Recent studies have shown that pregnancy and childbirth are frequently associated with the onset of Obsessive Compulsive Disorder (OCD).  While most women do not have the full set of symptoms to meet diagnostic criteria for OCD, many are bothered by obsessive-compulsive symptoms.

In their two studies, Miller and colleagues aimed to shed light on postpartum depression and anxiety, with and without obsessions.   A prospective cohort study of 461 women was performed to examine the phenomenology and the most common obsessive and compulsive symptoms present in postpartum women without a diagnosis of obsessive compulsive disorder (OCD). Of the 461 women included, 11.2% screened positive for OCD at 2 weeks postpartum, while 37.5% reported subclinical obsessions or compulsions. At 2 and at 6 weeks, among the women who screened negative for OCD, the most commonly reported obsessions were aggression and contamination, and the most common compulsions were cleaning/washing and checking. Women with compulsions and those with aggressive, religious and somatic obsessions or obsessions with symmetry were more likely to meet criteria for OCD .

Miller and colleagues’ data also showed that women with subclinical obsessions or compulsions were much more likely to be experiencing depression, as nearly 25% of these women also screened positive for depression.

In a secondary analysis of their prospective cohort study, Miller and colleagues examined the clinical course of postpartum anxiety and confirmed the clinical overlap between postpartum anxiety and depression. A large number of women with postpartum depression had anxiety symptoms and obsessive-compulsive symptoms in the immediate postpartum period. At 2 weeks postpartum, 19.9% of the women with depression were more likely to experience comorbid state-trait anxiety, compared to 1.3% in the women who screened negative for depression. At both 2 and 6 weeks postpartum, women with depression were more likely to report obsessions and compulsions than women without depression. While state-trait anxiety symptoms tended to resolve with time, obsessive-compulsive symptoms persisted. By 6 months postpartum, there were no differences in anxiety symptoms in women with and without depression; however, the difference in obsessive-compulsive symptoms persisted (p=0.017). Thus, it appears that  many postpartum women experience severe distress, a finding which has important therapeutic implications for clinicians.

Despite studies which have demonstrated that maternal anxiety during pregnancy can negatively affect offspring neurodevelopment, little attention has been given to postpartum maternal anxiety. This may be because of the clinical overlap between depression and anxiety symptoms.  Routine postpartum screening generally includes the assessment of symptoms of depression but anxiety disorders are often not identified. Given the potential adverse effects of untreated mood and anxiety symptoms on both the mother and child, careful screening and early recognition of anxiety symptoms during the postpartum period is recommended.

Recruiting Women for a New Study at Massachusetts General Hospital

Investigators at Massachusetts General Hospital are conducting a research study examining the nature and frequency of obsessive-compulsive symptoms in women who have had a baby in the last six months. They will also examine related mood and anxiety symptoms, in order to develop an effective intervention for these symptoms. Feedback will be provided to participants about their individual symptom profile. Please follow this link to participate:

Have you had a baby within the last six months? Please complete this 20-minute long questionnaire:

Link:  https://limesurvey.partners.org/limesurvey/index.php/463814?lang=en

Lavinia De Chiara, MD

Miller ES, Hoxha D, Wisner KL, Gossett DR.  Obsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder.  J Womens Health (Larchmt). 2015 Oct; 24(10):825-30.

Miller ES, Hoxha D, Wisner KL, Gossett DR.  The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms.  Arch Womens Ment Health. 2015 Jun;18(3):457-61.

More Information on OCD at tne OCD and Families website