This week I have a guest post written by Hollie Burton, who is about to start her PhD in Population Health at Oxford. Hollie’s specialism looks at maternal OCD, a topic I haven’t read too much about myself. I have learnt so much already and I am grateful to her for sharing her knowledge. One of the main issues with OCD is people being afraid to talk about “taboo” obsessions. It must be awful for new Mums (and Dads) who have their OCD triggered or exacerbated during what should be such a happy (albeit tiring) time in their lives. It must be especially difficult for those parents who have harm OCD in relation to their children, scared to speak out as they fear being misunderstood or worse. Research like Hollies will go a long way to raise awareness in this important area and help others get the support they need. Anyway, hope you enjoy the post! Richard
Over to Hollie…
It’s Maternal Mental Health Awareness Week! (See here). Plus… and this is probably the first time you’ve heard this… we are in the middle of a global pandemic. COVID-19 is likely to have long term consequences for some new parents’ mental health, for many different reasons, including reduced support, increased stress and isolation. Therefore we have an even more important duty this week, when raising awareness about maternal mental health, to underline the fact that new parents experiencing mental health disorders, whether that is the onset of new mental health problems or the exacerbation of existing problems, may be particularly struggling right now. So it’s a good time to widen the discussion around “maternal obsessive compulsive disorder” also known as “perinatal OCD”. This is why I’m going to explain why new parents might be at particular risk of developing OCD and describe some research I’ve carried out about the experiences of some women with existing OCD during pregnancy and soon after.
What is maternal OCD?
Maternal OCD, is OCD that begins during pregnancy or just after birth (known as the postpartum period) or already existing OCD that is exacerbated by pregnancy/postpartum. We know that during pregnancy and postpartum more women have OCD than women in the general population. Roughly 1% of the general female population has OCD, but this rises to about 2-2.5% in the pregnant/postpartum populations (1). That means 1 in 50 pregnancies are affected by OCD which equates to approximately 20,000 women a year in the UK.
Why might pregnancy/postpartum be a risk factor for the development or exacerbation of OCD symptoms?
There are various theories as to why pregnancy and postpartum might pose a risk for mothers developing OCD. The perinatal cognitive behavioural model by Fairbrother and Abramowitz (2), states that having a new baby/pregnancy reduces the threshold for the development of OCD because new parents experience the sudden increase of responsibility for a new treasured baby who relies on them solely. New parents might start to pay attention to normally occurring intrusive thoughts and misappraise these thoughts as important, which can trigger compulsive behaviours in response to these thoughts. This eventually leads to the cycle of obsessive compulsive symptoms and the development of OCD. I like this theory because it also explains why some fathers have a similar experience. If we know that women are more likely to develop OCD during pregnancy, then it makes sense that women with existing OCD might experience an exacerbation of their existing symptoms. Previous research has shown that about 1/3 of women with existing OCD will experience an exacerbation of their OCD symptoms.(3, 4)
Findings of my research
My research focused on the pregnancy and postpartum experiences of women with existing OCD because there has been very little research done about this group of women’s experiences; my upcoming PhD project will expand on this and include all women with OCD during pregnancy/postpartum.
I interviewed five women with existing OCD about their experiences of pregnancy and postpartum. More details about this study can be found here (5).
As part of this study I mapped the themes that emerged from the discussions during my interviews with these women. There were four overarching themes: exacerbation, trust, responsibility and control (Figure 1).
The findings of this research meant that I was able to extend the understanding of the underdeveloped concept of “exacerbation” of OCD as not only simply a “worsening of symptoms” but the “worsening of existing symptoms and the development of new types of symptoms”, violent harm concerns in particular. Four of the mothers experienced this exacerbation of their OCD. The mother who didn’t experience exacerbation said that she was able to maintain her mental health for herself and for her baby. She felt that she was adequately supported by her partner and medical professionals throughout her pregnancy and postpartum, and involved health professionals before becoming pregnant.
However, other participants felt overwhelmed with responsibility for their baby and were acutely aware of the effect their mental health might have on their babies which caused them significant distress. This led to some mothers stopping their medication during pregnancy out of fear they would harm their unborn child. Some of the mothers felt unable to ask their partners or family members to help look after their baby because of the intense intrusive thoughts which led to, for example, breast feeding for much longer than they had intended, increased slept deprivation and stress, and ultimately leading to feelings of isolation and secrecy.
Importantly, the mothers discussed several barriers that made accessing treatment difficult, namely that they did not trust and were afraid of health care professionals; two mothers in particular mentioned that they had been scared to tell anyone their thoughts because they feared their baby (and existing children) would be taken away if they told anyone about their thoughts. Historically there has been the misunderstanding by some professionals that women with OCD are a danger to their babies, when in reality they are not, and this fear prevents some people from seeking the treatment that they desperately need (6), and this is clearly an issue that needs addressing.
Main take away messages from this research:
- It is not ‘bad’ news for everyone, not all women experience an exacerbation of their existing OCD symptoms during pregnancy and postpartum, especially if support and health care is in place early.
- If you are concerned about having a pregnancy due to your OCD, think about discussing your concerns with your GP or mental health professional. Do this pre-pregnancy if possible, to ensure continued treatment or support is in place throughout your pregnancy. Whilst this does not guarantee a perfect pregnancy, accessing care as soon as possible will put you in the best position for you and your baby.
- There is an ongoing problem for those mothers (and fathers!) who do develop OCD and those who experience exacerbation. We need to be doing more to prevent women from experiencing perinatal OCD and provide better and more targeted support to those that do experience it i.e. services from pre-conception to postpartum, and continuing existing treatment for individuals when appropriate and safe after discussion with mother.
- We also need to work on reducing misunderstanding amongst professionals about who constitutes a real risk to their babies, and to reduce misidentification of OCD as other perinatal disorders e.g. perinatal psychosis, in order to allow women to access the care they need in a timely manner.
- During this pandemic we need to ensure that mental health is still part of the discussion about maternal health, our focus cannot solely be on COVID-19, we need to look at all aspects of maternal health to ensure that women are appropriately cared for whilst being aware of the fact that some services are limited at the moment and that this could be causing significant problems for some families.
Helpful links below: if you are having a hard time at the moment with your OCD or you are concerned that someone you love is developing OCD or is experiencing an exacerbation of their OCD (not just pregnancy related):
Thank you very much to Richard for asking me to write this guest blog post!
Find Hollie @Ozzieburton on Twitter
1. Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry. 2013;74(4):377-85.
2. Fairbrother N, Abramowitz JS. New parenthood as a risk factor for the development of obsessional problems. Behaviour Research and Therapy. 2007;45(9):2155-63.
3. Labad J, Menchón JM, Alonso P, Segalàs C, Jiménez S, Vallejo J. Female reproductive cycle and obsessive-compulsive disorder. 2005.
4. Guglielmi V, Vulink NCC, Denys D, Wang Y, Samuels JF, Nestadt G. Obsessive-compulsive disorder and female reproductive cycle events: results from the OCD and reproduction collaborative study. Depression and anxiety. 2014;31(12):979-87.
5. Burton HAL. How women with established obsessive compulsive disorder experience pregnancy and postpartum: an interpretative phenomenological analysis. Journal of Reproductive and Infant Psychology. 2020:1-13.
6. Challacombe FL, Wroe AL. A hidden problem: consequences of the misdiagnosis of perinatal obsessive–compulsive disorder. British Journal of General Practice. 2013;63(610):275.