Treating Postpartum Obsessive-Compulsive Disorder

It is not uncommon for mothers to experience an array of emotions following the arrival of a new baby. The postpartum period has long been known to be a time of increased risk for the appearance, worsening or recurrence of mood and anxiety disorders. Many studies have suggested that the postpartum period may also present a risk for the onset or worsening of obsessive-compulsive disorder (OCD).

Symptoms

Postpartum symptoms of OCD are most likely to occur within six weeks after childbirth but can begin during the pregnancy. In women who have preexisting OCD, there is some evidence that miscarriage can also act as a potent trigger of OCD symptoms.

The symptoms of OCD in women who have postpartum obsessive-compulsive disorder can often be distinguished from those who already had obsessive-compulsive disorder. A recent study showed that the biggest difference between the two is that with postpartum OCD, the obsessions are mostly related to the baby in some way. Specifically, women with postpartum obsessive-compulsive disorder often report more aggressive obsessions related to harming their new baby than women who already had OCD. As well, women with postpartum obsessive-compulsive disorder more frequently experience obsessions related to contamination of the baby than women without postpartum-onset OCD. 

Causes

At this stage, it is unclear why the postpartum period is a time of increased risk for the onset of OCD for some women. From a biological perspective, it has been speculated that profound changes in hormones such as estrogen may be partly responsible. Hormones can disrupt the activity of neurotransmitters in the brain, including serotonin. Disruptions of the serotonin system have been heavily implicated in the development of OCD.

From a psychosocial perspective, the arrival of a new baby presents a number of new challenges, which can be overwhelming for some women.

Treatment

Like postpartum depression, it is essential to treat postpartum obsessive-compulsive disorder as it can affect normal bonding between a mother and her baby. It can also cause substantial suffering and pain on the part of the mother and family members. If you have recently given birth and you are experiencing new psychological symptoms such as intrusive and disturbing thoughts or compulsive behaviors such as uncontrolled hand-washing, be sure to mention this to your primary care physician, obstetrician, pediatrician or psychiatrist.

If you are experiencing these or other symptoms, your doctor will likely do a full assessment that includes a full psychiatric history, as well as medical tests to rule out biological causes for your symptoms such as hypothyroidism.

Cognitive-behavioral therapy (CBT) may be a good option for women with ​postpartum obsessive-compulsive disorder as it eliminates the possibility of exposing the newborn to antidepressants such as selective serotonin reuptake inhibitors (SSRIs). Although antidepressants like SSRIs are transferred through breast milk, there is no data on the long-term effects of exposure to SSRIs in breast milk, including the nervous system, so the benefit of taking the medication needs to outweigh the risk. Be sure to speak with your doctor to determine which treatment option is right for you.