Opinion

Latimer: Postpartum obsessive thinking

Over the past few years public awareness has increased dramatically about the prevalence of postpartum depression.

We now understand the postpartum period is a time of great transition and chemical upheaval that puts new mothers at highly increased risk for the development of psychiatric symptoms.

Today, every woman receiving perinatal care in Canada is screened for symptoms of depression and the stigma surrounding it has lessened significantly.

Less attention is paid to other psychiatric conditions commonly triggered during the postpartum period —particularly anxiety disorders such as obsessive compulsive disorder (OCD).

A recent article in the American Journal of Psychiatry suggests postpartum OCD or obsessive-compulsive symptoms are more common than previously thought.

Obsessions are defined as ideas, thoughts, impulses or images that are intrusive and distressing to those experiencing them. In postpartum OCD, these are often thoughts or images of harming the infant. Postpartum obsessions are different from psychosis as the mother will recognize them as bizarre and distressing and understand that they are not rational.

She will have fears of harming her baby but no intention to do it. Women experiencing these symptoms are very unlikely to ever harm their babies.

Compulsions can manifest as active rituals such as excessive checking to ensure the baby has not been harmed or avoidance of feared situations. These are different from healthy maternal behaviours because they often interfere with the ability to care for the infant.

Symptoms like the above are quite common—one study found 87 per cent of women presenting to a perinatal mood disorders clinic had intrusive, obsessive-like thoughts with half of them being clinically significant.

Another study found 57 per cent of women with postpartum depression experienced obsessional thoughts about harming their babies and most had some related checking compulsions.

Treatment for postpartum OCD typically involves a combination of SSRI medication and cognitive-behaviour therapy. Therapy focuses on exposure to feared situations with response prevention.

Education about the nature of obsessive thoughts is also very helpful. Mothers experiencing these symptoms are usually very relieved to learn they are not at elevated risk of aggressive harm to their babies.

Although we are doing a much better job these days in recognizing, treating and supporting mothers experiencing postpartum depression, we should also be screening for symptoms of anxiety and obsessive thinking as they are also quite common during this period.

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