What is an Obsessive-Compulsive Disorder?

Obsessive-Compulsive Disorders are characterized by obsessive thoughts and compulsive behaviours which women usually find intensely distressing.

How often do women experience Obsessive-Compulsive Disorder during pregnancy and the postpartum period?

There appears to be a slightly higher risk of Obsessive-Compulsive Disorder occurring during pregnancy and the postpartum period but the risk is still low for the majority of women. Obsessive-Compulsive Disorder occurs in approximately 2% of pregnant women, and 2.4% of women in the postpartum period. This compares to approximately 1% of women who experience OCD in the general population.

Obsessive-Compulsive Disorder commonly occurs together with Major Depressive Disorder and with other Anxiety Disorders.

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

Obsessions: are recurrent intrusive thoughts, impulses or images

• Obsessions may seem inappropriate or may not make sense.
• Obsessions are not simply excessive worries about real-life problems.
• The woman recognizes that the obsessions are a product of her own mind.
• The woman attempts to ignore or suppress the obsessions, or tries to neutralize them with some other thoughts or actions.
• Common themes in pregnancy and the post-partum period include obsessional fears or images of harming the baby.

Compulsions: are repetitive behaviours or mental acts

• Compulsions may take the form of rituals with rigid rules, for example repeating acts a specific number of times, or in a specific order or manner.
• The woman is driven to perform these repetitive behaviours or acts in order to lessen the anxiety, discomfort, or disgust that results from the obsessions.
• Examples include:
  • washing/cleaning in response to concerns of contamination or germs
  • avoiding objects of aggression to decrease anxiety from intrusive violent images
  • repeatedly checking baby due to fear that something bad will happen
  • minimizing interactions with her baby for fears she may harm him/her

The obsessions and compulsions cause marked distress, can be extremely time-consuming, and interfere with the woman’s normal routine, work, and interpersonal relationships.

What are the risk factors for Obsessive-Compulsive Disorders?

Women are at greater risk of experiencing Obsessive-Compulsive Disorders during pregnancy or after the birth of the baby if they have a:

• previous history of Obsessive-Compulsive Disorder prior to pregnancy
• family history of an Obsessive-Compulsive Disorder

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

• Treatment can help decrease symptoms and decrease distress from the disorder.
• Untreated Obsessive-Compulsive Disorders may negatively affect the mother-child relationship; treatment may help mothers normalize fears, increase interactions with her baby, and promote bonding.
• Untreated Obsessive-Compulsive Disorders may decrease a woman’s ability to cope; treatment increases coping skills during the pregnancy and the postpartum period.
• Untreated Obsessive-Compulsive Disorder in pregnancy leads to a higher risk of developing Postpartum Depression.

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

Education:

• Helping women understand more about the disorder.
• Teaching coping strategies and how to build social networks and supports.
• Helping partners, friends, and family to support the woman.

Supportive Psychotherapy:

• Providing support, reassurance and education in helping the woman cope with OCD.

Cognitive Behaviour Therapy (CBT):

• Is based on the theory that thoughts, feelings, and behaviours are linked and therefore changing negative thought patterns or behaviours can result in emotional improvement. 
• Cognitive therapy is used to identify and challenge the woman's obsessions.
• Behaviour therapy is used to overcome compulsions.

Medications:

Antidepressants are often used which help to decrease obsessions. The most common type of antidepressant used is a Selective Serotonin Reuptake Inhibitor (SSRI).

Generally, SSRIs are considered safe in pregnancy and fore breastfeeding:

• There does not appear to be an increased risk to the developing fetus during pregnancy.
• There is no evidence of difficulties with IQ, behaviour, or development in childhood.
• There may be mild withdrawal symptoms in the baby after birth (difficulty feeding or sleeping, harder to soothe, jittery) but these usually resolve without the need for treatment.
• One study found an increased association with third trimester SSRI use and breathing difficulty in the baby. However, subsequent studies have not found any association and, even if a risk does exist, it is quite low (less than 1% risk).
• SSRIs are present in small amounts of breast milk. They have no or very minimal adverse effects on the baby.
• Early benefits of treatment with medication can be seen within a few days, but often several weeks are needed to see the full effect of SSRIs.
• In general, your doctor will prescribe medications at the lowest dose that is most effective to deal with symptoms.
• Medications are often recommended in combination with supportive psychotherapy or Cognitive Behavioural Therapy as this may have a better effect than each of the treatments alone.

There is more information available on Obsessive-Compulsive Disorders in the guide Coping with Anxiety During Pregnancy and After the Birth in the Resources Section.