What is obsessive-compulsive disorder?
Obsessive-compulsive disorder (OCD) is a common behavioral disorder that typically is chronic (long-lasting, often throughout life). It is characterized by the presence of recurring, uncontrollable thoughts (obsessions) and urges to perform a particular behavior that you feel you must repeat over and over (compulsions). The obsessions and compulsions are what psychologists and psychiatrists call ego-dystonic, or ego alien. This means that the person experiencing them knows that they are not normal, in contrast with a person who has unusual thoughts and compulsions that are part of a psychotic disorder, in which the person believes that such things are normal.
How common is OCD during pregnancy?
Along with being a fairly common condition in the overall population, OCD also commonly co-exists in pregnancy. Currently, it is estimated to affect about 2.07 percent of pregnant women and 2.43 percent of women in the period following delivery. This suggests that OCD can be provoked as pregnancy advances.
How is OCD diagnosed?
OCD is diagnosed in a mental health interview and examination in which the patient is assessed to see if they meet the criteria set forward in the current edition of the Diagnostic and Statistical Manual of Mental Disorders. To meet the criteria, the patient must have a minimum number of obsessions or compulsions present for at least a particular amount of time, the symptoms must interfere with normal function (such as in work or in school), and the symptoms must not be the result of some other condition.
Examples of OCD obsessions include:
- Fear of germs or contamination
- A need to have things in perfect or symmetrical, order
- Unwanted forbidden or taboo thoughts involving sex, religion, and harm
- Aggressive thoughts towards others or self
Examples of OCD compulsions include:
- Compulsive counting
- Excessive cleaning and/or handwashing
- Ordering and arranging things in a particular, precise way
- Repeatedly checking on things, such as repeatedly checking to see if the door is locked or that the oven is off
Keep in mind that to count as a compulsion, the activity really must be excessive and consume a lot of the persons time. Checking the door lock once or twice before you go to sleep, or go out, does not count as a compulsion, but doing it twenty times and never feeling satisfied would be an example of compulsive behavior.
Does OCD cause problems during pregnancy?
Some research suggests that OCD can worsen during pregnancy. Whether it worsens or not, by keeping the person occupied with obsessions and compulsions, OCD reduces your quality of life and also can impact negatively your work, study, and family life. It also can distract you from activities that are truly vital to your health and safety. If you have an obstetrician appointment, for instance, repetitive actions, such as checking the oven or door at home, or washing your hands multiple times can cause you to miss the appointment. Due to anxiety and stress, there is also a possible increase in risk of placental abruption (disconnection of the placenta from the uterine wall, leading to severe bleeding), and sleeping problems.
Does OCD during pregnancy cause problems for the baby?
While OCD does not have a direct effect on the developing baby, studies suggest that a womans stress level, including stress associated with OCD, can reduce blood flow through the placenta. This can lead to preterm birth, reduced fetal growth, possible spontaneous abortion, and possibly emotional or behavioral problems for the newborn during childhood. After birth, the condition also can lead to feeding problems for the newborn.
What to consider about taking medications when you are pregnant or breastfeeding:
- The risks to yourself and your baby if you do not treat the OCD
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat my OCD during pregnancy?
Medications that are used often to treat OCD include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and citalopram. Other drugs that work against OCD include clomipramine, risperidone, haloperidol, olanzapine, quetiapine, and aripiprazole. Of all of these, SSRIs are the most commonly used group of medications for OCD during pregnancy, as studies suggest that they are fairly safe for the developing baby.
Who should NOT stop taking medication for OCD during pregnancy?
The decision on whether to use medications for OCD is often a tough call, especially during pregnancy, but if you are on medication that works well against your OCD symptoms, it is generally a good idea to continue taking it.
What should I know about choosing a medication for my OCD during pregnancy?
You may find Pregistrys expert reports about the individual medications used to treat OCD here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for my OCD when I am breastfeeding?
SSRI medications given to the mother are considered fairly safe for a nursing infant, as there is very little absorption into breast milk.
What alternative therapies besides medications can I use to treat my OCD during pregnancy?
Behavioral treatments, particularly cognitive behavioral therapy (CBT), are available and can be effective in reducing symptoms of OCD.
What can I do for myself and my baby when I have OCD during pregnancy?
Keep an open mind to all treatments, including medications and behavioral therapies. There is a great deal of variation in the response to treatment among people with OCD. Its generally best to see what works best for you and to stick with that treatment.
Resources for OCD in pregnancy:
For more information about OCD during and after pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or contact the following organizations:
- Royal College of Psychiatrists: Perinatal Obsessive Compulsive Disorder
- International OCD Foundation: What is OCD