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Postpartum Obsessive Compulsive Disorder

By Jenette Restivo
ABC news

B O S T O N, Jan. 23 For new mothers, having a baby is a time of emotional highs. But the postpartum period can also deliver a severe blow to the state of mind of some women.

"I was constantly shuddering at the thoughts that were going on in my mind," the Rev. Kristen Looney, a new mother, told ABCNEWS' Deborah Roberts in an interview for 20/20 Downtown.

Looney said she was tormented by fears that she might harm her baby girl, Caitlin. One of the most distressing thoughts, she said, was that of drowning her newborn. "It was horrible to give her a bath, and once I got her in the towel, there was huge relief, like, 'She's safe, she's out.'"
She also worried that she would suffocate the baby or throw Caitlin into the fireplace.

And while such horrific thoughts may seem inexcusable or even insane to many people, mental health professionals say they are — while potentially serious to the mother's mental health if left untreated — "more bark than bite" in terms of posing direct harm to the child.

OCD vs. Psychosis
Looney's symptoms are part of postpartum obsessive compulsive disorder, or postpartum OCD, a condition in which a new mother's hypervigilance about possible harm to her baby (posed by other people, situations or even herself) leads to intrusive thoughts, obsessive thoughts, avoidance behavior, anxiety, depression or fear.

Women with postpartum OCD will typically have thoughts that are out of character and very frightening. She may be consumed with recurrent thoughts of harm coming to her infant from other people or other situations, or even herself. She might be so preoccupied with harming her child that she avoids the baby all together.

But mental health professionals are clear in drawing the distinction between postpartum OCD and postpartum psychosis, an extremely serious and rare mental illness that is at issue in the trial of Andrea Yates, the Houston mother who drowned her five children last year.

The symptoms of postpartum OCD "may be uncomfortable and even tormenting to a woman, but in postpartum psychosis, a woman will act on those thoughts," says Dr. Lee Cohen, director of the Perinatal and Reproductive Psychiatry Clinical Research Program at Massachusetts General Hospital in Boston.

Women afflicted with postpartum psychosis tend to have difficulty sleeping, are prone to agitation or hyperactivity, and intermittently experience delusions, hallucinations and paranoia. In this delusional state, a mother loses touch with reality and may no longer be able to distinguish between right and wrong.

By contrast, experts say, women afflicted with postpartum OCD understand the thoughts are wrong.

Occurrence of OCD
Obsessive compulsive disorder is a mental disorder that has received a fair amount of media attention, including Jack Nicholson's depiction of a dry-witted neurotic in the movie As Good As It Gets.

The National Institute for Mental Health reports that about 3 percent of people in the United States have OCD, making it more common than either schizophrenia, bipolar disorder or panic disorder.

Still, experts aren't quite sure of the prevalence of OCD in new mothers, though they say their clinical experience suggests it's high.

Liz Torres, a psychologist at McLean Hospital in Belmont, Mass., and a psychology instructor at Harvard, says she has seen many patients with the condition in her own clinical practice.

"Pregnancy throws your mood-regulating system into the air. This is a biochemical experience and a major life transition," says Torres. Some experts suspect that the cause of postpartum OCD is associated with a cascade of hormones released by the brain during pregnancy and birth.

A history of premenstrual syndrome, infertility, stress in the marriage, or a difficult delivery can all contribute to the condition.

And while a past history of OCD prior to delivery or a family history of anxiety or mood disorders places a woman at greater risk in the postpartum period, the condition can also surface in women who have had not prior symptoms.

Finding Help
Aside from the debilitating symptoms, Torres says one of her main concerns with postpartum OCD is that women feel too embarrassed to talk about it. "A lot of women will tell [physicians] of their OCD thoughts. The problem is that women don't tell each other about it."

Cohen says women often keep their symptoms to themselves for fear of the consequences of disclosure. "Unfortunately, women are very reluctant to reveal those symptoms because they're fearful that [child welfare] is going to be at their door taking their baby away. So this is a disorder in which patients suffer in silence," says Cohen.

Besides talking with friends and family, mental health professionals urge women suffering from postpartum OCD to seek professional help to alleviate their symptoms.

"It is common for young mothers to have a fear of hurting her child. If she's having those feelings at all, she should talk to a professional. If, for no other reason, to tell them [the women] that it's OK," says Jerilynn Ross, president and CEO of the Anxiety Disorders Association of America.

Professionals can also offer women proven treatment options such as behavior therapy or medications. That's especially important, because, left untreated, postpartum OCD may lead to more chronic conditions such as depression or a recurrence of the condition with a subsequent pregnancy, say experts.

"I think the good news is that today we have really good treatments for OCD in general," says Cohen, who adds that the class of antidepressants called SSRIs (such as Prozac and Zoloft) are "exquisitely effective" in treating the condition.
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