obsessive compulsive disorder (OCD)

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What is perinatal OCD?

Obsessive Compulsive Disorder (OCD) is a relatively common mental illness. 


You may have had OCD before getting pregnant. For some women, pregnancy or birth can be the trigger for the disorder.


OCD has three main parts:

  • Thoughts or images that keep coming into your mind. These are called obsessions.
  • Anxiety - usually as a result of the obsessional thoughts.
  • Thoughts or actions you keep repeating to try to reduce your anxiety. These are called compulsions.

How common is it?

 OCD affects 2 in 100 women in pregnancy and 2 -3 in every 100 women in the year after giving birth. 

What causes it?

Perinatal OCD may be more likely in first time mothers but you can have it during or after any pregnancy. If you have had OCD before, you are more likely to get Perinatal OCD.


There may be many factors which cause you to have Perinatal OCD.  


  • Genes – OCD is sometimes inherited, so can occasionally run in the family.
  • Stress – Stressful life events bring it on in about one or two out of every three cases.
  • Life changes – Times where someone suddenly has to take on more responsibility – for example, puberty, the birth of a child or a new job.
  • Brain changes – We don't know if it’s a cause, or the result of OCD - but if you have the symptoms for more than a short time, researchers think that there may be changes in how chemical called serotonin (also known as 5HT) works in the brain12.
  • Personality – If you are a neat, meticulous, methodical person with high standards you may be more likely to develop OCD. These qualities are normally helpful, but can slip into OCD if they become too extreme.
  • Ways of thinking – Nearly all of us have odd or distressing thoughts or pictures in our minds at times – "what if I stepped out in front of that car?" or "I might harm my child". Most of us quickly dismiss these ideas and get on with our lives. But, if you have particularly high standards of morality and responsibility, you may feel that it's terrible to even have these thoughts. So, you are more likely to watch out for them coming back – which makes it more likely that they will.


Signs and symptoms

The main symptoms of Perinatal OCD are:


Obsessions


These are unwanted thoughts, images, urges or doubts. These happen repeatedly and can make you very distressed. Common examples are:

  • Intense fear that something is contaminated by germs or dirt. You find yourself worrying that  your baby will be harmed by contamination.
  • Worries about something you did or didn’t do. You may worry that you have left your doors or windows unlocked, or not sterilised your baby’s bottle correctly.
  • An image (a picture in your mind), or a thought, of harming someone. You may worry that you will accidentally or deliberately harm your baby, including sexual and violent thoughts. We know that people with OCD don't become violent or act on these thoughts.
  • Perfectionism. You may try to get everything exactly “right”.


Anxiety and other emotions


  • You may feel anxious, fearful, guilty, disgusted or depressed.
  • You feel better ( if you carry out your compulsive behaviour. This doesn't help for long.


Compulsions


These are the things you feel you need to do to reduce your anxiety, or to prevent what you fear from happening. They include:


  • Rituals - e.g. washing, cleaning or sterilising repetitively and excessively. This can take up so much time that it stops you doing other things you need to do.
  • Checking - e.g. repeatedly checking your baby throughout the night to ensure he/she is breathing.
  • Seeking reassurance - repeatedly asking others to tell you that everything is alright.
  • Correcting obsessional thoughts by counting, praying or saying a special word over and over again. This may feel as though it prevents bad things from happening. It can also be a way of trying to get rid of unpleasant thoughts or pictures in your mind.
  • Avoiding feared situations or activities. Someone with OCD will often avoid things that may trigger obsessions or compulsions. If you have perinatal OCD, you may avoid nappy changing, or hide all your knives. You may not attend mother and baby groups. Some women avoid spending time alone with their baby.

Treatment

The two main treatments are Cognitive Behavioural Therapy and Medication.  These can be used alone or in combination.


Cognitive Behavioural Therapy (CBT)

This is a talking therapy. CBT helps you examine patterns of thoughts and behaviour that distressing you. You will usually see a therapist on a weekly basis. Sometimes you can attend a full course of sessions over a shorter period.  Ypur GP can refer you onto services in your local area.  


Medication

Antidepressants are used to treat OCD. There are several antidepressants you can try. The ones most commonly used for OCD are called Selective Serotonin Reuptake Inhibitors (SSRIs). Sometimes other medications are added. 

Useful organisations

Maternal OCD: A charity set up by mothers recovered from perinatal OCD, who can provide support via email, twitter and skype. Email: info@maternalocd.org


OCD Action: A charity providing information about OCD, a dedicated OCD helpline, email support and advocacy service. Contact details: 0845 3906232; Email: support@ocdaction.org.uk


OCD UK: A charity run by and for people with lived experience of OCD including on line forum and support groups for people with OCD and family members Telephone and email support: Tel: 03332 127890. Email: support@ocduk.org


 Thank you to the Royal College of Psychiatrists for the information in this section

postpartum psychosis (PP)

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What is PP?

Postpartum Psychosis (PP) is a severe, but treatable, form of mental illness that occurs after having a baby. It can happen ‘out of the blue’ to women without previous experience of mental illness. There are some groups of women, women with a history of bipolar disorder for example, who are at much higher risk. PP normally begins in the first few days to weeks after childbirth. It can get worse very quickly and should always be treated as a medical emergency. Most women need to be treated with medication and admitted to hospital.

How common is it?

Postpartum psychosis (PP) is a serious, but rare, diagnosis occurring in around one in 1,000 births.

What causes it?

It is not clear what causes postpartum psychosis, but you're more at risk if you:


  • have a family history of mental health illness, particularly postpartum psychosis (even if you have no history of mental illness)
  • already have a diagnosis of bipolar disorder or schizophrenia
  • you have a traumatic birth or pregnancy
  • you developed postpartum psychosis after a previous pregnancy

Signs and symptoms

There are a large variety of symptoms that women with PP can experience. Women may be:


  • Excited, elated, or ‘high’.
  • Depressed, anxious, or confused.
  • Excessively irritable or changeable in mood.


Postpartum Psychosis includes one or more of the following:


  • Strange beliefs that could not be true (delusions).
  • Hearing, seeing, feeling or smelling things that are not there (hallucinations).
  • High mood with loss of touch with reality (mania).
  • Severe confusion.


These are also common symptoms:


  • Being more talkative, sociable, on the phone an excessive amount.
  • Having a very busy mind or racing thoughts.
  • Feeling very energetic and like ‘super-mum’ or agitated and restless.
  • Having trouble sleeping, or not feeling the need to sleep.
  • Behaving in a way that is out of character or out of control.
  • Feeling paranoid or suspicious of people’s motives.
  • Feeling that things are connected in special ways or that stories on the TV or radio have special personal meaning.
  • Feeling that the baby is connected to God or the Devil in some way.

Treatment

Most women need to be treated in hospital. Ideally, this would be with your baby in a specialist psychiatric unit called a mother and baby unit (MBU). But you may be admitted to a general psychiatric ward until an MBU is available.


Medication

You may be prescribed one or more of the following:


  • Antidepressants – to help ease systems of depression
  • Antipsychotics – to help with manic and psychotic symptoms, such as delusions or hallucinations 
  • Mood stabilisers (for example, lithium) – to stabilise your mood and prevent symptoms recurring 


Psychological therapy

As you move forward with your recovery, your GP may refer you to a therapist for cognitive behavioural therapy (CBT).  CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.


Electroconvulsive therapy (ECT)

ECT is used only very rarely. You may have this therapy if your symptoms are particularly severe – for example, if you have severe depression or mania.


Most women with postpartum psychosis make a full recovery as long as they receive the right treatment.

Useful organisations

Action for Postpartum Psychosis


A wonderful charity providing award winning peer support, information and training 


https://www.app-network.org/


020 33229900

app@app-network.org


Action on Postpartum Psychosis

c/o Birmingham Mother & Baby Unit

The Barberry National Centre for Mental Health

25 Vincent Drive, Birmingham, B15 2FG


Thank you to APP and NHS Choices for the information in this section 

tokophobia

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What is tokophobia?

 Tokophobia refers to a marked fear of childbirth (and sometimes fear of pregnancy) that gives rise to anxiety symptoms. There is usually avoidance of anything related to childbirth, such as talking about childbirth, watching programmes about childbirth and pregnancy itself is often avoided. 

How common is it?

 Approximately 14% of women may experience severe tokophobia: many more will have mild to moderate anxieties about childbirth.  Some men also experience tokophobia, with the fear usually focused on the health of mother and child during birth.  

What causes it?

 Tokophobia can happen if you have:


  • a fear of childbirth in your family
  • heard frightening birth stories from people in your family
  • or have had an anxiety disorder
  • experienced sexual abuse, assault or rape
  • had gynaecological problems

Signs and symptoms

 Symptoms of tokophobia can include:


  • Sleep disturbances 
  • Panic attacks
  • Nightmares
  • Feelings of dread at the thought of pregnancy and birth
  • Anxiety and depression
  • Extreme fear of birth defects, stillbirth, or maternal death
  • Insistence on a Caesarean section for their birth

Treatment

  • Discuss your fears with your doctor or midwife. Some anxiety is normal, and they may be able to provide reassurance and further assistance.


  • Begin forming a birth plan. Talk to your doctor about your wants and needs, including your options for pain management and giving birth. Having a plan can help you feel more empowered and in control.


  • Talk to people you trust. Knowing that there are people who understand your fears and are there to offer support can help reduce anxiety.


  • Avoid childbirth “horror stories.” If people try to share stories that you do not want to hear, it is ok to ask them to stop.


  • Find a good quality antenatal class. Learning about what happens during childbirth and what you can do to manage labor pain can help you feel more capable as your approach giving birth.  


  • Talk to a mental health professional.  Cognitive Behavioural Therapy (CBT) is particularly useful for phobias and can be accessed through your GP or local talking therapies service.