Obsessive-compulsive symptoms in pregnancy and the puerperium:: A review of the literature

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Abstract

In this article, we review the available research on postpartum obsessive-compulsive disorder (OCD). Most studies are retrospective in nature, thus not answering questions as to overall prevalence of such symptoms. However, there are consistent findings with regard to symptom profile: obsessional thoughts in postpartum OCD tend to concern fears of harm to the infant. We discuss distinctions between postpartum OCD symptoms and postpartum depression and psychosis. Although preliminary, research on treatments for postpartum OCD indicates the effectiveness of medications and cognitive-behavioral therapy. We explore the relationship between OCD symptoms and postpartum depression and offer possible directions for future study. We also consider the proposed etiological models and offer a fresh conceptualization of this condition.

Section snippets

Prevalence

Three early studies on factors associated with onset of OCD identified subgroups of patients whose symptoms began during or immediately following pregnancy. In one investigation, Pollitt (1957) reviewed histories of 150 patients with OCD (63 males and 87 females) and found that 93 of these individuals (62%) believed a specific event precipitated onset of their symptoms. For 10 patients (11%) the significant event was pregnancy or childbirth. Ingram (1961) conducted a similar study of 89

Etiological theories

To date, the literature has largely endorsed a biological etiology of postpartum OCD. Guided by the well-known “serotonin hypothesis” (Barr, Goodman, & Price, 1993), authors have generally implicated a dysregulation of the serotonin system in the generation of obsessional thoughts and compulsive behavior. In particular, there is some evidence to suggest that fluctuations in estrogen and progesterone levels (as observed in late pregnancy) may alter serotonergic transmission, reuptake, and

Treatment

Research over the last 30 years suggests that two forms of treatment are effective for OCD: (a) pharmacotherapy by serotonin reuptake inhibitor medication (SRIs), and (b) cognitive-behavioral psychotherapy using the procedures of exposure and response prevention (Abramowitz, 1997). SRI pharmacotherapy, the most widely used therapy for OCD, typically results in a 20–40% reduction in symptoms. Two studies on postpartum OCD described use of this treatment. Buttolph and Holland (1990), in their

Future directions

To date, only a small number of retrospective studies have focused on the interesting phenomenon of puerperal OCD. Although it appears that some women (and perhaps their partners) experience a rapid onset of obsessive-compulsive symptoms during or immediately following pregnancy, the existing research cannot answer important questions related to the prevalence, course, or etiology of this problem. Because OCD poses a potential threat to parent and child well being, prospective investigations

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      Our results about OCS onset and comorbidity are in line with other studies that suggest that pregnancy may trigger or exacerbate OCS (Abramowitz et al., 2003; McGuinness et al., 2011), which are closely related to anxiety and depression during the same period (Collardeau et al., 2019; Speisman et al., 2011). Together with other studies (eg.: McGuinness et al., 2011; Abramowitz et al., 2003), our results raise the question of whether perinatal OCD represents a discrete subgroup of OCD. There is now growing acceptance that OCD is a clinically heterogeneous condition with wide variation in the specific content of obsessions and compulsions (Abramowitz, McKay, & Taylor, 2005; McGuinness et al., 2011).

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