Best Practices for Assessing and Treating Perinatal Obsessive-Compulsive Disorder

What you need to know

• Perinatal OCD affects 2-17% of women during pregnancy and after childbirth
• Symptoms often involve intrusive thoughts about harming the baby and related compulsive behaviors
• Expert recommendations cover screening, assessment, differential diagnosis, and treatment approaches
• Cognitive-behavioral therapy and certain medications are recommended evidence-based treatments
• Providing psychoeducation and involving partners/family members in care is important

Understanding Perinatal OCD

Obsessive-compulsive disorder (OCD) that occurs during pregnancy or after childbirth is known as perinatal OCD. The perinatal period is a time of increased risk for developing OCD symptoms, particularly for women. Common symptoms include:

• Intrusive, distressing thoughts about harm coming to the baby
• Obsessive worries about being an inadequate parent
• Compulsive behaviors like excessive cleaning or checking on the baby
• Avoidance of situations that trigger obsessive thoughts

These symptoms can be very upsetting for new parents and may interfere with bonding and caring for the baby. However, perinatal OCD is treatable with proper assessment and evidence-based interventions.

Screening and Assessment Recommendations

The expert panel recommended that all pregnant women and new mothers should be screened for perinatal OCD symptoms, especially those with a history of anxiety or OCD. Key assessment recommendations include:

• Using screening tools with items specific to perinatal OCD
• Asking directly about intrusive thoughts and compulsive behaviors
• Assessing the frequency, intensity, and impact of symptoms
• Exploring how symptoms affect parenting and relationships
• Determining if symptoms began or worsened during the perinatal period

Importantly, assessments should be done sensitively, as many parents fear disclosing intrusive thoughts about harming their baby. Clinicians should explain the assessment process and confidentiality limits upfront.

Differential Diagnosis Considerations

A critical part of assessment is distinguishing perinatal OCD from other mental health conditions. Key differential diagnosis recommendations include:

• Determining if intrusive thoughts are ego-dystonic (inconsistent with the parent’s true values/desires)
• Assessing if the parent is trying to suppress thoughts vs. engaging with them
• Differentiating OCD fears from depressive rumination or delusional beliefs
• Evaluating if avoidance is related to OCD triggers vs. other mental health issues

Proper differential diagnosis is crucial, as misdiagnosis can lead to inappropriate treatment and potentially negative outcomes. Referral to an OCD specialist may be needed in complex cases.

Evidence-Based Treatment Approaches

The expert panel endorsed several evidence-based treatments for perinatal OCD:

• Cognitive-behavioral therapy (CBT) with exposure and response prevention as first-line treatment
• Selective serotonin reuptake inhibitors (SSRIs) as a medication option, weighing risks/benefits
• Combination of CBT and medication for some individuals
• Considering intensive outpatient or inpatient treatment for severe cases

Treatment should be tailored to the individual, considering factors like symptom severity, comorbid conditions, and treatment preferences. The infant may be safely involved in exposure exercises when appropriate.

Supporting Parents and Families

Recommendations for supporting individuals with perinatal OCD and their families include:

• Providing psychoeducation about perinatal OCD to parents and partners
• Involving partners/family members in treatment when the parent consents
• Addressing family accommodation of symptoms
• Offering referrals to support groups and resources
• Considering the impact on parent-infant bonding and interactions

Clinicians should take a family-centered approach while respecting the parent’s privacy and treatment preferences.

Conclusions

• Perinatal OCD is common but often misunderstood or misdiagnosed
• Proper screening, assessment and differential diagnosis are crucial
• Evidence-based treatments like CBT and medication can be very effective
• A family-centered, culturally-sensitive approach to care is recommended

These expert consensus recommendations provide valuable guidance for clinicians working with individuals experiencing perinatal OCD. Implementing these best practices can help ensure parents receive appropriate, compassionate care during a vulnerable time. More research is still needed, particularly on fathers’ experiences of perinatal OCD.