blame other people and overload ways that your own attitudes and behaviour might contribute to a problem.

Adapted from David D. Burns, MD, “Feeling Good: The New Mood Therapy” (New York: William Morrow & Company, 1980.

Group Therapy: Public Health Nurses in conjunction with other community service providers may co-facilitate postpartum support groups Peer support groups are offered by several non-profit organizations across B.C., such as the Pacific Postpartum Support Society Mental Health Teams may offer general depression support groups. For more information , refer to your health authority’s website link to Partners & Affiliations

The Reproductive Mental Health Program offers group psychotherapy for those postpartum women attending the program:

Family & Relationship Counseling - assists women and their significant others to develop strategies to cope with this stressful time.
Pharmacotherapy (i.e., Anti-obsessional )

For more detailed information about Anti-obsessional medication, see Best Practices Guideline 5.

top