A comprehensive guide to Perinatal OCD
Perinatal OCD is a form of OCD that occurs in women during pregnancy; it denotes the period between conception of pregnancy and 1 year after childbirth, and is usually characterized by the sufferer having irrational/intrusive thoughts, mental images and compulsions to do with harming the fetus or child.
Perinatal OCD affects at least 3.9% of women in the perinatal period, because studies show that Perinatal OCD affects about 1% of women during pregnancy, and 2.9% during the postnatal period (which is the first 6 weeks after childbirth).
This article seeks to provide useful information regarding Perinatal OCD, including its symptoms, treatment options, causes and more.
What causes Perinatal OCD?
According to “Key Topics in Perinatal Mental Health”, a book that was published very recently (March 15th, 2022) and contains contributions from various experts, the causes for Perinatal OCD are not yet fully understood.
As such, the current potential explanations to do with the causes of Perinatal OCD involves a mixture of different reasons, such as nature vs nurture (in other words, genetic as well as environmental factors) as well as estrogen, progesterone and oxytocin levels (these are all hormones that fluctuate in level during pregnancy). However, a recent study concluded that the evidence for any specific biological cause(s) is too limited to come to any conclusions at this time.
Another proposed idea is that Perinatal OCD could start developing as a result of a heightened feeling of being responsible for one’s child, combined with an increase in harm-centered ideas and thoughts.
A few other things that have been linked to Perinatal OCD are a lack of sleep and the baby having a low APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score 5 minutes after delivery, which is used to determine the health of newborns.
Examples of Perinatal OCD
- compulsively checking on your baby to make sure they are still breathing
- intrusive thoughts about harming your baby (either deliberately or accidentally)
- constantly asking for reassurance that you have not hurt your baby
- not wanting to drive in case you have an accident and hurt the baby
- thinking something might happen to the baby via contamination (e.g. from food)
- repeatedly checking whether you’ve properly sterilized the baby’s feeding bottle
How can Perinatal OCD be treated?
In a very recent study published in April 2022 on Perinatal OCD, it was outlined that the first-line treatment for Perinatal OCD is CBT (cognitive behavioral therapy) combined with the principles of ERP (exposure and response prevention).
The same study concludes that SSRI-category antidepressants can also be helpful, although the evidence is limited; however, some earlier studies say that SSRIs can be useful, for example, in treatment-resistant cases of OCD, especially in combination with antipsychotic medications.
A specific example of ERP being given to a patient with perinatal OCD (9 weeks after giving birth to her first child) is described in a 2020 study – the patient had anxious and obsessive thoughts about harming her baby; she was then given exposure (e.g. leaving the gas grill and the oven on for 5 minutes) followed by response prevention (the patient was told not to check whether she unknowingly placed her baby inside). For this particular patient, ERP turned out to be very effective, and eventually her obsessions stopped being serious enough for an OCD diagnosis.
What is the Dimensional Obsessive-Compulsive Scale (DOCS)?
The Dimensional Obsessive-Compulsive Scale (DOCS) is a questionnaire designed to assess the severity of OCD symptoms; it’s a self-report type of measure, which means that patients answer questions on their own (concerning their OCD symptoms) and the clinical psychologist (or psychiatrist) then interprets the results.
The DOCS consists of 20 items, each of which is rated on a scale of 0 to 4; the categories are “(a) Germs and Contamination; (b) Responsibility for Harm, Injury, or Mistakes; (c) Unacceptable Obsessional Thoughts; and (d) Symmetry, Completeness, and Ordering”.
Research from last year shows that this is a reasonably good screening test for determining Perinatal OCD symptoms, especially with the “Unacceptable Thoughts” subscale part of the test.
You can take a look at the test here.
Perinatal OCD during the COVID-19 pandemic
Several studies (such as this from 2021) have shown that since the COVID-19 pandemic began in 2020, there has been a significant increase in the prevalence of Perinatal OCD among pregnant women.
There are several reasons for this, such as the pandemic having created additional fears of contamination (and therefore the potential impact of infection on oneself and the fetus), as well as causing a lack of resources (or just anxiety about a potential lack of resources) for prenatal care.
For more reading material on this topic, you can check out this report on maternal mental health during the COVID-19 pandemic from the Maternal Mental Health Alliance (a charity based in London, UK).
How to help a family member or friend who suffers from Perinatal OCD
When someone you know or love is suffering from Perinatal OCD, the most important thing is to know how to support them without reinforcing their obsessions or compulsions.
It is important for you to suggest evidence-based treatment options and professional help, especially if their Perinatal OCD is severely distressing or debilitating.
In this sort of situation, it is therefore very helpful to first educate oneself about Perinatal OCD and seek to understand the condition better; to help you, the reader, we have added a few relevant reading materials below.
Talk to other people about Perinatal OCD
You can check out our community forum where you can talk to other people and share experiences about OCD, talk about treatments, and so on!
Read more about Perinatal OCD – a few helpful resources
- The International OCD Foundation’s (IOCDF) fact sheet on Perinatal/Postpartum OCD
- Free PDF resource on Perinatal OCD on the HSE’s (Health Service Executive – Ireland’s public healthcare system) website
- Perinatal Anxiety and Depression Aotearoa’s (PADA – a perinatal mental health charity in New Zealand) PDF pamphlet on Perinatal OCD
- About the Author
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Hello, I am Jonas Eriksson. I suffered from severe OCD for many years and have now recovered. My OCD is related to an autoimmune disorder called Autoimmune basal ganglia disorder. Sadly I was undiagnosed for 27 years. The inflammation put my brain to be in a state of constant terror. By sharing helpful information, I hope someone will get motivated to seek treatment and learn more about OCD and related disorders.