Beyond Depression: Diagnosing Postpartum OCD–Part 2 (& video)

 

Beyond Depression: Diagnosing Postpartum OCD (Part 2); www.DrChristinaHibbert.com  #PPD #Postpartum #Pregnancy #OCDIn Part 1, we explained the symptoms of Pregnancy/Postpartum Obsessive-Compulsive Disorder (PPOCD) and what makes this disorder the most misunderstood of all the Perinatal Mood/Anxiety Disorders. (If you have not yet read Part 1, I suggest doing so before moving on.)

 

In Part 2 we discuss the diagnosis of PPOCD, what makes it so tricky, and tips for families and providers to help mothers get the best possible diagnosis and care.

 

Postpartum OCD: The Most Misdiagnosed Disorder

Postpartum Obsessive-Compulsive Disorder is not only considered the most misunderstood disorder; it’s also considered the most misdiagnosed. Many people—even well-established medical and mental health professionals—confuse Postpartum OCD with Postpartum Depression (PPD), thinking these mothers are “just depressed,” and failing to recognize the extreme anxiety and duress these mothers and families are experiencing. Though treatment for PPD might help with the depressive symptoms, the misdiagnosed PPOCD mother often fails to get the treatment she needs to address the intrusive thoughts and reduce her anxiety.

Even more harmful, PPOCD is too often misdiagnosed as the more rare and potentially life-threatening Postpartum Psychosis (which affects 1 in 1000 mothers). In my 13 years as a psychologist and expert on pregnancy/postpartum mental health, I have witnessed the unfortunate hospitalization of several mothers experiencing postpartum OCD. Misdiagnosed with Postpartum Psychosis, these mothers were seen as a threat to their infants and subsequently hospitalized in behavioral health units, placed on antipsychotic medication, and separated from their infants—many for up to a month or more. Most were also told they must stop breastfeeding, and some were reported to Child Protective Services.

The damage done to these mothers–and their husbands, infants, and families–is, understandably, heartbreaking. Only once they were released and began to research their symptoms did they learn about Postpartum OCD. They were eventually able to find me, or another expert on Perinatal Mental Health, and receive the proper diagnosis and treatment, including a referral for the right kind of medication, and psychotherapy.

This is why I am writing this article—because medical and mental health providers, and families, need education on perinatal mental health if we are to prevent the unnecessary suffering of so many mothers, babies, and families.

 

Why is PPOCD so often Misdiagnosed?

Having trained hundreds of providers over the past nine years as Founder of the Arizona Postpartum Wellness Coalition, I’ve learned a few things about why PPOCD is so misdiagnosed:

1)   These are usually well-meaning providers who are trying to do the right thing. They simply lack important information, education, and/or clinical experience to make the right diagnosis. Unfortunately, some have never even heard of Postpartum OCD.

2)   Providers want to protect the baby, and rightly so. Keeping babies safe is obviously a top priority, as it should be. Unfortunately, providers hear “thoughts/images about harm coming to the baby,” and they panic. They immediately fear the mother may be a threat to her child, so they act in order to protect the baby without taking the time to research, assess thoroughly, and consult.

3) However, protecting the mother is part of protecting the baby (I think most providers would agree). Babies need healthy, strong mothers who are receiving the best treatment to help them get well soon. With proper training, education, and diagnosis, we can protect both babies and their mothers. We can heal families and not cause more harm.

 

Diagnosis: Postpartum OCD vs. Psychosis

 Watch this 3-Minute Therapy video, “Beyond PPD: Diagnosing Postpartum OCD,” on my YouTube Channel, and watch Part 1 video, “Beyond PPD: Understanding Postpartum OCD” here. Then, please continue reading, below.

[stream provider=youtube flv=http%3A//www.youtube.com/watch%3Fv%3Dve9MghsJLNc img=x:/img.youtube.com/vi/ve9MghsJLNc/0.jpg embed=false share=false width=640 height=360 dock=true controlbar=over bandwidth=high autostart=false responsive=16:9 /]

 

Following is a list of the distinct differences between Postpartum OCD and Psychosis. Understanding these differences can help families and providers distinguish PPOCD from Postpartum Psychosis to help make the correct diagnosis. Please note: This is article is merely for educational purposes, however, and should never replace true medical/mental health assessment and care.

Postpartum OCD:

  • Thoughts are in the mind–they are non-psychotic, intrusive thoughts. This means the woman is still “in reality,” and the thoughts come from her mind and not her outside environment. She does not want the thoughts to come. They intrude upon her.
  • Women recognize thoughts/images are unhealthy. They are highly aware these thoughts are not “okay,” and they may work very hard to try and stop the thoughts from coming (hence the compulsive behaviors).
  • Extreme anxiety related to thoughts/images. These mothers are worried, stressed, and fearful of the thoughts. They experience great distress because of them.
  • More gradual onset and brief duration. Sometimes OCD starts in pregnancy, then continues and perhaps intensifies postpartum. Other times it starts days, weeks, or even months after the baby is born. Episodes tend to last for seconds or minutes, though the aftereffects (like anxiety) can last much longer.
  • Overly concerned about “becoming crazy.” They will research and ask loved ones/providers, over and over, “Are you sure I’m not going crazy?” This only proves they are well-aware of what they are experiencing, and not at all out of touch with reality.

 

Postpartum Psychosis:

  • Thoughts are psychotic in nature—including delusions (false beliefs) and/or hallucinations (hearing/seeing things). This means the mother is experiencing a break with reality.
  • Women do not recognize actions/thoughts are unhealthy. Psychotic people do not know that what they are saying/doing are wrong, scary, or in anyway abnormal.
  • May seem to have less anxiety when indulging in thoughts/behavior. Psychotic people typically seem to feel less anxious the more they indulge in their psychotic thoughts/behaviors. Their affect is usually very flat, with a detached, spaced out sense about them.
  • Acute onset—a sudden noticeable change from normal functioning. Postpartum Psychosis usually occurs quickly, often in the first seven days postpartum. Symptoms come suddenly, and family members often describe a sudden, distinct difference in behavior and personality.
  • Thoughts are longer in duration and more all-encompassing. Psychotic episodes may last for hours or days, and it’s as if they take over the person, as if she is not herself.
  • Thoughts come from the environment. She may have thoughts in response to people/situations around her, wheras PPOCD mothers’ thoughts intrude into their minds and are not a result of their outside world.

 

Final Important Things To Know about Diagnosing Postpartum OCD

My intention with this article is to open the door to greater awareness and education about PPOCD, so we can help mothers, babies, fathers, and families get the diagnosis and care they need and deserve. Again, this article is in no way intended to replace medical/mental health care, though I hope it might enhance it.

For Mothers & Families:

  • Postpartum OCD is highly treatable, and there are some excellent providers out there who can help you with what Beyond Depression: Diagnosing Postpartum OCD (Part 2) (& video); www.DrChristinaHibbert.com #PPD #postpartum #pregnancy #OCDyou need.
  • Postpartum Support International (PSI) is the best resource to help you find the proper provider for you. They also provide phone support and advocacy, so please contact them for help. I have been a member, volunteer, state coordinator, and board member with PSI over the past 15 years, and I can attest that they are the best postpartum resource around.
  • Remember to keep trying until you find the provider that is right for you. It’s not only okay to seek a second (or even third) opinion, it is recommended if you feel you’re not receiving the proper care.
  • Involve your partner/husband/mother/family in your care, too. This will help you feel like you have a team supporting you and will help you keep at it until you get the right care. (More on treatment of OCD to come in Part 3, so Subscribe, below, or check back soon. Also, check out my Postpartum Depression Treatment series for more on overall treatment options.) 

 

For Medical/Mental Health Provders:

  • Connect with others in this field, and consider joining PSI. Attend their annual conference and others like it, for more in-depth education on perinatal mental health. I’ve been attending for 14 years, and they are incredibly informative every time.
  • Most importantly: If you feel uncomfortable diagnosing PPOCD on your own, seek consultation or supervision. If you can find a perinatal mental health expert in your area, consult with them, or refer your client to them, if that feels like the best option. Call and explain your concerns, discussing them together. This is the best way to ensure you are keeping both baby and mom—and the whole family—safe and well.
  • Another important factor in making the right diagnosis is involving the mother’s husband/partner and family in the assessment. Ask them how she has been and how they feel about her. Involve them in helping you monitor her symptoms and getting her to other providers for treatment, as needed.

 

This is such an important topic, and one I fear gets far too little attention. So, join me–let’s start this discussion, and keep it going. Let’s get talking, so our mothers, fathers, families, and healthcare providers will understand Postpartum OCD. Let’s get educating so our postpartum families will no longer have to suffer in silence–so they will receive the concern, help, and care they so rightly deserve.

 

Read Part 3 of this “Beyond Depression” series, on Postpartum OCD & Treatment.

Read Part 1:  “Beyond Depression, Part 1: Understanding Pregnancy/Postpartum OCD

 

I’ve received more feedback, messages, emails, and discussion on this topic than any other, ever, on my site. If you have something to say about this, I would like to hear it. Please leave a comment, below, with your thoughts/questions/concerns. Let’s get and keep this important dialogue going.

#1 Amazon Bestseller, This Is How We Grow, by Dr. Christina Hibbert, Available now on Amazon.com! www.ThisIsHowWeGrow.com
Be sure to check out Dr. Hibbert’s Amazon Bestseller, This is How We Grow
available now on Amazon.com!

 

Beyond Depression: Diagnosing Postpartum OCD (Part 2); www.DrChristinaHibbert.com  #PPD #Postpartum #Pregnancy #OCD

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Related Articles/Posts:

Beyond Depression: Understanding Pregnancy/Postpartum OCD (Part 1) (& video)

Beyond Depression: Postpartum OCD Treatment (part 3) (& video)

Pregnancy & Postpartum Emotional Health

Postpartum Depression Treatment

Postpartum Depression Treatment: For Dads & Partners

Postpartum Depression Treatment: For Couples

Postpartum Depression Treatment: Complementary Alternative Modalities

Postpartum Depression Treatment: Psychotherapy

Postpartum Depression Treatment: Medication

Postpartum Depression Treatment: Self-Help

Postpartum Depression Treatment: Sleep

Postpartum Depression & Men: The Facts on Paternal Postnatal Depression

The Baby Blues & You

Postpartum Survival Mode

16 Things I’d Like My Postpartum Self to Know, 16 Years & 6 Kids Later (PSI Blog Hop)

Moving Beyond Shame: The Ultimate Power of Support & Time (PSI Blog Hop) 

Pregnancy & Postpartum Mood & Anxiety Disorders: Are Women of Advanced Maternal Age at Higher Risk?

In Praise of Fathers: 10 Research-Based Ways Dads Impact Kids for the Better

5 Reasons Self-Esteem is a Myth

How to Feel Self-Worth: “The Pyramid of Self-Worth”

Thought Management, Part 1: The Relationship between Thoughts, Feelings, the Body, & Behavior

Womens’ Emotions & Hormones– Series

Achieving Balance–Why You’ve Got it Wrong, & How to Get it Right

Pregnancy & Postpartum Loss, Grief, & Family Healing (Part 1)

How to Cope with and Treat Perinatal Loss & Grief (Part 2)

 

 

Pregnancy/Postpartum Resources & Help:

Postpartum Support International Website (Worldwide help and support for new mothers and families, including a bilingual hotline and state/country coordinators to help you find the right treatment provider or support in your area.)

Postpartum Progress Blog (Excellent source of education and support for mothers and families)

Pregnancy & Postpartum Resources

Arizona Postpartum Wellness Coalition (AZ Support Groups, Events, Education)

Postpartum Stress Center (Education for Providers and Families)

Postpartum Couples Website

 

References:

Facts for this article were taken from The Arizona Postpartum Wellness Coalition‘s 2-Day, research-based course, Perinatal Mood/Anxiety Disorders: Assessment & Treatment, and my 1-Day, research based course, Perinatal Mood/Anxiety Disorders: Advanced Clinical Skills. For more on these programs, please visit www.postpartumcouples.com or www.azpostpartum.org, or email me. For more on PPOCD and links to research, please visit www.postpartum.net.

 

**This article is not intended to replace proper medical/mental health care. If you think you may be suffering from Postpartum OCD, please contact your medical or mental health provider, or PSI, for referrals/help/support.**

Beyond Depression: Understanding Pregnancy & Postpartum OCD–Part 1

Beyond Depression: Understanding #Pregnancy & #Postpartum Obsessive-Compulsive Disorder; www.DrChristinaHibbert.com #PPDBeyond Postpartum Depression (PPD)

Postpartum Depression (PPD) is the most commonly talked about and treated form of Perinatal Mood/Anxiety Disorder (PMAD). It affects as many as one in five new mothers (up to 20%), and can have a significant impact on the father, the infant, and the entire family.

Yet there is much to learn about Perinatal Mood/Anxiety Disorders beyond PPD. In fact, there’s a spectrum of disorders— ranging from the mild to the severe and including depression, various anxiety disorders, and yes, even psychosis.

The most misunderstood of these disorders is Pregnancy/Postpartum Obsessive-Compulsive Disorder (OCD).

 

What is Pregnancy/Postpartum Obsessive-Compulsive Disorder?

According to research, OCD affects 3-5% of all new mothers, and some studies estimate those rates might be even higher. [1] Symptoms may start in pregnancy and continue through postpartum, or they may begin after the baby is born—sometimes several months later.

 

Symptoms of Pregnancy/Postpartum Obsessive-Compulsive Disorder include:

  • Obsessions:
    • Recurrent, persistent thoughts, impulses or images that are intrusive and inappropriate.
    • These are typically related to the baby, and cause mothers intense anxiety or distress.
    • These thoughts/images are not simply excessive worry about real problems.
    • The mother attempts to ignore or suppress the thoughts/ images.
    • The mother recognizes these thoughts/images are a product of her own mind
  • Compulsions:
    • Repetitive behaviors or mental acts she feels driven to perform in response to the obsessive thoughts/images
    • These behaviors/mental acts are aimed at reducing/preventing some dreaded event or situation, but they are not connected in a realistic way or are clearly excessive.
  • A sense of horror about the obsessive thoughts/images.

 

Watch this video from my YouTube channel–> Beyond PPD: Understanding Postpartum OCD–3-Minute Therapy w/ Dr. Christina Hibbert. Then, continue reading, below.

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Other important facts about PPOCD symptoms:

  • The “obsessive” thoughts most pregnant/postpartum women experience are usually vivid images or thoughts in their head. These images are often like a movie playing in the mind and are typically centered around the baby. These women actually see terrible things happening to their body (in pregnancy) or the baby (postpartum), and it causes them deep distress.
  • The “compulsive,” ritualistic behaviors often include: checking the baby, avoiding situations that cause distress (like cooking, sleeping with the baby, or taking the baby up the stairs), and/or searching for information about her symptoms on the internet or in books, etc.
  • Unlike general OCD, in Pregnancy/Postpartum, the symptoms of OCD are directly related to baby.
  • There are often co-occurring symptoms of Depression related to the OCD thoughts/images.
  • Mothers feel intense anxiety/worry about the thoughts/images.
  • The mother recognizes the obsessions/compulsions are excessive.
  • They cause her severe distress or significantly interfere with normal life.

 

Understanding Pregnancy/Postpartum Obsessive-Compulsive Disorders

I’ve been working with pregnant and postpartum women for fifteen years, and I have helped many mothers deal with OCDBeyond Depression: Understanding Pregnancy & Postpartum Obsessive-Compulsive Disorder; www.DrChristinaHibbert.com #PPD in pregnancy and postpartum. In fact, a significant portion of my clients have presented with PPOCD. Here are a few things I have learned as I have treated PPOCD; I hope they will help you better understand PPOCD, too.

1)   Mothers experiencing symptoms of Pregnancy or Postpartum OCD present with extreme anxiety, or even fear, about their symptoms. They are often afraid they are “going crazy” or that they are going to become psychotic. I’ve even had a mother show up at my office with her bag packed—certain I would commit her to “the mental hospital” because of her symptoms, and ready to go if I did. (I didn’t.)

2)   These mothers are highly concerned about the welfare of their babies and go to extreme lengths to take care of and protect their children and families. They are devoted, wonderful mothers, but they will say things like, “What kind of mother would think such things about her baby?” They tend to take a severe hit to their sense of self-worth because of their symptoms, and that’s one reason therapy is so helpful, especially Cognitive-Behavioral Therapy–because it works to identify and correct these distorted thoughts and self-beliefs.

3)   These mothers are afraid of telling anyone about their OCD thoughts/images, because they fear others will take their baby away or say they are unfit as mothers (which, unfortunately, happens sometimes—see below).

4)   The fact that these mothers are so genuinely worried, nervous, and concerned about the thoughts/images they’re having is proof they are not psychotic. Psychotic people don’t understand what is real and what is not, and they do not experience anxiety about their disturbing thoughts. In fact, they find them ego-syntonic. (We’ll discuss this more in Part 2.)

5)   Unlike psychosis, which can be life-threatenting, PPOCD women are much more likely to harm themselves before ever letting anything happen to their babies. In fact, there are no incidents on record of a PPOCD mom ever harming her child.

6)   Part of my job as a psychologist specializing in Perinatal Mental Health is to help PPOCD moms understand the thoughts are not their fault. They’re a misfiring of the brain, and they mean nothing about the kind of mother a PPOCD mom really is. I help them get the right doctor who will understand their symptoms and work with them to find the right medication. I also work to help them understand their symptoms, overcome them, and feel like the wonderful mothers they are. (Read 3 Things Every Mom Needs to Hear, and How to Feel Self-Worth.)

7)   Unfortunately, many mental health and healthcare professionals do not understand Pregnancy/Postpartum OCD, and so many women have been unnecessarily diagnosed with Postpartum Psychosis and hospitalized. (Part 2 of this article discusses diagnosis in greater detail, and Part 3 discusses Treatment.)

8)   This is why greater education on Perinatal Mood/Anxiety Disorders is needed—for all medical and mental health providers—and why mothers and families need education, too, so they can find the treatment and providers who will understand and help them with their concerns.

9)   The good news is this: Pregnancy/Postpartum Obsessive-Compulsive Disorder is treatable–the gold standard of treatment being a combination of medication (to correct the brain chemistry and help the thoughts stop) and psychotherapy (preferably with someone who specializes in Perinatal Mental Health). Postpartum Support International (PSI) is an excellent resource to help you find a provider that is right for you.

 

To all mothers and families experiencing Postpartum or Pregnancy OCD…

Please remember this: “You are not alone. You are not to blame. With time, you will be well.” (PSI’s universal motto)

 

Join me in Part 2: Diagnosing Postpartum OCD (& video), as we discuss diagnosis, including taking a look at PPOCD vs. Psychosis. And in Part 3, we discuss PPOCD & Treatment.

#1 Amazon Bestseller, This Is How We Grow, by Dr. Christina Hibbert, Available now on Amazon.com! www.ThisIsHowWeGrow.com
Be sure to check out Dr. Hibbert’s Amazon Bestseller, This is How We Grow
available now on Amazon.com!

 

 

 Beyond Depression: Understanding #Pregnancy & #Postpartum Obsessive-Compulsive Disorder; www.DrChristinaHibbert.com #PPDJoin my  This is How We Grow Personal Growth Group!

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Don’t miss a thing! 

SUBSCRIBE, below, “like” my Facebook pages (Dr. Christina HibbertThis Is How We Grow) and follow me on Twitter,Pinterest, & Instagram!

 


 

 

 

Related Articles/Posts:

Beyond Depression: Diagnosing Postpartum OCD–Part 2 (& video)

Beyond Depression: Postpartum OCD Treatment–part 3 (& video)

Pregnancy & Postpartum Emotional Health

Postpartum Depression Treatment

Postpartum Depression Treatment: For Dads & Partners

Postpartum Depression Treatment: Complementary Alternative Modalities

Postpartum Depression Treatment: Psychotherapy

Postpartum Depression Treatment: Medication

Postpartum Depression Treatment: Self-Help

Postpartum Depression Treatment: Sleep

Postpartum Depression & Men: The Facts on Paternal Postnatal Depression

The Baby Blues & You

Postpartum Survival Mode

16 Things I’d Like My Postpartum Self to Know, 16 Years & 6 Kids Later (PSI Blog Hop)

Moving Beyond Shame: The Ultimate Power of Support & Time (PSI Blog Hop) 

Pregnancy & Postpartum Mood & Anxiety Disorders: Are Women of Advanced Maternal Age at Higher Risk?

5 Reasons Self-Esteem is a Myth

How to Feel Self-Worth: “The Pyramid of Self-Worth”

Thought Management, Part 1: The Relationship between Thoughts, Feelings, the Body, & Behavior

Womens’ Emotions & Hormones– Series

Achieving Balance–Why You’ve Got it Wrong, & How to Get it Right

Pregnancy & Postpartum Loss, Grief, & Family Healing (Part 1)

 

 

Pregnancy/Postpartum Resources & Help:

Postpartum Support International Website (Worldwide help and support for new mothers and families, including state and country coordinators to help you find the right treatment provider or support in your area!)

Postpartum Progress Blog (Excellent source of education and support for mothers and families)

Pregnancy & Postpartum Resources

Arizona Postpartum Wellness Coalition (AZ Support Groups, Events, Education)

Postpartum Stress Center (Education for Providers and Families)

Postpartum Couples Website

 

References:

[1] Brandes et al. (2004) Postpartum Onset Obsessive-Compulsive Disorder: Diagnosis & Management. Archives of Women’s Mental Health, vol. 7; is. 2: 99-102.
Ghadiali, N.  (2007).  Comorbidities in Perinatal Mental Health.  PSI 21st Annual Conference, presentation, June 22.  Kansas City, MO.
Labad, et. al. (2005). Female Reproductive Cycle & Obsessive-Compulsive Disorder. Journal of Clinical Psychiatry, 66(4):428-35.
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