New Perspective on OCD Symptoms in New Mothers

Posted on June 5th, 2013
Posted in Mental Health

Obsessive-compulsive disorder (OCD) is a form of mental illness that belongs to a larger group of conditions called anxiety disorders. People with classic cases of the disorder develop unwanted fixations on certain thoughts or emotions, as well as compulsive, seemingly involuntary behaviors that temporarily ease the intensity of their mental fixations. Women who have just given birth experience OCD-like symptoms much more frequently than other women or the general population. According to the results of a new study published in 2013 in the Journal of Reproductive Medicine, these symptoms sometimes reflect certain natural, short-term mental changes appropriate for someone with a newborn child. However, in other cases, they indicate the onset of longer-term, diagnosable OCD.

Obsessive-Compulsive Disorder Basics

Obsessive-compulsive disorder is viewed as an anxiety disorder because people affected by the condition repeatedly experience obsessive thoughts, emotions, feelings, or sensations that elicit fearful, worried, or panicked states of mind. According to the classic working theory of OCD, compulsive behaviors arise in response to recurring obsessions and give the affected individual a way to ease the anxiety-inducing effects of those obsessions. However, some modern research indicates that compulsive behaviors may actually arise before any corresponding obsessions take root. In this theory of the disorder, obsessions arise in order to give the brain a plausible excuse for otherwise inexplicable compulsions.

Postpartum OCD Basics

Postpartum obsessive-compulsive disorder symptoms usually appear within a 30-day period following the birth of a child. Generally speaking, women with these symptoms fixate on unwanted child-related obsessions such as accidentally harming or killing a newborn during a fall, unintentionally exposing a newborn to harmful dirt or germs, losing a newborn during an episode of choking, and losing control and harming a newborn through means such as shaking or drowning. Common compulsive actions in postpartum women include repeatedly checking to make sure a newborn is still breathing, repeatedly looking for signs of illness in a newborn, and repeatedly making sure that things such as cribs and baby monitors work properly.

Natural Changes vs. Diagnosable OCD

In the study published in the Journal of Reproductive Medicine, a team of researchers from Northwestern University’s Feinberg School of Medicine assessed a group of over 450 new mothers for self-reported symptoms associated with OCD, depression and anxiety.  An initial assessment was made two weeks after these women gave birth; most of the participants also received a second assessment for these same symptoms half a year later.

The researchers concluded that 11 percent of the women in the study had symptoms commonly associated with obsessive-compulsive disorder two weeks after childbirth. This figure is substantially higher than the 2 to 3 percent rate of OCD found in the general population; it’s also much higher than the 1 to 3 percent rate of postpartum OCD reported by several other modern studies. Six months later, half of the study participants affected by OCD-like symptoms in the aftermath of childbirth had experienced a significant reduction in those symptoms. However, the other half did not experience an improvement, and some of the women who didn’t have OCD-like symptoms two weeks after giving birth had developed those symptoms by the time of the follow-up assessment.

The authors of the study concluded that many of the OCD-like symptoms exhibited by new mothers actually reflect natural concerns that other mothers might feel but express in different ways. For instance, concerns about the health and welfare of a newborn are common to the vast majority of new mothers, and many mothers without OCD go out of their way to guarantee that they meet the needs of their babies as much as possible. Potential underlying mechanisms for temporary OCD-like thoughts and behaviors in the postpartum period include built-in genetic responses to childbirth and shifting levels of the sex hormones estrogen and progesterone.

The authors of the study also concluded that the longer OCD-like symptoms last after childbirth, the greater the chance those symptoms reflect the presence of established OCD and not a temporary mental/behavioral adjustment. The risks for true, diagnosable obsessive-compulsive disorder are probably highest in those women who don’t show symptoms shortly after giving birth but develop them at a later date. Generally speaking, the window for postpartum OCD remains open for roughly one year following childbirth.

Considerations

Seventy percent of the women in the Northwestern University study who reported symptoms of obsessive-compulsive disorder during their initial assessment also reported symptoms of major depression. Some researchers believe that this type of overlap between symptoms identifies postpartum OCD as a specific form of depression rather than a unique form of mental illness. However, the authors of the study believe that postpartum OCD likely deserves its distinction as a separate mental disorder.

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