Postpartum OCD is a fairly common (3-5% of postpartum women) and often misdiagnosed perinatal mood & anxiety disorder (PMAD). It can manifest as symptoms of obsessions, compulsions, or both, and often interferes with daily life.
Obsessions are also called intrusive thoughts, and usually of harm coming to the baby. They are usually accompanied by guilt, shame, horror, and hypervigilance. It's important to note that these thoughts do not indicate intent, and if the mother is horrified by these thoughts, she is in touch with reality, which is a distinction from psychosis.
Compulsions are repetitive behaviors that are done in response to obsessions, and can include: cleaning, checking on things or the baby, counting, and putting things in order.
The main risk factors for postpartum OCD are a personal history or a family history of anxiety or OCD (which unfortunately is often unrecognized).
OCD is typically treated with medication, psychotherapy (talk therapy), or both.
Psychotherapy. Psychotherapy can be an effective treatment for adults and children with OCD. Research shows that certain types of psychotherapy, including cognitive behavior therapy (CBT) and other related therapies (e.g., habit reversal training) can be as effective as medication for many individuals. Research also shows that a type of CBT called Exposure and Response Prevention (EX/RP) is effective in reducing compulsive behaviors in OCD, even in people who did not respond well to SRI medication. For many patients EX/RP is the add-on treatment of choice when SRIs or SSRIs medication does not effectively treat OCD symptoms.
Medication. Serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) are used to help reduce OCD symptoms. Examples of medications that have been proven effective in both adults and children with OCD include clomipramine, which is a member of an older class of “tricyclic” antidepressants, and several newer “selective serotonin reuptake inhibitors” (SSRIs), including:
SRIs often require higher daily doses in the treatment of OCD than of depression, and may take 8 to 12 weeks to start working, but some patients experience more rapid improvement.