Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-27T15:54:24.536Z Has data issue: false hasContentIssue false

OCD in the Perinatal Period: Is Postpartum OCD (ppOCD) a Distinct Subtype? A Review of the Literature

Published online by Cambridge University Press:  05 January 2011

Mary McGuinness*
Affiliation:
University of Birmingham, and Birmingham and Solihull Mental Health Foundation Trust, UK
Jackie Blissett
Affiliation:
School of Psychology, University of Birmingham, UK
Chris Jones
Affiliation:
School of Psychology, University of Birmingham, UK
*
Reprint requests to Mary McGuinness, BSMHFT - Perinatal Mental Health Service, Chamomile Suite, The Barberry, 25 Vincent Drive, Edgbaston, Birmingham B15 2SG, UK. E-mail: mary.mcguinness@bsmhft.nhs.uk

Abstract

Background: It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation of OCD and that postpartum OCD (ppOCD) presents a distinct clinical picture. This raises the possibility that ppOCD might be a distinct subtype of OCD. This review examines this contention. Method: A search using Ovid (Medline, PsycINFO and Embase), EBSCO, Cochrane Library, Web of Science (ISI), Pubmed databases and Google Scholar was carried out using the key words: “obsessive compulsive disorder” (and derivatives), “perinatal”, “pregnancy”, “postnatal”, “postpartum”, “mothers” (and derivatives), “anxiety disorders” and “subtypes.” These articles and their references were reviewed. Results: The majority of studies reviewed were retrospective, which makes it impossible to infer causality. Two prospective studies found a higher incidence of OCD in the postpartum period. These were carried out in Turkey and Brazil and, as such, may be limited in their applicability to other cultural groups. Conclusion: The concept of ppOCD as a specific subtype has not been robustly demonstrated. The evidence that OCD is more prevalent in the postpartum period is mixed. The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling. In view of the impact of culture and religion on the expression of OCD, collaborative, international, prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.

Type
Research Article
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramowitz, J. S. and Fairbrother, N. (2008). Postpartum obsessive compulsive disorder. In Abramowitz, J., McKay, D. and Taylor, S. (Eds.), Clinical Handbook of Obsessive Compulsive Disorder and Related Problems (pp. 139155). Baltimore, MD: John Hopkins Press.Google Scholar
Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J. and Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behaviour Research and Therapy, 44, 13611374.CrossRefGoogle ScholarPubMed
Abramowitz, J. S., McKay, D. and Taylor, S. (2005). Special series: subtypes of obsessive compulsive disorder. Introduction. Behaviour Therapy, 36, 367369.CrossRefGoogle Scholar
Abramowitz, J. S., Nelson, C., Rygwall, R. and Khandker, M. (2007). The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. Journal of Anxiety Disorders, 21, 91104.CrossRefGoogle ScholarPubMed
Abramowitz, J. S., Schwartz, S. A. and Moore, K. M. (2003a). Obsessional thoughts in postpartum females and their partners: content, severity and relationship with depression. Journal of Clinical Psychology in Medical Settings, 10, 157164.CrossRefGoogle Scholar
Abramowitz, J. S., Schwartz, S., Moore, K. and Luenzmann, K. (2003b). Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. Journal of Anxiety Disorders, 17, 461478.CrossRefGoogle ScholarPubMed
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders 4th ed., (text revision). Washington, DC: American Psychiatric Association.Google Scholar
Andersson, L., Sundström-Poromaa, I., Bixo, M., Wulff, M., Bondestam, K. and Åström, M. (2003). Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. American Journal of Obstetrics and Gynecology, 189, 148154.CrossRefGoogle ScholarPubMed
Arnold, L. M. (1999). A case series of women with postpartum-onset obsessive-compulsive disorder. Primary Care Companion to the Journal of Clinical Psychiatry, 1, 103108.Google ScholarPubMed
Belloch, A., Del Valle, G., Morillo, C., Carrio, C. and Cabedo, E. (2009). To seek advice or not seek advice about the problem: the help seeking dilemma for obsessive-compulsive disorder. Social Psychiatry and Psychiatric Epidemiology, 44, 257264.CrossRefGoogle ScholarPubMed
Bhagwanani, S. G., Seagraves, K., Dierker, L. J. and Lax, M. (1997) Relationship between prenatal anxiety and perinatal outcome in nulliparous women: a prospective study. Journal of the National Medical Association, 89, 9398.Google ScholarPubMed
Blashfield, R. K. and Livesley, W. J. (1999). Classification. In Millon, T., Blaney, P.H. and Davies, R.D. (Eds.), Oxford Textbook of Psychopathology (pp. 328). New York: Oxford University Press.Google Scholar
Brandt, K. R. and Mackenzie, T. B. (1987). Obsessive-compulsive disorder exacerbated during pregnancy: a case report. International Journal of Psychiatry in Medicine, 17, 361366.CrossRefGoogle ScholarPubMed
Buttolph, M. L. and Holland, A. D. (1990). Obsessive compulsive disorders in pregnancy and childbirth. In Jenicke, M., Baer, L. and Minichiello, W. E. (Eds.), Obsessive Compulsive Disorders: theory and management (pp. 8997). Chicago: Year Book Medical.Google Scholar
Chelmow, D. and Halfin, V. P. (1997). Pregnancy complicated by obsessive compulsive disorder. The Journal of Maternal Fetal Medicine, 6, 3134.Google ScholarPubMed
Christian, L. M. and Storch, E. A. (2009). Cognitive behavioral treatment of postpartum onset obsessive compulsive disorder with aggressive obsessions. Clinical Case Studies, 8, 7283.CrossRefGoogle Scholar
Cilli, A. S., Telcioglu, M., Askin, R., Kaya, N., Bodur, S. and Kucur, R. (2004). Twelve month prevalence rate of obsessive compulsive disorder in Koya, Turkey. Comprehensive Psychiatry, 45, 367374.CrossRefGoogle Scholar
Cooper, C., Jones, L., Dunn, E., Forty, L, Haque, S., Oyebode, F., Craddock, N. and Jones, I. (2007). Clinical presentation of postnatal and non-postnatal depressive episodes. Psychological Medicine, 37, 12731280.CrossRefGoogle ScholarPubMed
Crino, R., Slade, T. and Andrews, G. (2005). The changing prevalence and severity of obsessive compulsive disorder criteria from DSM-III to DSM-IV. American Journal of Psychiatry, 162, 876882.CrossRefGoogle ScholarPubMed
Dennis, C. L. (2004). Treatment of postpartum depression, Part 2: a critical review of non-biological interventions. Journal of Clinical Psychiatry, 65, 12521265.CrossRefGoogle Scholar
Dennis, C. L. and Stewart, D. E. (2004). Treatment of postpartum depression, Part 1: a critical review of biological interventions. Journal of Clinical Psychiatry, 65, 12421251.CrossRefGoogle ScholarPubMed
Diaz, S. F., Grush, L. R., Sichel, D. A. and Cohen, L. S. (1997). In Dicstein, L.J., Riba, M. B. and Oldham, J. M. (Eds.). Review of Psychiatry 16, 97112. Washington, DC: American Psychiatric Press.Google Scholar
Fairbrother, N. and Abramowitz, J. S. (2007). New parenthood as a risk factor for the development of obsessional problems. Behaviour Research and Therapy, 45, 21552163.CrossRefGoogle ScholarPubMed
Fairbrother, N. and Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women's Mental Health, 11, 221229.CrossRefGoogle ScholarPubMed
Fireman, B., Koran, L. M., Leventhal, J. L. and Jacobson, A. (2001). The prevalence of clinically recognised obsessive-compulsive disorder in a large health maintenance organisation. American Journal of Psychiatry, 158, 19041910.CrossRefGoogle Scholar
Fontenelle, L. F. and Hasler, G. (2008). The analytical epidemiology of obsessive compulsive disorder: risk factors and correlates. Progress in Neuropsychopharmocology and Biological Psychiatry, 32, 115.CrossRefGoogle ScholarPubMed
Fontenelle, L. F., Mendlowicz, M. V. and Versiana, M. (2006). The descriptive epidemiology of obsessive compulsive disorder. Progress in Neuropsychopharmocology and Biological Psychiatry, 30, 327337.CrossRefGoogle ScholarPubMed
Fridell, M. and Hesse, M. (2006). Clinical diagnosis and SCID-II assessment of DSM–III-R personality disorders. European Journal of Psychological Assessment, 22, 104108.CrossRefGoogle Scholar
Geller, P., Klier, C. and Neugebauer, R. (2002) Anxiety disorders following miscarriage. Journal of Clinical Psychiatry: 62, 432438.CrossRefGoogle Scholar
Horwath, E. and Weissman, M. M. (2000). The epidemiology and cross national presentation of obsessive-compulsive disorder. Psychiatric Clinics of North America, 23, 493507.CrossRefGoogle ScholarPubMed
Iancu, I., Lepkifker, E., Dannon, P. and Kotler, M. (1995). Obsessive compulsive disorder limited to pregnancy. Psychotherapy and Psychosomatics, 64, 109112.CrossRefGoogle ScholarPubMed
Ingram, I. M. (1961). Obsessional illness in mental hospital patients. Journal of Mental Science, 107, 382402.CrossRefGoogle ScholarPubMed
Jennings, K. D., Ross, S., Popper, S. and Elmore, M. (1999). Thoughts of harming infants in depressed and non-depressed mothers. Journal of Affective Disorders, 54, 2128.CrossRefGoogle Scholar
Julien, D., O'Connor, K. P. and Aardema, F. (2009). Intrusions related to obsessive-compulsive disorder: a question of content or context? Journal of Clinical Psychology, 65, 709722.CrossRefGoogle ScholarPubMed
Kalra, H., Tandon, R., Trivedi, J. K. and Janca, A. (2005). Pregnancy induced obsessive compulsive disorder: a case report. Annals of General Psychiatry, 4, 1214.CrossRefGoogle ScholarPubMed
Karadag, F., Oguzhanoglu, N. K., Ozdel, O., Atesci, F. C. and Amuk, T. (2006). OCD symptoms in a sample of Turkish patients: a phenomenological picture. Depression and Anxiety, 23, 145152.CrossRefGoogle Scholar
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593602.CrossRefGoogle ScholarPubMed
Kessler, R. C., Chiu, W. T., Delmer, O. and Walters, M. S. (2005). Prevalence, severity and comorbidity of 12 month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 618709.Google ScholarPubMed
Labad, J., Alonso, P., Segalas, C., Real, E., Jimenez, S., Bueno, B., Vallejo, J. and Menchon, J. M. (2010). Distinct correlates of hoarding and cleaning symptom dimensions in relations to onset of obsessive compulsive disorder at menarche or the perinatal period. Archives of Women's Mental Health, 13, 7581.CrossRefGoogle ScholarPubMed
Labad, J., Menchón, J. M., Alonso, P., Segalas, C., Jimenez, S. and Vallejo, J. (2005). Female reproductive cycle and obsessive-compulsive disorder. Journal of Clinical Psychiatry, 66, 428435.CrossRefGoogle ScholarPubMed
Larsen, K., Schwartz, S. A., Whiteside, S. P., Khandker, M., Moore, K. M. and Abramowitz, J. S. (2006). Thought control strategies used by parents reporting postpartum obsessions. Journal of Cognitive Psychotherapy, 20, 435445.CrossRefGoogle Scholar
Leckman, D., Mayes, L. C., Feldman, R., Evans, D. W. and Cohen, D. J. (1999). Early parental preoccupations and behaviours and their possible relationship to the symptoms of obsessive-compulsive disorder. Acta Psychiatrica Scandinavia, 100, 126.CrossRefGoogle Scholar
Lee, H. J., Lee, S. H, Kim, H. S., Kwon, S. M. and Telch, M. J. (2005). A comparison of autogenous/reactive obsessions and worry in a nonclinical population: a test of the continuum hypothesis. Behaviour Research and Therapy, 43, 9991010.CrossRefGoogle Scholar
Levine, R. E., Oandasan, A. P., Primeau, L. A. and Berenson, A. B. (2003). Anxiety disorders during pregnancy and postpartum. American Journal of Perinatology. 20, 239248.CrossRefGoogle ScholarPubMed
Lo, W. H. (1967). A follow-up study of obsessional neurotics in Hong Kong Chinese. British Journal of Psychiatry, 113, 823832.CrossRefGoogle ScholarPubMed
Maina, G., Albert, U., Bogetto, F. and Vaschetto, L. R. (1999). Recent life events and obsessive-compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Research, 89, 4958.CrossRefGoogle ScholarPubMed
National Institute of Clinical Excellence (2007). Antenatal and Postnatal Mental Health: the NICE clinical, management and service guidance. London: National Collaborating Centre for Mental Health.Google Scholar
Nestadt, G., Samuel, J., Riddle, M., Bienvenu, O. J. III, Liang, K. Y., Labuda, M., Walkup, J., Grados, M. D. and Hoehn-Saric, R. (2000). A family study of obsessive compulsive disorder. Archives of General Psychiatry, 57, 358363.CrossRefGoogle ScholarPubMed
Neziroglu, F., Anemone, R. and Yaryura-Tobia, J. (1992). Onset of obsessive-compulsive disorder in pregnancy. American Journal of Psychiatry, 149, 947950.Google ScholarPubMed
O'Connor, T. G., Heron, J., Golding, J., Beveridge, M. and Glover, V. (2002). Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. British Journal of Psychiatry, 180, 502508.CrossRefGoogle ScholarPubMed
Pollitt, J. (1957). Natural history of obsessional states: a study of 150 cases. British Medical Journal, 32, 194198.CrossRefGoogle Scholar
Purdon, C. and Clark, D. A. (1993). Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31, 713720.CrossRefGoogle ScholarPubMed
Rachman, S. J. (2003). The Treatment of Obsessions. Oxford: Oxford University Press.CrossRefGoogle Scholar
Rachman, S. and De Silva, P. (1978). Abnormal and normal obsessions, Behaviour Research and Therapy, 16, 233248.CrossRefGoogle ScholarPubMed
Rasmussen, S. A. and Eisen, J. I. (1989). Clinical features and phenomenology of obsessive compulsive disorder. American Journal of Psychiatry, 143, 317322.Google Scholar
Rasmussen, S. A. and Eisen, J. I. (2002). The course and clinical features of obsessive compulsive disorder. In Davis, K. L., Charney, D., Coyle, J. T. and Nemeroff, C. (Eds.), Psychopharmacology: a fifth generation of progress. Philadelphia: Williams and Williams.Google Scholar
Rassin, E., Cougle, R. J. and Muris, P. (2007), Content difference between normal and abnormal obsessions. Behaviour Research and Therapy, 45, 28002803.CrossRefGoogle ScholarPubMed
Rassin, E. and Muris, P. (2006). Abnormal and normal obsessions: a reconsideration. Behaviour Research and Therapy, 45, 10651070.CrossRefGoogle ScholarPubMed
Robins, E. R. and Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: it's application to schizophrenia. The American Journal of Psychiatry, 126, 983987.CrossRefGoogle Scholar
Rojansky, N., Brzezinski, A. and Schenker, J. G. (1992). Seasonality in human reproduction: an update. Human Reproduction, 7, 735745.CrossRefGoogle ScholarPubMed
Ross, L. E. and McLean, L. M. (2006). Anxiety disorders during pregnancy and the post partum period: a systematic review. Journal of Clinical Psychiatry, 67, 12851298.CrossRefGoogle ScholarPubMed
Rowa, K., Purdon, C., Summerfeldt, L. J. and Antony, M. M. (2005). Why are some obsessions more upsetting than others? Behaviour, Research and Therapy, 43, 14531465.CrossRefGoogle ScholarPubMed
Ruscio, A. M., Stein, D. J., Chiu, W. T. and Kessler, R. C. (2008). The epidemiology of obsessive compulsive disorder in the national comorbidity survey replication. Molecular Psychiatry: advance online publication 26 August 2008; doi: 10.1038/mp.2008.94CrossRefGoogle Scholar
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29S52.CrossRefGoogle ScholarPubMed
Sasson, Y., Zohar, J., Chopra, M., Lustig, M., Iancu, I. and Hendler, T. (1997). Epidemiology of world obsessive compulsive disorder: a view. Journal of Clinical Psychiatry, 58, (Suppl 12), 710.Google Scholar
Sichel, D. A., Cohen, L. S., Dimmock, J. A. and Rosenbaum, J. F. (1993a). Postpartum obsessive-compulsive disorder: a case series. Journal of Clinical Psychiatry, 54, 156159.Google ScholarPubMed
Sichel, D. A., Cohen, L. S., Rosenbaum, J. F. and Driscoll, J. D. (1993b). Postpartum onset of obsessive-compulsive disorder. Psychosomatics, 34, 277279.CrossRefGoogle ScholarPubMed
Sutter-Dallay, A. L., Giaconne-Marcesche, V., Glatigny-Dallay, E. and Verdoux, H. (2004). Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. European Psychiatry, 19, 459463.CrossRefGoogle ScholarPubMed
Taylor, S. (2005). Dimensional and subtype models of OCD. In Abramowitz, J. S. and Houts, A. C., (Eds.), (Concepts and Controversies in Obsessive-Compulsive Disorder (pp. 2741). New York: Springer.CrossRefGoogle Scholar
Teixeira, J. M. A., Fisk, N. M. and Glover, V. (1999). Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. British Medical Journal, 318, 153157.CrossRefGoogle ScholarPubMed
Uguz, F., Akman, C., Kaya, N. and Cilli, A. S. (2007). Postpartum-onset obsessive compulsive disorder: incidence, clinical features and related factors. Journal of Clinical Psychiatry, 68, 132138.CrossRefGoogle ScholarPubMed
Uguz, F., Gezginc, K., Zeytinci, I. E., Karatayli, S., Askin, R., Guler, O., Sahin, F. K., Emul, M., Ozbulut, O. and Gecici, O. (2007a). Course of obsessive-compulsive disorder during early postpartum period: a prospective analysis of 16 cases. Comprehensive Psychiatry, 48, 558561.CrossRefGoogle Scholar
Uguz, F., Gezginc, K., Zeytinci, I. E., Karatayli, S., Askin, R., Guler, O., Sahin, F. K., Emul, M., Ozbulut, O. and Gecici, O. (2007b). Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Comprehensive Psychiatry, 48, 441445.CrossRefGoogle ScholarPubMed
Uguz, F., Kaya, N., Sahingoz, M. and Cilli, A. S. (2008). One year follow-up of postpartum onset obsessive compulsive disorder: a case series. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 32, 10911092.CrossRefGoogle ScholarPubMed
Weissman, M. M., Prusoff, B. A., Thompson, D. W., Harding, P. S. and Myers, J. K. (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients, Journal of Nervous and Mental Disorders, 16, 317326.CrossRefGoogle Scholar
Wenzel, A., Gorman, L. L., O'Hara, M. W. and Stuart, S. (2001). The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: a prospective study. Archives of Women's Mental Health, 4, 512.CrossRefGoogle Scholar
Wenzel, A., Haugen, E. N., Jackson, L. C. and Brendle, J. R. (2005). Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders, 19, 295311.CrossRefGoogle ScholarPubMed
Woodward, K. (1997). Motherhood identities, meanings and myths. In Woodward, K. (Ed.), Identity and Difference (pp 239298). London: SAGE.Google Scholar
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioral Disorders: diagnostic criteria for research. Geneva: World Health Organization.Google Scholar
Williams, K. and Koran, L. (1997). Obsessive-compulsive disorder in pregnancy, the puerperium and the premenstrual. Journal of Clinical Psychiatry, 58, 330334.CrossRefGoogle Scholar
Wisner, K. L., Peindl, K. S., Gigliotti, T. and Hanusa, B. H. (1999). Obsessions and compulsions in women with postpartum depression. Journal of Clinical Psychiatry, 60, 176180.CrossRefGoogle ScholarPubMed
Zar, M., Wijma, K. and Wijma, B. (2002). Relations between anxiety disorders and fear of childbirth during late pregnancy. Clinical Psychology and Psychotherapy, 9, 122130.CrossRefGoogle Scholar
Zambaldi, C. F., Cantilino, A., Montenegro, A. C., Paes, J. A., de Aluquerque, T. L. C. and Sougey, A. B. (2009). Postpartum obsessive compulsive disorder: prevalence and clinical characteristics. Comprehensive Psychiatry, 50, 503509.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.