Skip to main content
SpringerLink
Log in

Obsessive–Compulsive Disorders

  • Chapter
  • First Online:
Key Topics in Perinatal Mental Health

  • 998 Accesses

Abstract

Obsessive–compulsive disorder (OCD) is a relatively common psychiatric disorder with a multifactorial etiology. Biological and psychosocial factors play a key role in modulating the liability to OCD. Pregnancy, especially the third trimester, and the postpartum period are at risk of onset, recurrence, or exacerbation of OCD, leading to severe suffering and impairment for the patient, the baby, and the family as well. Peripartum OCD is more likely to be characterized by aggressive thoughts focused on the baby and obsessions about contamination with associated compulsions involving repetitive checking and cleaning. Perinatal OCD symptoms may cause severe personal distress, significant levels of anxiety, and feelings of guilt. Consequently, women are unlikely to report obsessional thoughts to family or healthcare professionals, and perinatal OCD is undetected and untreated. Timely diagnosis and effective treatments should be offered to patients in order to avoid persistent impairment in family life and activities of daily living, as well as extensive family involvement and accommodation of OCD symptoms, with a burden that leads families to increase their distress and reduce their global functioning. The purpose of the present chapter is to address prevalence, etiopathogenesis, clinical features, and clinical management of peripartum OCD.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover 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. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-V. Arlington, VA: APA; 2013.

    Book  Google Scholar 

  2. Stein DJ, Costa DLC, Lochner C, et al. Obsessive–compulsive disorder. Nat Rev Dis Primers. 2019;5(1):52.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Pauls DL, Abramovitch A, Rauch SL, et al. Obsessive–compulsive disorder: an integrative genetic and neurobiological perspective. Nat Rev Neurosci. 2014;15:410–24.

    Article  CAS  PubMed  Google Scholar 

  4. Maina G, Rosso G, Zanardini R, et al. Serum levels of brain-derived neurotrophic factor in drug-naïve obsessive-compulsive patients: a case-control study. J Affect Disord. 2010b;122(1–2):174–8.

    Article  CAS  PubMed  Google Scholar 

  5. Fernandez TV, Leckman JF. Prenatal and perinatal risk factors and the promise of birth cohort studies: origins of obsessive-compulsive disorder. JAMA Psychiatry. 2016;73(11):1117–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Diaz SF, Grus LR, Sichel DA, et al. Obsessive-compulsive disorder in pregnancy and the puerperium. Am Psychiatr Press Rev Psychiatry. 1997;16(97–11):216.

    Google Scholar 

  7. Maina G, Albert U, Bogetto F, et al. Recent life events and obsessive-compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Res. 1999;89:49–58.

    Article  CAS  PubMed  Google Scholar 

  8. Albert U, Maina G, Bogetto F, et al. The role of recent life events in the onset of obsessive-compulsive disorder. CNS Spectr. 2000;5(12):44–50.

    Article  CAS  PubMed  Google Scholar 

  9. Maina G, Vaschetto P, Ziero S, et al. The post-partum as specific risk factor for the onset of obsessive-compulsive disorder: clinical- controlled study. Epidemiol Psichiatr Soc. 2001;10(2):90–5.

    Article  CAS  PubMed  Google Scholar 

  10. Imthon AK, Caldart CA, do Rosário MC, et al. Stressful life events and the clinical expression of obsessive-compulsive disorder (OCD): an exploratory study. J Clin Med. 2020;9(10):3371.

    Article  Google Scholar 

  11. Rosso G, Albert U, Asinari GF, et al. Stressful life events and obsessive–compulsive disorder: clinical features and symptom dimensions. Psychiatry Res. 2012a;197(3):259–64.

    Article  PubMed  Google Scholar 

  12. Rasmussen SA, Eisen JL. The epidemiology and clinical features of obsessive-compulsive disorder. Psychiatr Clin North Am. 1992;15(4):743–58.

    Article  CAS  PubMed  Google Scholar 

  13. Albert U, Manchia M, Tortorella A, et al. Admixture analysis of age at symptom onset and age at disorder onset in a large sample of patients with obsessive–compulsive disorder. J Affect Disord. 2015;187:188–96.

    Article  PubMed  Google Scholar 

  14. Frydman I, do Brasil PE, Torres AR, et al. Late-onset obsessive-compulsive disorder: risk factors and correlates. J Psychiatr Res. 2014;49:68–74.

    Article  PubMed  Google Scholar 

  15. Ravizza L, Maina G, Bogetto F. Episodic and chronic obsessive-compulsive disorder. Depress Anxiety. 1997;6(4):154–8.

    Article  CAS  PubMed  Google Scholar 

  16. Sharma E, Math SB. Course and outcome of obsessive-compulsive disorder. Indian J Psychiatry. 2019;61:S43–50.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Tükel R, Oflaz SB, Özyildirım I, et al. Comparison of clinical characteristics in episodic and chronic obsessive-compulsive disorder. Depress Anxiety. 2007;24:251–5.

    Article  PubMed  Google Scholar 

  18. Drummond LM, Hameed AK, Ion R. Physical complications of severe enduring obsessive-compulsive disorder. World Psychiatry. 2011;10(2):154.

    Article  Google Scholar 

  19. Di Salvo G, Pessina E, Aragno E, et al. Impact of comorbid obsessive-compulsive disorder on suicidality in patients with bipolar disorder. Psychiatry Res. 2020;290:113088.

    Article  PubMed  Google Scholar 

  20. Adam Y, Meinlschmidt G, Gloster AT, et al. Obsessive-compulsive disorder in the community: 12-month prevalence, comorbidity and impairment. Soc Psychiatry Psychiatr Epidemiol. 2012;47:339–49.

    Article  PubMed  Google Scholar 

  21. Maina G, Albert U, Salvi V, et al. Early-onset obsessive–compulsive disorder and personality disorders in adulthood. Psychiatry Res. 2008a;158:217–25.

    Article  PubMed  Google Scholar 

  22. Torres AR, Prince MJ, Bebbington PE, et al. Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. Am J Psychiatry. 2006;163:1978–85.

    Article  PubMed  Google Scholar 

  23. Angelakis I, Gooding P, Tarrier N, et al. Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clin Psychol Rev. 2015;39:1–15.

    Article  PubMed  Google Scholar 

  24. Albert U, De Ronchi D, Maina G, et al. Suicide risk in obsessive-compulsive disorder and exploration of risk factors: a systematic review. Curr Neuropharmacol. 2019a;17:681–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Howard LM, Khalifeh H. Perinatal mental health: a review of progress and challenges. World Psychiatry. 2020;19(3):313–27.

    Article  PubMed  PubMed Central  Google Scholar 

  26. McGuinness M, Blissett J, Jones C. OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behav Cogn Psychother. 2011;39:285–310.

    Article  PubMed  Google Scholar 

  27. McKee K, Admon LK, Winkelman TNA, et al. Perinatal mood and anxiety disorders, serious mental illness, and delivery-related health outcomes, United States, 2006–2015. BMC Womens Health. 2020;20(1):150.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Fawcett EJ, Fairbrother N, Cox ML, et al. The prevalence of anxiety disorders during pregnancy and the postpartum period: a multivariate bayesian meta-analysis. J Clin Psychiatry. 2019;80(4):18.

    Article  Google Scholar 

  29. Uguz F, Gezginc K, Zeytinci IE, et al. Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Compr Psychiatry. 2007;48(5):441–5.

    Article  PubMed  Google Scholar 

  30. Sharma V, Sommerdyk C. Obsessive–compulsive disorder in the postpartum period: diagnosis, differential diagnosis and management. Womens Health. 2015;11(4):543–52.

    CAS  Google Scholar 

  31. House SJ, Tripathi SP, Knight BT, et al. Obsessive-compulsive disorder in pregnancy and the postpartum period: course of illness and obstetrical outcome. Arch Womens Ment Health. 2016;19(1):3–10.

    Article  PubMed  Google Scholar 

  32. Steiner M, Dunn E, Born L. Hormones and mood: from menarche to menopause and beyond. J Affect Disord. 2003;74(1):67–8.

    Article  CAS  PubMed  Google Scholar 

  33. Chaudron LH, Nirodi N. The obsessive–compulsive spectrum in the perinatal period: a prospective pilot study. Arch Womens Ment Health. 2010;13(5):403–10.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Leckman JF, Goodman WK, North WG, et al. The role of central oxytocin in obsessive compulsive disorder and related normal behaviour. Psychoneuroendocrinology. 1994;19(8):723–49.

    Article  CAS  PubMed  Google Scholar 

  35. Forray A, Focseneanu M, Pittman B, et al. Onset and exacerbation of obsessive-compulsive disorder in pregnancy and the postpartum period. J Clin Psychiatry. 2010;71(8):1061–8.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Zambaldi CF, Cantilino A, Montenegro AC, et al. Postpartum obsessive-compulsive disorder: prevalence and clinical characteristics. Compr Psychiatry. 2009;50(6):503–9.

    Article  PubMed  Google Scholar 

  37. Obeysekare JL, Cohen ZL, Coles ME, et al. Delayed sleep timing and circadian rhythms in pregnancy and transdiagnostic symptoms associated with postpartum depression. Transl Psychiatry. 2020;10(1):14.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Sharma V. Role of sleep deprivation in the causation of postpartum obsessive-compulsive disorder. Med Hypotheses. 2019;122:58–61.

    Article  PubMed  Google Scholar 

  39. Chang JJ, Pien GW, Duntley SP, et al. Sleep deprivation during pregnancy and maternal and fetal outcomes: is there a relationship? Sleep Med Rev. 2010;14(2):107–14.

    Article  PubMed  Google Scholar 

  40. Manchanda S, Singh H, Kaur T, et al. Low-grade neuroinflammation due to chronic sleep deprivation results in anxiety and learning and memory impairments. Mol Cell Biochem. 2018;449(1–2):63–72.

    Article  CAS  PubMed  Google Scholar 

  41. Uguz F, Ayhan MG. Epidemiology and clinical features of obsessive- compulsive disorder during pregnancy and postpartum period: a review. J Mood Disord. 2011;1(4):178–86.

    Article  Google Scholar 

  42. Rosso G, Bechon E, Bogetto F, et al. OCD during pregnancy and post-partum. Riv Psichiatr. 2012b;47(3):200–4.

    PubMed  Google Scholar 

  43. Starcevic V, Eslick GD, Viswasam K, et al. Symptoms of obsessive-compulsive disorder during pregnancy and the postpartum period: a systematic review and meta-analysis. Psychiatr Q. 2020;91:965–81.

    Article  PubMed  Google Scholar 

  44. Fairbrother N, Abramowitz JS. New parenthood as a risk factor for the development of obsessional problems. Behav Res Ther. 2007;45:2155–63.

    Article  PubMed  Google Scholar 

  45. Miller ES, Chu C, Gollan J, et al. Obsessive-compulsive symptoms during the postpartum period. J Reprod Med. 2013;58(3–4):115–22.

    PubMed  PubMed Central  Google Scholar 

  46. Yakut E, Uguz F, Aydogan S, et al. The course and clinical correlates of obsessive-compulsive disorder during the postpartum period: a naturalistic observational study. J Affect Disord. 2019;254:69–73.

    Article  PubMed  Google Scholar 

  47. Kaya V, Uguz F, Sahingoz M, et al. Pregnancy-onset obsessive-compulsive disorder: clinical features, comorbidity, and associated factors. Bull Clin Psychopharmacol. 2016;25(3):248–58.

    Article  Google Scholar 

  48. Kaminsky ZA, Osborne LM, Guglielmi V, et al. Postpartum depression biomarkers predict exacerbation of OCD symptoms during pregnancy. Psychiatry Res. 2020;293:113332.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Miller ES, Hoxha D, Wisner KL, et al. The impact of perinatal depression on the evolution of anxiety and obsessive-compulsive symptoms. Arch Womens Ment Health. 2015;18(3):457–61.

    Article  PubMed  Google Scholar 

  50. Overbeek T, Schruers K, Vermetten E, et al. Comorbidity of obsessive-compulsive disorder and depression: prevalence, symptom severity, and treatment effect. J Clin Psychiatry. 2002;63(12):1106–111210.

    Article  PubMed  Google Scholar 

  51. Arnold LM. A case series of women with postpartum-onset obsessive-compulsive disorder. Prim Care Companion J Clin Psychiatry. 1999;1(4):103–8.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Abramowitz JS, Franklin ME, Schwartz SA, et al. Symptom presentation and outcome of cognitive-behavioral therapy for obsessive-compulsive disorder. J Consult Clin Psychol. 2003;71(6):1049–57.

    Article  PubMed  Google Scholar 

  53. Williams KE, Koleva H. Identification and treatment of peripartum anxiety disorders. Obstet Gynecol Clin North Am. 2018;45(3):469–81.

    Article  PubMed  Google Scholar 

  54. Rodriguez-Cabezas L, Clark C. Psychiatric emergencies in pregnancy and postpartum. Clin Obstet Gynecol. 2018;61(3):615–27.

    Article  PubMed  Google Scholar 

  55. Sinesi A, Maxwell M, O’Carroll R, et al. Anxiety scales used in pregnancy: systematic review. BJPsych Open. 2019;5(1):e5.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Goodman WK, Price LH, Rasmussen SA, et al. The yale-brown obsessive compulsive scale. I. Development, use, and reliability. Arch Gen Psychiatry. 1989;46(11):1006–11.

    Article  CAS  PubMed  Google Scholar 

  57. Speisman BB, Storch EA, Abramowitz JS. Postpartum obsessive-compulsive disorder. J Obstetr Gynecol Neonatal Nurs. 2011;40(6):680–90.

    Article  Google Scholar 

  58. Lord C, Rieder A, Hall GBC, et al. Piloting the perinatal obsessive-compulsive scale (POCS): development and validation. J Anxiety Disord. 2011;25(8):1079–84.

    Article  PubMed  Google Scholar 

  59. Cox J, Holden J, Sagovsky R, et al. Detection of postnatal depression: development of the 10-item Edinburgh Postanatal depression scale. Br J Psychiatry. 1987;150(6):782–6.

    Article  CAS  PubMed  Google Scholar 

  60. Spielberg CD, Gorsuch RL, Luschene R, et al. State-trait anxiety inventory for adults; 1983.

    Google Scholar 

  61. Nillni YI, Mehralizade A, Mayer L, et al. Treatment of depression, anxiety, and trauma-related disorders during the perinatal period: a systematic review. Clin Psychol Rev. 2018;66:136–48.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Albert U, Di Salvo G, Solia F, et al. Combining drug and psychological treatments for obsessive-compulsive disorder: what is the evidence, when and for whom. Curr Med Chem. 2018b;25(41):5632–46.

    Article  CAS  PubMed  Google Scholar 

  63. Del Casale A, Sorice S, Padovano A, et al. Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Curr Neuropharmacol. 2019;17:710–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Katzman MA, Bleau P, Blier P, et al. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry. 2014;14(1):S1.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Maina G, Rosso G, Rigardetto S, et al. No effect of adding brief dynamic therapy to pharmacotherapy in the treatment of obsessive-compulsive disorder with concurrent major depression. Psychother Psychosom. 2010a;79(5):295–302.

    Article  PubMed  Google Scholar 

  66. Sharma V. Pharmacotherapy of postpartum obsessive-compulsive disorder: a systematic review. Expert Rev Neurother. 2018;18(12):925–31.

    Article  CAS  PubMed  Google Scholar 

  67. Koran LM, Hanna GL, Hollander E, et al. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007;164(7):5–53.

    PubMed  Google Scholar 

  68. Maina G, Saracco P, Giolito MR, et al. Impact of maternal psychological distress on fetal weight, prematurity and intrauterine growth retardation. J Affect Disord. 2008b;111(2–3):214–22.

    Article  PubMed  Google Scholar 

  69. Fumeaux CJF, Harari MM, Weisskopf E, et al. Risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation based on best available evidence - an update. Expert Opin Drug Saf. 2019;18(10):949–63.

    Article  CAS  Google Scholar 

  70. Albert U, Marazziti D, Di Salvo G, et al. A systematic review of evidence-based treatment strategies for obsessive- compulsive disorder resistant to first-line pharmacotherapy. Curr Med Chem. 2018a;25(41):5647–61.

    Article  CAS  PubMed  Google Scholar 

  71. Albert U, Barbaro F, Bramante S, et al. Duration of untreated illness and response to SRI treatment in obsessive-compulsive disorder. Eur Psychiatry. 2019b;58:19–26.

    Article  PubMed  Google Scholar 

  72. Damkier P, Videbech P. The safety of second-generation antipsychotics during pregnancy: a clinically focused review. CNS Drugs. 2018;32(4):351–66.

    Article  CAS  PubMed  Google Scholar 

  73. Belzeaux R, Sanguinetti C, Murru A, et al. Pharmacotherapy for the peripartum management of bipolar disorder. Expert Opin Pharmacother. 2019;20(14):1731–41.

    Article  CAS  PubMed  Google Scholar 

  74. Panchaud A, Weisskopf E, Winterfeld U, et al. Pharmacokinetic alterations in pregnancy and use of therapeutic drug monitoring. Therapie. 2014;69(3):223–34.

    Article  PubMed  Google Scholar 

  75. Chad L, Pupco A, Bozzo P, et al. Update on antidepressant use during breastfeeding. Can Fam Physician. 2013;59(6):633–4.

    PubMed  PubMed Central  Google Scholar 

  76. Cuomo A, Maina G, Neal SM, et al. Using sertraline in postpartum and breastfeeding: balancing risks and benefits. Expert Opin Drug Saf. 2018;17(7):719–25.

    Article  CAS  PubMed  Google Scholar 

  77. Creeley CE, Denton LK. Use of prescribed psychotropics during pregnancy: a systematic review of pregnancy, neonatal, and childhood outcomes. Brain Sci. 2019;9(9):235.

    Article  CAS  PubMed Central  Google Scholar 

  78. Fineberg NA, Hollanderd E, Pallanti S, et al. Clinical advances in obsessive-compulsive disorder: a position statement by the International College of Obsessive- Compulsive Spectrum Disorders. Int Clin Psychopharmacol. 2020;35(4):173–93.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosciences “Rita Levi Montalcini”, San Luigi Gonzaga University Hospital, University of Turin, Orbassano (TO), Italy

    Gianluca Rosso & Giuseppe Maina

Authors
  1. Gianluca Rosso
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giuseppe Maina
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Maina .

Editor information

Editors and Affiliations

  1. Department of Mental Health and Addiction Services, Niguarda Hospital, Milan, Italy

    Mauro Percudani

  2. Policentro Donna Ambulatory, Italian Marcé Society, Milan, Italy

    Alessandra Bramante

  3. Department of Mental Health and Addiction Services, Niguarda Hospital, Italian Marcé Society, Milan, Italy

    Valeria Brenna

  4. Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK

    Carmine Pariante

Rights and permissions

Reprints and permissions

Copyright information

© 2022 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

Rosso, G., Maina, G. (2022). Obsessive–Compulsive Disorders. In: Percudani, M., Bramante, A., Brenna, V., Pariante, C. (eds) Key Topics in Perinatal Mental Health. Springer, Cham. https://doi.org/10.1007/978-3-030-91832-3_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-91832-3_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-91831-6

  • Online ISBN: 978-3-030-91832-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation