March 5, 2013
Many New Mothers Exhibit Signs Of Obsessive-Compulsive Disorder
April Flowers for redOrbit.com - Your Universe Online
A new mom is full of worries. She checks to see if the baby is breathing or she worries about germs — washing and re-sterilizing bottles to make sure they are clean. A new baby, especially the first one, seems so fragile that worrying becomes a way of life.
A new study from Northwestern Medicine reveals women who have recently given birth have a much higher rate of obsessive-compulsive symptoms than the general population.
In the first large-scale longitudinal study of obsessive-compulsive symptoms during the postpartum period, the researchers found 11 percent of women at two weeks and six months postpartum experience significant obsessive-compulsive symptoms. This is compared with two to three percent in the general population.
Such symptoms can include fear of injuring the baby and excessive worry about germs. They are usually temporary and could be the result of hormonal changes. The symptoms might also be an adaptive response to caring for a new baby. If, however, the compulsions interfere with a mother's functioning, a psychological disorder may be indicated.
"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," said Dana Gossett, M.D., chief and assistant professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine. Gossett is also a physician at Northwestern Memorial Hospital. "But when it interferes with normal day-to-day functioning and appropriate care for the baby and parent, it becomes maladaptive and pathologic."
The study was born out of Gossett and her colleagues' recollections of their own obsessive and upsetting thoughts after giving birth, leading the team to investigate if the experience is universal to all new mothers.
Emily Miller, M.D., clinical fellow in maternal fetal medicine at Feinberg, explains obsessions are unwanted and repeated thoughts or images that cause anxiety. "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."
Research shows obsessive-compulsive disorder (OCD) may be caused by such stress. Stressful situations, for example pregnancy and the postpartum period, may exacerbate or predispose women to OCD.
Participants in the study reported concerns about dirt and germs as their most prevalent obsessions, followed by compulsions to check they did not "make a mistake" Some of the behaviors reported include checking and rechecking the baby monitor is working correctly, the baby's crib side is latched properly, or bottles are sterilized correctly.
Some participating mothers reported intrusive thoughts they would harm the baby. "That can be emotionally painful," Miller said. "You don't intend to harm the baby, but you're fearful that you will."
For women in the postpartum period who exhibit obsessive-compulsive symptoms but are otherwise functioning normally, Gossett said, "It would be reassuring to hear that their thoughts and behaviors are very common and should pass."
After giving birth to her own first child, Gossett recalls 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 said.
Further research is needed to determine what is normal and what is pathologic, the team asserts.
Participants in the study were recruited during their delivery hospitalization at Northwestern Memorial. A total of 461 women completed screening tests for anxiety, depression and OCD at two weeks after release from the hospital, and 329 of the original group completed the surveys at six months. Symptoms were self-reported and the women did not receive a clinical diagnosis by a psychologist.
Approximately 50 percent of the women surveyed reported an improvement in their symptoms by six months. New mothers, however, developed symptoms at that point who had not experienced them at two weeks.
"If those symptoms are developing much later after delivery, they are less likely to be hormonal or adaptive," Gossett said, noting the risk for psychological disorders persists for up to a year after delivery.
Of the women who screened positive for obsessive-compulsive symptoms, about 70 percent also screened positive for depression. Taken along with the unique subset of obsessions and compulsions, this overlap could indicate postpartum OCD represents a distinct postpartum mental illness that is not currently well classified.
"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 said. "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."
The findings of this study will be published in The Journal of Reproductive Medicine.