Eleven percent of new mothers experience significant obsessive-compulsive symptoms compared to two to three percent in the general population.
These symptoms, including fear of injuring the baby and worry about germs, are usually temporary and could result from hormonal changes or be an adaptive response to caring for a new baby, researchers says.
But if the compulsions interfere with a mother’s functioning, they may indicate a psychological disorder. Says study senior author Dana Gossett, chief and assistant professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine and a physician at Northwestern Memorial Hospital:
“It may be that certain kinds of obsessions and compulsions are adaptive and appropriate for a new parent, for example those about cleanliness and hygiene.
But when it interferes with normal day-to-day functioning and appropriate care for the baby and parent, it becomes maladaptive and pathologic.”
Gossett and colleagues’ recollections of their own obsessive and upsetting thoughts after giving birth led them to investigate if the experience was universal.
Obsessions are unwanted and repeated thoughts or images that create anxiety. Explains Emily Miller, lead study author and a clinical fellow in maternal fetal medicine:
“A compulsion is a response to those obsessive thoughts, a ritualistic behavior that temporarily allays the anxiety but can’t rationally prevent the obsession from occurring.”
Obsessive-compulsive disorder (OCD) may be triggered by stress, research shows. Thus, stressful situations, such as pregnancy and the postpartum period, may exacerbate or predispose women to OCD.
The most prevalent thoughts women reported in the study were concern about dirt or germs followed by compulsions to check that they did not “make a mistake,” Miller says. New mothers may check and recheck that baby monitors are working, the baby’s crib side is properly latched, or bottles are properly sterilized, for example.
Some women in the study reported intrusive thoughts that they would harm the baby.
“That can be emotionally painful,” Miller says. “You don’t intend to harm the baby, but you’re fearful that you will.”
For postpartum women with obsessive-compulsive symptoms who otherwise are functioning normally, Gossett says, “It would be reassuring to hear that their thoughts and behaviors are very common and should pass.”
Gossett recalled that after she gave birth to her first child, she routinely worried about falling down the stairs with her baby or the baby would fall out of bed.
“It comes into your mind unbidden and it’s frightening,” she says.
The new research is the first large-scale longitudinal study of obsessive-compulsive symptoms in the postpartum period. Researchers now need to determine what behavior is normal and what’s pathologic, Gossett says.
Overlap With Depression
The women in the study were recruited during their delivery hospitalization at Northwestern Memorial and completed screening tests for anxiety, depression, and OCD two weeks and six months after going home.
A total of 461 women completed the surveys at two weeks and 329 of the original group completed them at six months. The women’s symptoms were self-reported and they did not receive a clinical diagnosis by a psychologist.
About 50 percent of the women reported an improvement in their symptoms by six months, but at that time point new women developed symptoms despite not having experienced them at two weeks.
“If those symptoms are developing much later after delivery, they are less likely to be hormonal or adaptive,” Gossett says.
The risk for psychological disorders persists for up to a year after delivery, she notes.
About 70 percent of the women who screened positive for obsessive-compulsive symptoms also screened positive for depression. That overlap and the unique subset of obsessions and compulsions could indicate postpartum OCD represents a distinct postpartum mental illness that is not well classified, Miller says.
“There is some debate as to whether postpartum depression is simply a major depressive episode that happens after birth or its own disease with its own features,” Miller says.
“Our study supports the idea that it may be its own disease with more of the anxiety and obsessive-compulsive symptoms than would be typical for a major depressive episode.”
Emily S. Miller, M.D., M.P.H., Christine Chu, B.A., Jacqueline Gollan, Ph.D., and Dana R. Gossett, M.D.
Obsessive-Compulsive Symptoms During the Postpartum Period: A Prospective Cohort
JRM Volume 58, No. 2 115-122