Skip to main content
SpringerLink
Log in

Care of the Homicidal Patient in Pregnancy or During the Postpartum Period: Managing Intrusive Thoughts; Special Considerations for OCD

  • Chapter
  • First Online:
Women's Mood Disorders

  • 1035 Accesses

Abstract

Assessing the thoughts of perinatal women around harm to others, particularly harm to their babies, is a critical part of care that needs to occur systematically and regularly. Three cases are used to illustrate common situations related to thoughts of harm to their infants. Postpartum psychosis and perinatal obsessive-compulsive disorder (OCD) both associate with thoughts of harm to the infant and both are treatable medical conditions. However, differentiating intrusive thoughts from delusions and understanding all of the contributory factors for any woman is instrumental to developing treatment plans and ensuring that mother and child are safe and healthy. Some guiding principles are outlined. This chapter also discusses cultural and legal considerations around infanticide and filicide. Finally, treatment options for clear cases of postpartum psychosis and perinatal OCD, as well as cases that are not as clear, are described including medication and therapy.

I love him so much, but it’s obviously a terrible kind of love,” she agonized in a 13-page handwritten note. “It’s a love where I can’t bear knowing he is going to suffer physically and mentally/emotionally for much of his life. – Cindy Wachenheim

The New York Times

After Baby, an Unraveling

A Case Study in Maternal Mental Illness

By Pam Belluck

June 16, 2014

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Spinelli MG. Infanticide: contrasting views. Arch Womens Ment Health. 2005;8:15–24.

    Article  CAS  Google Scholar 

  2. Hudak R, Wisner KL. Diagnosis and treatment of postpartum obsessions and compulsions that involve infant harm. Am J Psychiatry. 2012;169:360–3.

    Article  Google Scholar 

  3. Brockington I. Suicide and filicide in postpartum psychosis. Arch Womens Ment Health. 2017;20:63–9.

    Article  Google Scholar 

  4. Yardley J. Despair plagued a mother held in children’s deaths. The New York Times. 2001.

    Google Scholar 

  5. Denmo DW. Who is Andrea Yates? A short story about insanity. Duke J. Gend. Law Policy. 2003;10:1.

    Google Scholar 

  6. Spinelli MG. Maternal infanticide associated with mental illness: prevention and the promise of saved lives. Am J Psychiatry. 2004;161:1548–57.

    Article  Google Scholar 

  7. Bergink V, Rasgon N, Wisner KL. Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry. 2016;173:1179–88.

    Article  Google Scholar 

  8. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA. 2006;296:2582–9.

    Article  CAS  Google Scholar 

  9. Brockington I. Late onset postpartum psychoses. Arch Womens Ment Health. 2017;20:87–92.

    Article  Google Scholar 

  10. Di Florio A, Forty L, Gordon-Smith K, Heron J, Jones L, Craddock N, Jones I. Perinatal episodes across the mood disorder spectrum. JAMA Psychiat. 2013;70:168–75.

    Article  Google Scholar 

  11. Rodriguez-Cabezas L, Clark C. Psychiatric emergencies in pregnancy and postpartum. Clin Obstet Gynecol. 2018;61:615–27.

    Article  Google Scholar 

  12. Resnick PJ. Child murder by parents: a psychiatric review of filicide. Am J Psychiatry. 1969;126:325–34.

    Article  CAS  Google Scholar 

  13. Sharma V, Bergink V, Berk M, Chandra PS, Munk-Olsen T, Viguera AC, Yatham LN. Childbirth and prevention of bipolar disorder: an opportunity for change. Lancet Psychiatry. 2019;6:786–92.

    Article  Google Scholar 

  14. Stanton J, Simpson A, Wouldes T. A qualitative study of filicide by mentally ill mothers. Child Abuse Negl. 2000;24:1451–60.

    Article  CAS  Google Scholar 

  15. Lawrence PJ, Craske MG, Kempton C, Stewart A, Stein A. Intrusive thoughts and images of intentional harm to infants in the context of maternal postnatal depression, anxiety, and OCD. Br J Gen Pract. 2017;67:376–7.

    Article  Google Scholar 

  16. Uguz F, Akman C, Kaya N, Cilli AS. Postpartum-onset obsessive-compulsive disorder: incidence, clinical features, and related factors. J Clin Psychiatry. 2007;68:132–8.

    Article  Google Scholar 

  17. Zambaldi CF, Cantilino A, Montenegro AC, Paes JA, de Albuquerque TLC, Sougey EB. Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics. Compr Psychiatry. 2009;50:503–9.

    Article  Google Scholar 

  18. Uguz F, Gezginc K, Zeytinci IE, Karatayli S, Askin R, Guler O, Kir Sahin F, Emul HM, Ozbulut O, Gecici O. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry. 2007;48:441–5.

    Article  Google Scholar 

  19. Rachman S. A cognitive theory of obsessions. Behav Res Ther. 1997;35:793–802.

    Article  CAS  Google Scholar 

  20. Abramowitz JS, Khandker M, Nelson CA, Deacon BJ, Rygwall R. The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behav Res Ther. 2006;44:1361–74.

    Article  Google Scholar 

  21. Fang A, Berman NC, Chen JA, Zakhary L. Treating obsessive-compulsive disorder in the postpartum period: diagnostic and cultural considerations. Harv Rev Psychiatry. 2018;26:82–9.

    Article  Google Scholar 

  22. Rohde A, Raic D, Varchmin-Schultheiß K, Marneros A. Infanticide: sociobiographical background and motivational aspects. Arch Womens Ment Health. 1998;1:125–30.

    Article  Google Scholar 

  23. Chan SW-C, Levy V, Chung TKH, Lee D. A qualitative study of the experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression. J Adv Nurs. 2002;39:571–9.

    Article  Google Scholar 

  24. Fernandez Arias P, Yoshida K, Brockington IF, Kernreiter J, Klier CM. Foetal abuse. Arch Womens Ment Health. 2019;22:569–73.

    Article  Google Scholar 

  25. Abramowitz JS, Schwartz SA, Moore KM. Obsessional thoughts in postpartum females and their partners: content, severity, and relationship with depression. J Clin Psychol Med Settings. 2003;10:157–64.

    Article  Google Scholar 

  26. Booth BD, Friedman SH, Curry S, Ward H, Stewart SE. Obsessions of child murder: underrecognized manifestations of obsessive-compulsive disorder. J Am Acad Psychiatry Law. 2014;42:66–74.

    PubMed  Google Scholar 

  27. Razali S, Fisher J, Kirkman M. “Nobody came to help”: interviews with women convicted of filicide in Malaysia. Arch Womens Ment Health. 2019;22:151–8.

    Article  Google Scholar 

  28. Spinelli M. Infanticide and American criminal justice (1980-2018). Arch Womens Ment Health. 2019;22:173–7.

    Article  Google Scholar 

  29. Granowsky E, Manzanares M, Rackers HS, Kimmel MC. NC Maternal Mental Health MATTERS: screening, assessment, and treatment of behavioral health conditions in primary care settings.

    Google Scholar 

  30. Klampfl SM, Bosch OJ. When mothers neglect their offspring: an activated CRF system in the BNST is detrimental for maternal behavior. Arch Womens Ment Health. 2019;22:409–15.

    Article  Google Scholar 

  31. Kimmel M. Hormonal contributions to perinatal obsessive–compulsive disorder. In: Biomarkers of postpartum psychiatric disorders. London: Elsevier; 2020. p. 111–25.

    Chapter  Google Scholar 

  32. Bergink V, Burgerhout KM, Koorengevel KM, Kamperman AM, Hoogendijk WJ, Lambregtse-van den Berg MP, Kushner SA. Treatment of psychosis and mania in the postpartum period. Am J Psychiatry. 2015;172:115–23.

    Article  Google Scholar 

  33. Amerio A, Maina G, Ghaemi SN. Updates in treating comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. J Affect Disord. 2019;256:433–40.

    Article  CAS  Google Scholar 

  34. Jones I, Craddock N. Bipolar disorder and childbirth: the importance of recognising risk. Br J Psychiatry. 2005;186:453–4.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Mary Kimmel

Authors
  1. Mary Kimmel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary Kimmel .

Editor information

Editors and Affiliations

  1. Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Elizabeth Cox

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Kimmel, M. (2021). Care of the Homicidal Patient in Pregnancy or During the Postpartum Period: Managing Intrusive Thoughts; Special Considerations for OCD. In: Cox, E. (eds) Women's Mood Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-71497-0_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-71497-0_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-71496-3

  • Online ISBN: 978-3-030-71497-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation