Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder

Fairbrother, Nichole; Collardeau, Fanie; Woody, Sheila R.; Wolfe, David A.; Fawcett, Jonathan M.

doi:10.4088/jcp.21m14006

Cited by 15 publications

(18 citation statements)

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“…Depression and anxiety symptomatology were used as criteria because their comorbidity with OC symptoms is well established [ 11 , 14 , 40 , 41 , 42 ]. It is known that mothers’ depression severity is positively related to various aspects of intrusive thoughts’ severity and interference [ 10 , 18 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…OCD prevalence in the postpartum, approximately 3.0–7.0% [ 1 , 2 , 8 , 9 ], is higher than in the general population (1.08%) [ 5 ]. Even when the criteria for a full OCD diagnosis are not met, OC symptoms are more common in the perinatal period than in other times of a woman’s life [ 5 , 10 ]. In the postpartum context, unwanted, intrusive thoughts of infant-related harm are reported by nearly all new mothers (between 70 and 100%), with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…The presence of such slightly intrusive and repetitive thoughts does not necessarily represent an obsession or lead to OCD [ 4 ]. Differences from OCD obsessions are their shorter duration, less distress, less difficult to dismiss and low association with compulsive behaviors [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample

Pereira

Araújo

Azevedo

et al. 2022

IJERPH

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Background: Although obsessive-compulsive (OC) symptoms are common in the perinatal period, measures to comprehensively assess their presence, frequency, interference and severity are lacking. The Perinatal Obsessive–Compulsive Scale (POCS) is the only self-report questionnaire with context-specific items. It includes items to assess perinatal-specific obsessions and compulsions, a severity scale and an interference scale. Objectives: (1) to analyze the validity and reliability of the Portuguese version of the POCS; (2) to find Obsessive–Compulsive Disorder (OCD) prevalence in postpartum and determine the POCS cut-off scores and its accuracy (sensitivity, specificity and predictive values) in screening for OCD according to DSM-5 criteria; (3) to describe the prevalence, content, severity, interference and onset of OC symptoms in the postpartum. Methods: 212 women in postpartum filled in a booklet, including the POCS Portuguese preliminary version, the Perinatal Anxiety Screening Scale and the Postpartum Depression Screening Scale; they were interviewed with the Diagnostic Interview for Psychological Distress—Postpartum. Results: Confirmatory Factor Analysis revealed that POCS presented acceptable fit indexes (χ2/df = 2.2971; CFI= 0.9319; GFI = 0.8574; TLI = 0.9127; RMSEA = 0.860, p < 0.001). The Cronbach’s alphas were all > 0.800. The POCS cut-off point that maximized the Youden Index (J = 0.86, 95% CI [0.94–0.99]) was 20, corresponding to an Area Under the Curve of 0.970 (p < 0.001; Standard Error = 0.031; 95% CI: 0.937 to 0.988). The prevalence of postpartum OCD was 3.30%. The severity of thoughts and behaviors was moderate to severe for approximately 15% of women. For thirty-five percent of women, the onset of symptoms was in the first three months postpartum. Conclusions: The Portuguese version of POCS has good validity, reliability and accuracy and may be considered ready for use in both clinic and research fields. POCS provides specific information regarding symptoms and individual patterns experienced by each woman, which allows normalization, destigmatization and personalized intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample

Pereira

Araújo

Azevedo

et al. 2022

IJERPH

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“…Intrusive thoughts can be confused with psychosis or delusional thoughts. Unwanted or intrusive thoughts, including those of harming the infant, are very common and are often related to fears of something happening (168). Intrusive thoughts can occur in the absence of a mental health condition; however, they are also associated with perinatal depression, anxiety, and OCD (169).…”

Section: Clinical Recommendations and Evidence Summarymentioning

confidence: 99%

Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum

2023

Obstetrics &Amp; Gynecology

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PURPOSE:To review evidence on the current understanding of mental health conditions in pregnancy and postpartum, with a focus on mood and anxiety disorders, and to outline guidelines for screening and diagnosis that are consistent with best available scientific evidence. The conditions or symptoms reviewed include depression, anxiety and anxiety-related disorders, bipolar disorder, suicidality, and postpartum psychosis. For information on psychopharmacologic treatment and management, refer to American College of Obstetricians and Gynecologists (ACOG) Clinical Practice Guideline Number 5, “Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum” (1).TARGET POPULATION:Pregnant or postpartum individuals with mental health conditions. Onset of these conditions may have predated the perinatal period or may have occurred for the first time in pregnancy or the first year postpartum or may have been exacerbated in that time.METHODS:This guideline was developed using an a priori protocol in conjunction with a writing team consisting of one specialist in obstetrics and gynecology and one maternal–fetal medicine subspecialist appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics and two external subject matter experts. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements.RECOMMENDATIONS:This Clinical Practice Guideline includes recommendations on the screening and diagnosis of perinatal mental health conditions including depression, anxiety, bipolar disorder, acute postpartum psychosis, and the symptom of suicidality. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.

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“…These beliefs include thought action fusion—that a thought about harming another person is equivalent to the imagined action (e.g., “thinking about hurting my loved ones is the same as actually hurting them”; Shafran & Rachman, 2004 ), and feared self‐beliefs, where the individual believes they possess bad, dangerous, or immoral characteristics as a result of experiencing unwanted thoughts (e.g., “I must be a dangerous person for thinking about harming another person”; Aardema & O'Connor, 2007 ; Jaeger et al, 2021 ; Moulding et al, 2011 ; Shafran & Rachman, 2004 ). Both Veale et al ( 2009 ) and Fairbrother et al ( 2022 ) suggest that there should be no concern regarding whether a person with OCD will carry out their aggressive intrusions, as they are highly ego‐dystonic to the individual and are associated with significant distress and trepidation.…”

Section: Introductionmentioning

confidence: 99%

Exploring predictors of aggressive intrusive thoughts and aggressive scripts: Similarities and differences in phenomenology

Fernandez

Daffern

Moulding

et al. 2022

Aggressive Behavior

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Experiencing a thought about harming or injuring another person is commonly reported by the general population. Aggressive intrusive thoughts (AITs) and aggressive scripts are two constructs commonly used to define the experience of thinking about harming another person. However, they are generally investigated separately and with two significantly different population groups; respectively, individuals with obsessive‐compulsive disorder and people with a history of violent behavior. AITs and aggressive scripts are assumed to have very different implications for violence risk assessment, but conceptual overlap and an absence of empirical research renders this assumption premature. Using a battery of self‐report measures, this study aimed to investigate the differential predictors of AITs and aggressive script rehearsal in a nonclinical sample. Additionally, using regression analyses, the predictors of self‐reported aggressive behavior were explored in a sample of 412 adults (73% females; Mage = 31.96 years, SD = 11.02). Violence‐supportive beliefs and frequency of anger rumination predicted the frequency of aggressive script rehearsal, and aggressive script rehearsal, anger rumination, and violence‐supportive beliefs predicted a history of aggressive behavior. In contrast, obsessive beliefs were predictive of AITs, and only AITs were related to ego‐dystonicity. Both AITs and aggressive script rehearsal were related to the use of thought control strategies. These findings support the contributions that maladaptive beliefs have in the experience of aggressive scripts and AITs. Beliefs about violence, a history of aggressive behavior, and ego‐dystonicity appear to differentiate aggressive scripts from AITs.

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Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder

Cited by 15 publications

References 0 publications

The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample

The Postpartum Obsessive-Compulsive Scale: Psychometric, Operative and Epidemiologic Study in a Portuguese Sample

Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum

Exploring predictors of aggressive intrusive thoughts and aggressive scripts: Similarities and differences in phenomenology

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