General postpartum mood disorders, specifically depression
and anxiety, have been well studied in the literature. However,
there is limited data regarding the identification, diagnosis,
and management of postpartum obsessive compulsive disorder
(ppOCD). Women with this diagnosis are frequently undiagnosed
or misdiagnosed and, regretfully, suffer with their
symptomatology. The purpose of this review is to educate
the clinician on the prevalence and signs and symptoms of
ppOCD, and to offer recommendations regarding the pharmacologic
and psychotherapeutic management of this disorder.
Postpartum OCD is thought to occur in approximately 1-5%
of all postpartum mothers. Pregnant and postpartum women
are more likely to experience OCD compared to the general
population. Risk factors include a personal history of
anxiety disorders and/or OCD, personal history of depression
(El-Mallakh or a family history of anxiety or depression.
The onset of symptoms may occur rapidly, within a week of
delivery. Interestingly, the focus of the obsessions and compulsions
are similar between mothers. Aggressive obsessive
thoughts involving the baby are significantly more common in
groups of women with postpartum depression. Due to
the disturbing obsessive thoughts that mothers have, many
fear telling their physician or families for concern that their
child will be taken from them, resulting in non-identification
and non-treatment of their disorder.
As part of a routine postpartum follow up exam, the Edinburgh
Postnatal Depression Scale (EPDS) is recommended for
evaluating women for postpartum depression. This scale includes
10 questions which are completed by the patient and
scored by the provider. Within this scale, some questions (#4-
6) focus on anxiety symptoms. If and when women have elevated
scores on this section, it is worthwhile to further investigate
for anxiety disorders, including ppOCD. Although there
is no specific screening tool for ppOCD, the Florida Obsessive
Compulsive Index (FOCI) is one example of a screening tool
that can be given to the postpartum patient for completion.
Scores of 8 or higher on this scale are highly suggestive of OCD.
For providers that may not have access to the EPDS or FOCI,
simply asking the woman if she finds herself having repetitive
thoughts or avoiding certain things or behaviors may give the
clinician additional information and evidence for a diagnosis
of ppOCD. This should lead the clinician to further investigate
the symptoms and determine whether they need additional
evaluation by the clinician or referral to a psychiatrist.
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