Obsessive-Compulsive Disorder in the Perinatal Period

Terri Buysse

Obsessive-Compulsive Disorder is an anxiety disorder that often worsens or comes on rapidly during the perinatal period. It is found in 2 to 3% of the general population but at a much higher rate in the perinatal population. According to Chaudron et al., 29% of participants in their study had sufficient symptomatology for a diagnosis of postpartum (pp)OCD. It has not been determined whether ppOCD is a specific subtype of OCD, but clinical evidence suggests that is does present a distinctive clinical picture (McGuinness, 2011). Current research supports the idea that OCD symptoms worsen or present rapid onset during the perinatal period. In one study with 58 female subjects, 3.5% of women in the third trimester met criteria for OCD. Two of these women met criteria in the second trimester. The most common obsessions in descending order were contamination and symmetry/exactness and the most common compulsions were cleaning/washing and checking behaviors (MGH Center for Women’s Health, 2009). Vasconcelos et al. found that risk factors predicting ppOCD from pregnancy included prolonged labor and edema.
Clinicians and researchers are finding links between the female reproductive cycle and the initiation or exacerbation of symptom severity in OCD (MGH Center for Women’s Health, 2009). Of 46 subjects sampled, 22% had an onset of OCD symptoms the same year as the initiation of menarche, 2% had an onset of symptoms at pregnancy, 7% at postpartum, and 2% at menopause. Authors of this study hypothesize that the onset or worsening of symptoms present during the particularly vulnerable times of hormonal fluctuations including the premenstrual phase of the menstrual cycle and the perinatal period. They suggest increased monitoring of women during these vulnerable times when hormones are fluctuating.
OCD symptoms are correlated in 40 to 50% of women with postpartum-onset depression. The predominant symptom in this subgroup of women is intrusive harm-related obsessional thoughts inconsistent with a woman’s identity and belief system. Women with OCD, particularly in the perinatal period, often experience shame that keeps them from treatment and symptom relief. They often fail to share their symptoms with providers even when asked, unless symptoms are normalized and fears addressed and quelled (MGH Center for Women’s Health, 2009).
The Perinatal Obsessive Compulsive Scale (POCS) has been developed and validated to help clinicians detect perinatal OCD (Lord, 2011). This scale can also be used to facilitate conversations about this sensitive topic.

Chaudron, L., & Nirodi, N. (October 2010) Archives of Women’s Mental Health, 13: 403-410.
MGH Center for Women’s Health, (June 2009) Psychiatric Disorders During Pregnancy
McGuinness, M., Blissett, J., Jone, C., (January 2011) OCD in the perinatal period: Is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behavioral Cognitive Psychotherapy.
Vasconcelos, M.S., Sampaio, A.S. Hounie, A.G., et al. (February 2007) Prenatal, Perinatal and Postnatal Risk Factors in Obsessive-Compulsive Disorder. Biological Psychiatry. 3: 301-307.
Lord, C., Rieder, A. Hall, G.B.C., Soares, C.N.& Steiner, M. (December 2011) Piloting the Perinatal Obsessive-Compulsive Scale (POCS). Journal of Anxiety Disorders, 8: 1079-1084.