Abstract
The postpartum period has been associated with elevated rates of onset of obsessive-compulsive disorder (OCD) among women, with a prevalence of 2–9%. Postpartum OCD is often characterized by recurrent, unwanted, and highly distressing thoughts, images, or impulses of deliberate infant harm. This study investigated health practitioners’ recognition of, and clinical management strategies for, postpartum obsessive-compulsive symptoms (OCS). Ninety-four perinatal health practitioners from a range of disciplines and professional backgrounds completed a survey comprised of a hypothetical case vignette and questions eliciting their responses to a clinical presentation of postpartum infant harming obsessions. Almost 70% of participants did not accurately identify OCS within the case. Furthermore, the majority of practitioners endorsed at least one contraindicated clinical management strategy likely to aggravate postpartum OCS. Accurate recognition of OCS was associated with the selection of fewer contraindicated strategies. Some aspects of practitioner training and experience were associated with correct OCS identification. These findings underscore the need for targeted, interdisciplinary education to improve the detection and management of women experiencing postpartum OCS.
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References
Abramowitz JS, Schwartz SA, Moore KM, Luenzmann KR (2003) Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. J Anxiety Disord 17:461–478. https://doi.org/10.1016/S0887-6185(02)00206-2
Abramowitz JS, Nelson CA, Rygwall R, Khander M (2007) The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. J Anxiety Disord 21:91–104. https://doi.org/10.1016/j.anx.2006.05.2003
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Press, Virginia
Austin M-P, Highet N, the Expert Working Group (2017) Mental health care in the perinatal period: Australian clinical practice guideline. Centre of Perinatal Excellence. https://www.cope.org.au/health-professionals/health-professionals-3/review-of-new-perinatal-mental-health-guidelines/. Accessed 12 August 2019
Barrett R, Wroe AL, Challacombe FL (2016) Context is everything: an investigation of responsibility beliefs and interpretations and the relationship with obsessive-compulsive symptomatology across the perinatal period. Behav Cogn Psychother 44:318–330. https://doi.org/10.1017/S1352465815000545
Brok EC, Lok P, Oosterbaan DB, Schene AH, Tendolkar I, van Eijindhoven PF (2017) Infant-related intrusive thoughts of harm in the postpartum period: a critical review. J Clin Psychiatry 78:e913–e923. https://doi.org/10.4088/JCP.16r11083
Challacombe F, Salkovskis P (2009) A preliminary investigation of the impact of maternal obsessive-compulsive disorder and panic disorder on parenting and children. J Anxiety Disord 23(7):848–857. https://doi.org/10.1016/j.janxdis.2009.04.002
Challacombe FL, Wroe AL (2013) A hidden problem: consequences of the misdiagnosis of perinatal obsessive-compulsive disorder. Br J Gen Pract 62:275–276. https://doi.org/10.3399/bjgp13X667376
Challacombe FL, Salkovskis PM, Woolgar M, Wilkinson EL, Read J, Acheson R (2016) Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: effects of obsessional symptoms and mood. Infant Behav Dev 44:11–20. https://doi.org/10.1016/j.infbeh.2016.04.003
Challacombe FL, Salkoviskis PM, Woolgar M, Wilkinson EL, Read J, Acheson R (2017) A pilot randomized controlled trial of time-intensive cognitive-behaviour therapy for postpartum obsessive-compulsive-disorder: effects on maternal symptoms, mother-infant interactions and attachment. Psychol Med 47:1478–1488. https://doi.org/10.1017/S0033291716003573
Chaudron LH, Nirodi N (2010) The obsessive-compulsive spectrum in the perinatal period: a prospective pilot study. Archives Womens Ment Health 13:403–410. https://doi.org/10.1007/s00737-010-0154-6
Fairbrother N, Abramowitz JS (2016) Obsessions and compulsions during pregnancy and the postnatal period. In: Wenzel A (ed) The Oxford handbook of perinatal psychology. Oxford University Press, New York, pp 167–181
Fairbrother N, Woody SR (2008) New mothers’ thoughts of harm related to the newborn. Archives Womens Ment Health 11:221–229. https://doi.org/10.1007/s00737-008-0016-7
Garcίa-Soriano G, Roncero M (2017) What do Spanish adolescents think about obsessive-compulsive disorder? Mental health literacy and stigma associated with symmetry/order and aggression-related symptoms. Psychiatry Res 250:193–199. https://doi.org/10.1016/j.psychres.2017.01.080
Glazier K, Calixte RM, Rothschild R, Pinto A (2013) High rates of OCD symptom misidentification by mental health professionals. Ann Clin Psychiatry 25:205–209
Gupta S, Kiran S (2018) Obsessive-compulsive disorder and child safeguarding. BJ Psych Adv 25:185–186. https://doi.org/10.1192/bja.2018.60
Jenny C, Isaac R (2006) The relation between child death and child maltreatment. Arch Dis Child 91:265–269. https://doi.org/10.1136/adc.2004.066696
Lawrence PJ, Craske MG, Kempton C, Stewart A, Stein A (2017) Intrusive thoughts and images of intentional harm to infants in the context of maternal postnatal depression, anxiety, and OCD. B J Gen Pract 67:376–377. https://doi.org/10.3399/bjgp17X692105
Matthews B, Kenny MC (2008) Mandatory reporting legislation in the United States, Canada, and Australia: a cross-jurisdictional review of key features, differences, and issues. Child Maltreatment 13:50–63. https://doi.org/10.1136/adc.2004.066696
McGuinness M, Blissett J, Jones C (2011) OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? Behav Cogn Psychother 39:285–310. https://doi.org/10.1017/S1352465810000718
Miller ES, Chu C, Gollan J, Gossett DR (2013) Obsessive-compulsive symptoms during the postpartum period. J Reprod Med 58:115–122 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5705036/. Accessed 11 August 2019
Miller ES, Hoxha D, Wisner KL, Gossett DR (2015) Obsessions and compulsions in postpartum women without obsessive compulsive disorder. J Women's Health 24:825–830. https://doi.org/10.1089/jwh.2014.5063
National Institute for Health and Care Excellence (2005) Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31). https://www.nice.org.uk/guidance/cg31. Retrieved 12 August 2019
National Institute for Health and Care Excellence (2014) Antenatal and postnatal mental health: clinical management and service guidance (CG192). https://www.nice.org.uk/guidance/cg192. Retrieved 12 August 2019
Russell EJ, Fawcett JM, Mazmanian D (2013) Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry 74:377–385. https://doi.org/10.4088/JCP.12r07917
Sharma, Sommerdyk C (2015) Obsessive-compulsive disorder in the postpartum period: diagnosis, differential diagnosis and management. Women Health 11:543–542. https://doi.org/10.2217/WHE.15.20
Simonds LM, Thorpe SJ (2003) Attitudes towards obsessive-compulsive disorders: an experimental investigation. Soc Psychiatry Psychiatr Epidemiol 38:331–336. https://doi.org/10.1007/s00127-003-0637-0
Storch EA (2015) What to make of misidentification rates in OCD. J Clin Psychiatry 76:e820–e821. https://doi.org/10.4088/JCP.14com09430
Veale D, Freeston M, Krebs G, Heyman I, Salkovskis P (2009) Risk assessment and management in obsessive-compulsive disorder. Adv Psychiatr Treat 15:332–343. https://doi.org/10.1192/apt.bp.107.004705
Wahl K, Kordon A, Kuelz KA, Voderholzer U, Hohagen F, Zurowski B (2010) OCD is still an unrecognised disorder: a study on the recognition of OCD in psychiatric outpatients. Eur Psychiatry 25:374–377. https://doi.org/10.1016/j.eurpsy.2009.12.003
Warman DM, Phalen PL, Martin JM (2015) Impact of a brief education about mental illness on stigma of OCD and violent thoughts. J Obsess-Compuls Rel 5:16–23. https://doi.org/10.1016/j.jocrd.2015.01.003
Acknowledgments
The authors wish to thank the health practitioners who participated in this study.
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This study was completed as part of the first author’s PhD studies, supported through an Australian Government Research Training Program Scholarship.
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Participants provided informed written consent prior to undertaking the study. Approval was obtained from the Curtin University Human Research Ethics Committee before the study was commenced.
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Mulcahy, M., Rees, C., Galbally, M. et al. Health practitioners’ recognition and management of postpartum obsessive-compulsive thoughts of infant harm. Arch Womens Ment Health 23, 719–726 (2020). https://doi.org/10.1007/s00737-020-01026-y
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DOI: https://doi.org/10.1007/s00737-020-01026-y