Intrusive Thoughts and Compulsive Behaviors During the Perinatal Period: Prevalence Rates and Longitudinal Course

• In Event: Beyond Depression and Anxiety: New Insights into Perinatal Maternal Mental Health

Abstract

Introduction: Perinatal obsessive-compulsive disorder (pOCD) is characterized by intrusive, unwanted, thoughts or images (i.e., obsessions) that increase distress, and can occur with or without avoidance of stimuli that trigger obsessions or functionally related behavioral or mental rituals (i.e., compulsions) used to reduce distress. For reasons not fully understood, research suggests the pre- and postnatal period are particularly vulnerable times for OCD symptoms to occur, with a recent meta-analysis of 12 studies indicating rates of 2.07% and 2.43% respectively (relative to 1.08% in the general population; Russell, Fawcett, & Mazmanian, 2013). However, because obsessions in pOCD often involve violent or horrific content (e.g., the thought to put the baby in the microwave), pOCD symptoms are thought to go underreported, underrecognized, and undertreated due to women experiencing feelings of shame, guilt, or fear of reporting to health providers. To our knowledge, no existing research has prospectively assessed the longitudinal course of pOCD symptoms across gestation and from the pre- to postpartum period, data which are needed to inform future research and clinical work.
Aims: The current study characterized the prevalence rates and longitudinal course of maternal perinatal obsessive-compulsive symptoms in a community sample.
Study population: 125 women were recruited during early pregnancy from community sources and one university-affiliated prenatal clinic in the Minneapolis-St. Paul metro area into a longitudinal study. Women were between 19-42 years of age (M = 31.55) and primarily identified as white (82%). Data collection is nearly complete and preliminary results include 111 women; complete results will be available in April.
Methods: Participants completed the PreOCS at 5 time points during pregnancy (8-16 weeks, 20-24, 25-29, 30-34, 35-40) and the PostOCS at 3-6 months postpartum (Lord et al., 2011). Both questionnaires are designed to assess OCD symptoms in the pre- and postnatal periods; a cutoff score ≥ 10 indicates clinically significant symptoms.
Results: Maternal pOCD symptoms were present on a continuum in this sample, and clinically significant symptoms were relatively common. Of the 111 women, clinically significant symptoms were reported for roughly 1 in 4 (24%) at some point during pregnancy, 1 in 5 (22%) at 3-6 months postpartum, and 1 in 3 (31%) at any time point during the perinatal period assessed. On average, symptom severity during pregnancy peaked at 20-24 weeks (M=4.76; SD=5.38), decreased throughout gestation, and was greatest in the postpartum period (M=5.33; SD=5.63). Women who reported clinically significant symptoms in the postpartum period were more likely to have higher levels of prenatal OCD symptoms.
Conclusions: The current investigation suggests that clinically significant levels of maternal pOCD symptoms are relatively prevalent during pregnancy. On average, symptoms increased postnatally, and longitudinal data suggests that women who report higher symptoms during pregnancy may be more likely to experience clinically significant symptoms after delivery. Results offer implications for both research and clinical work, as untreated maternal psychiatric disorders can negatively affect both a woman and her child’s development. These data may inform early detection and intervention work to support optimal well-being of the maternal-child dyad.

Authors

• Colleen Doyle, University of Minnesota - Twin Cities
  Presenting Author

• Mariann Howland, University of Minnesota - Twin Cities
  Non-Presenting Author

• Katelyn Day, University of Minnesota
  Non-Presenting Author

• Andrea M Maxwell, University of Minnesota - Twin Cities
  Non-Presenting Author

• Jed T. Elison, University of Minnesota - Twin Cities
  Non-Presenting Author

• Megan R. Gunnar, University of Minnesota - Twin Cities
  Non-Presenting Author