Perinatal Obsessive-Compulsive Disorder (OCD) Tip Sheet
Perinatal OCD Tip Sheet
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Perinatal OCD Slide Deck
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Understanding Perinatal OCD (pOCD)
Definition:
A subtype of OCD occurring during pregnancy or postpartum, characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions).
Prevalence:
- 2.9% during pregnancy
- 8.1% postpartum
- 30% of women with OCD report perinatal-related onset.
Key Features:
- Obsessions: Fear of contamination, harm, symmetry, intrusive sexual thoughts.
- Compulsions: Checking, reassurance-seeking, avoidance, excessive cleaning.
Differences Between GAD, OCD, and Worry
Generalized Anxiety Disorder (GAD)
- Thought Content:
- Excessive worry about real-life concerns (e.g., finances, health, relationships)
- Cognitive Processes:
- Difficult to control worry, but thoughts are not intrusive
- Behavioral Response:
- Avoidance, seeking reassurance, over-planning
- Duration and Intensity:
- Persistent, excessive, and generalized across domains
- Common Example:
- "What if my baby doesn’t meet developmental milestones?"
- Treatment Approach:
- CBT, mindfulness, medication
Obsessive-Compulsive Disorder (OCD)
- Thought Content:
- Intrusive, distressing thoughts that feel unwanted and often unrelated to reality
- Cognitive Process:
- Obsessions cause distress; compulsions aim to reduce it
- Behavioral Response:
- Engaging in compulsions to neutralize distress
- Duration and Intensity:
- Specific and repetitive, with rituals to reduce anxiety
- Common Example:
- "If I don’t check the baby’s breathing 10 times, something bad will happen."
- Treatment Approach:
- Exposure and Response Prevention (ERP), medication
Typical Worry
- Thought Content:
- Everyday concerns about common issues
- Cognitive Process:
- Worries are generally controllable
- Behavioral Response:
- Problem-solving or seeking reassurance
- Duration and Intensity:
- Usually short-lived and situation-specific
- Common Example:
- "I hope my baby is gaining weight okay."
- Treatment Approach:
- Lifestyle adjustments, stress management
Key Differences Between Perinatal and Non-Perinatal OCD
- Increased Responsibility
- Heightened sense of responsibility for baby's safety.
- Avoidance-Based Compulsions:
- Avoiding situations to prevent triggering thoughts.
- Unique Content:
- Common themes include baby’s health, safety, and contamination fears.
- Diagnostic Challenges:
- Obsessions may focus singularly on baby care.
- Ego-dystonic nature (thoughts feel intrusive and distressing).
- Misinterpreted as psychosis—evaluate insight and hallucinations carefully.
When to Refer for Specialized Treatment
Indicators for Referral:
- Moderate-to-severe anxiety related to baby’s well-being.
- Persistent reassurance-seeking from healthcare providers.
- Excessive fear of being alone with baby.
- Functional impairment despite mood appearing stable.
Screening Tools:
- Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
- Perinatal Anxiety Screening Scale (PASS).
- Edinburgh Postnatal Depression Scale (EPDS).
Evidence-Based Treatment Approaches
- Exposure and Response Prevention (ERP):
- Gold standard for OCD treatment.
- Gradual exposure to feared thoughts/situations without engaging in compulsions.
- Cognitive Behavioral Therapy (CBT):
- Addressing misappraisals and reducing avoidance behaviors.
- Medication Management:
- SSRIs (Selective Serotonin Reuptake Inhibitors) are first-line pharmacotherapy.
Collaborative Care Considerations
- Communication Strategies:
- Normalize distress and intrusive thoughts to reduce shame.
- Validate parental concerns without reinforcing obsessions.
- Educate on the difference between OCD and psychosis.
- Safety Planning:
- Assess insight to differentiate OCD from actual safety concerns.
- Avoid unnecessary escalation (e.g., CPS involvement without clinical need).
- Family Involvement:
- Encourage support without enabling reassurance-seeking behaviors.
Documentation Best Practices
Include:
- Symptoms and impact on daily functioning.
- Treatment interventions and patient response.
- Safety considerations and patient insight.
Exclude:
- Unnecessary detail of intrusive thoughts to avoid reinforcing obsessions.