This week is OCD Awareness Week (#OCDweek), a worldwide event that serves to increase awareness of OCD.  Obsessive-compulsive disorder (OCD) and subthreshold obsessive–compulsive (OC) symptoms are common during pregnancy and the postpartum period, yet they are frequently under-recognized in routine obstetric and primary care settings. In non-perinatal populations, OCD most commonly presents with fears of contamination, catastrophic thoughts, or checking, symmetry, and ordering rituals.  

In the perinatal period, however, symptoms frequently center on the baby and may be especially distressing to parents. 

Many women with postpartum OCD, as well as those with other postpartum mood and anxiety disorders, experience intrusive, unwanted, and ego-dystonic thoughts of harming their infant, along with associated compulsive checking, mental rituals, or avoidance behaviors. These symptoms can cause substantial distress, interfere with maternal functioning and bonding, and are often not disclosed due to shame or fear of judgment. 

Because commonly used perinatal screening tools, such as the Edinburgh Postnatal Depression Scale (EPDS), do not ask directly about obsessions, compulsions, or intrusive thoughts, clinicians may miss clinically significant OC symptoms unless they use additional, targeted screening tools.

There are several validated instruments that can assist clinicians in identifying OCD and OC symptoms, both in the general population and specifically in perinatal women. Below, we summarize commonly used tools for assessing OCD in non-perinatal populations and then describe parallel perinatal-specific measures that can be incorporated into clinical practice.

Assessment of OCD in Non-Perinatal Populations

In the general (non-perinatal) population, the following tools are most commonly used to assess OCD symptoms and severity:

Yale-Brown Obsessive Compulsive Scale (Y-BOCS)

• Semistructured, clinician-rated interview that assesses severity of obsessions and compulsions (time, interference, distress, resistance, and control).
• Considered the gold standard for measuring OCD symptom severity and monitoring treatment response.
• Not typically used as a screening tool, given the time and training required to administer.
• Total scores range from 0 to 40; with scores indicating mild (8–15), moderate (16–23), severe (24–31), or extreme (32–40) symptoms.

Obsessive-Compulsive Inventory-Revised (OCI-R) and short forms (OCI-12, OCI-4)

• OCI-R is an 18-item self-report measure that assesses core OCD symptom dimensions, including washing, checking, neutralizing, obsessing, ordering, and hoarding.
• Brief, easy to score, and psychometrically robust
• The OCI-R and its shortened forms can be used as screening tools and for monitoring treatment response over time.

Dimensional Obsessive-Compulsive Scale (DOCS)

• A 20-item self-report measure that assesses four OCD symptom dimensions: contamination, responsibility for harm and mistakes, unacceptable thoughts, and symmetry/completeness.
• Used in both research and clinical settings as a dimensional measure of OCD symptoms.
• Can function as a practical screening tool and severity measure; scores can be followed over time to monitor response to treatment.
• The DOCS does not have established severity categories comparable to the Y-BOCS. In non-perinatal samples, scores in the low-to-mid teens may reflect elevated and clinically meaningful obsessive-compulsive symptoms, although empirically derived cutoffs vary by sample and study design.

Measures of Perinatal-Specific OCD Symptoms

Instruments such as the Y-BOCS, OCI-R, and DOCS have been used in pregnant and postpartum individuals and can certainly identify OCD symptoms in these populations. However, these general measures may be less sensitive to perinatal-specific concerns—particularly infant-focused intrusive thoughts and caregiving-related rituals—and may therefore underestimate the presence or clinical significance of OCD in perinatal women. 

To address this gap, perinatal-specific tools have been developed to capture the unique phenomenology of OCD during pregnancy and the postpartum period.

Parental Thoughts and Behaviors Checklist (PTBC)

• The most comprehensive measure of perinatal OCD symptoms.
• Semi-structured interview assesses the frequency, severity, resistance, and control over a wide array of obsessions and compulsions specific to the perinatal period.
• Structure and format were modeled after the Y-BOCS.
• Allows clinicians to rate overall severity and interference and to identify specific symptom targets for treatment.
• A self-report version of the PTBC has been developed and largely overlaps with the interview-based version. 
• Specific severity thresholds for screening or treatment response have not yet been firmly established. 

Perinatal Obsessive-Compulsive Scale (POCS)

• Self-report measure specifically designed to assess perinatal OCD symptoms.
• Checklist of 19 obsessions and 14 compulsions that are relevant to pregnancy and the postpartum period, as well as scales assessing severity and interference.
• Has demonstrated acceptable reliability and validity but has been less widely used.

Perinatal Anxiety Screening Scale (PASS)

• A 31-item, self-report instrument developed specifically to assess a broad range of perinatal anxiety symptoms, including generalized anxiety, panic, social anxiety, and OCD symptoms.
• Assesses obsessions, compulsions, and related avoidance, embedded within its broader anxiety domains.
• Typically scored by summing item responses to yield a total score, with a score of 21–41 indicating mild to moderate anxiety and 42 or higher severe anxiety.
• While not an OCD-specific instrument, PASS can serve as a perinatal-specific anxiety screen that is more sensitive to OCD and related anxiety conditions than depression-only scales like the EPDS.

Screening for OCD in Perinatal Populations

Screening tools are designed to identify individuals in a population who may have clinically significant symptoms and would benefit from a more thorough diagnostic evaluation. In perinatal mental health, the goal is to minimize missed cases of OCD and related conditions, even if this comes at the cost of some false positives.

Because the EPDS and Patient Health Questionnaire (PHQ) primarily assess depressive symptoms, they may fail to identify women whose predominant difficulties are anxiety and OCD symptoms. A reasonable stepwise approach is:

• Use the EPDS (or PHQ-9) as a universal screen for depressive symptoms.
• Add the PASS to screen for a broad spectrum of anxiety disorders, including OCD, recognizing that PASS is more sensitive to perinatal anxiety than the EPDS or GAD-7.
• Supplement the EPDS with a brief OCD screener, such as the DOCS or an OCI-based measure.

Recent work has highlighted the utility of extremely brief OCD screeners in perinatal populations. The OCI-4, a four-item derivative of the OCI, has been shown to:

• Reliably detect OCD symptoms in pregnant and postpartum women.
• Distinguish OCD from generalized anxiety symptoms.
• A score of 3 or greater can be used to identify individuals who may have perinatal OCD and warrant further assessment.

As with other screening tools, these instruments are not substitutes for a diagnostic evaluation; rather, they flag individuals with higher symptom levels who may benefit from psychiatric referral and a more detailed assessment of psychiatric symptoms.

Evaluating and Monitoring OCD Symptoms

Comprehensive tools such as the Y-BOCS and the PTBC cover a wide array of obsessions and compulsions and play an important role beyond initial screening. Clinically, these measures offer several advantages:

• They can uncover unusual, shame-laden, or embarrassing symptoms that might not emerge in an unstructured clinical interview, providing both diagnostic clarity and reassurance to patients that their experiences are shared by others.
• They help clinicians and patients identify specific symptom targets (e.g., particular intrusive thoughts or rituals) for cognitive-behavioral therapy with exposure and response prevention (ERP).
• They offer a structured way to rate severity and interference, facilitating communication regarding treatment response.

Several instruments can also be used repeatedly to monitor treatment response and functional recovery. Most commonly:

• The Y-BOCS is used as the gold-standard clinician-rated measure of OCD severity.
• The OCI-R (and its short forms) provide a self-report index of symptom severity and are often easier to implement as routine progress?monitoring tools.

In perinatal practice, clinicians may choose a combination approach: using the EPDS (and possibly PASS) as universal screens for mood and anxiety disorders, adding a brief OCD screener such as the OCI-4 or DOCS when intrusive thoughts or compulsive behaviors are suspected, and then using more comprehensive tools (Y-BOCS or PTBC) to guide diagnosis and monitor response in women with confirmed or strongly suspected OCD.

The Bottom Line

Although the EPDS and PHQ remain the most commonly used instruments to screen for mood and, indirectly, some anxiety symptoms in pregnant and postpartum populations, they often fail to capture women whose primary difficulties are intrusive thoughts, compulsions, and related avoidance. Incorporating perinatal-specific anxiety and OCD tools—alongside brief, general OCD screeners—can substantially improve detection of perinatal OCD and inform more targeted treatment. Screening tools should be viewed as the first step in a stepped-care pathway: they help clinicians identify women at risk, who can then receive a more thorough diagnostic evaluation and evidence-based interventions aimed at reducing OCD symptoms, improving functioning, and supporting the developing parent–infant relationship.