Postpartum Psychosis + Mental Health Stigma= 40 Years in Prison: It’s time to speak up!

Postpartum Psychosis + Mental Health Stigma= 40 Years in Prison; It's time to speak up! www.DrChristinaHibbert.com #ppd #MH #stigma“Never be afraid to raise your voice for honesty and truth and compassion against injustice and lying and greed. If people all over the world…would do this, it would change the earth.

~William Faulkner

I’ve been working as the expert evaluator on a postpartum case for over five years. Because the case is still active, and because I’m still the expert witness, I’ve had to keep silent about it all this time. But, I can keep silent no longer. Her attorneys and advocates and I all feel the same: we must speak up. Something must be done. (Though I have permission from the client to use her name, at the advice of her attorneys I refrain from doing so, because I don’t want to endanger her case in any way.)

 

2001…

This woman, at 23 years of age, was sentenced to 40 years without parole for child abuse. After evaluating her case these past years, it is clear to me she was suffering from significant postpartum mental illness at the time, including postpartum posttraumatic stress disorder (as a result of a horrific childbirth experience), postpartum obsessive-compulsive disorder, postpartum depression, and eventually and most prominently, postpartum psychosis.

The baby recovered from her injuries and was adopted away into another family after this woman’s parental rights were severed. She could never have children again, thanks to the emergency hysterectomy she’d endured while passed out from blood loss during childbirth, and thus, another punishment was inflicted—sentenced to a childless life.

She was never evaluated for postpartum mental illness in her initial trial. In fact, she was hardly evaluated for any mental illness at all; it certainly wasn’t mentioned at her trial, even though the judge stated that clearly she had to be mentally ill to do what she had done. Because it was considered a “child abuse” case, the stigma was strong. She was an “abuser,” and seen as a criminal. The prosecutor threw the book at her. The judges’ hands were tied. Even though he stated his vehement disagreement with the sentence, by law, he had to impose it—four back to back sentences of 10 years, or 40 years total.

 

2014…

Now, after serving thirteen years in the state prison system, and with the help of dedicated advocates, attorneys, and experts who are working pro bono, she was finally given the opportunity to seek “clemency,” or a commutation of her current ten-year sentence. Each sentence would have to receive clemency, so this was really only seeking her release for the last six years of this sentence (with two more 10-year sentences to follow for which clemency would have to be reevaluated).

Last Monday, we finally had the hearing. The room was full of attorneys, advocates, family, friends, and we were there for six hours. I was grilled on my findings, report, and expertise on postpartum mental illness (something I am very confident about). We were also all grilled on multiple small details that seemed insignificant to us, but on which they seemed stuck. I could see their ignorance about mental illness, though I did my best to educate them. I could feel the stigma speaking louder than any of us, shouting even.

In the end, judgment was swift and harsh. Clemency was denied.

 

After…

I left feeling beaten up. Exhausted. Depleted. I drove the two hours back home in silence, going over everything and praying for a way to let it go. In the back of my mind was the sense that this was one of those life-changing days, the kind of day you don’t forget. The kind of day that forces you to change.

It somehow reminded me of my sister’s death; a result of depression and alcoholism, she ultimately died by her Postpartum Psychosis + Mental Health Stigma =40 Years in Prison; It's time to speak up! www.DrChristinaHibbert.com #MH #stigma #ppdown hand, an overdose of alcohol and acetaminophen. She was too drunk to know what she was doing. It reminded me of my close friend’s suicide, only five months ago, also a result mental illness—depression and intense anxiety. It reminded me of the great stigma attached to suicide and to the mental illnesses that led them there.

It made me think of my oldest son, away at college on his own for the first time, and the loss I’ve been feeling since he left. It made me think of my five other children at home, especially my daughter, who’s only slightly younger than this woman’s daughter would be now. It made me grateful for parents who raised me with safety and opportunities and education—who didn’t expose me to trauma, but sheltered me from it. It made me want to crawl into my husband’s arms the second I returned home and let him hold me. It reminded me what a blessed gift it is to have freedom and family and love.

 

And, it made my heart break. I kept picturing her, alone in her cell, feeling like this was all her fault. It made me feel guilty I could just drive back home and be with my family. She couldn’t do that. Why should I be able to? She’d been present at the hearing, via teleconference, and we could see her trying to be strong (she couldn’t see us) as the board interrogated her with question after painful question. She was definitely feeling broken at the time, and I could only imagine how broken she was feeling now.

How could this happen again? I kept asking myself. How could any one person be so misunderstood, mistreated her whole life, and flat-out discarded so many times? How does she carry on after all these blows? She’s made of stronger stuff than I; she must be. I don’t think I could survive all she’s been through.

 

It’s not that what she did wasn’t wrong. No one was saying that—least of all the woman herself. She even said she felt she deserved 40 years for a long time, like she was willing to trade her life for her baby’s survival. She had told me many times she was grateful she had been arrested. Fate had intervened and stopped the hurt and pain for her baby; even if it meant she would have to suffer in prison, at least her baby would survive.

No, it’s not that it wasn’t wrong. And it’s not even that she was trying to give an “excuse” for what she did. It’s that we were all trying to help the courts and judges and boards, and whomever is in a position to do something, to understand that there was a reason she did what she did: extreme mental illness. There is a clear, explanatory reason—posptartum psychosis.

 

Postpartum Psychosis

Postpartum psychosis is a potentially life-threatening illness affecting about 1-2 of every 1,000 births, in which a mother becomes detached from rational thinking, in which she experiences hallucinations (hearing or seeing things), delusions (false beliefs), extreme agitation, inability to concentrate, and waxing and waning episodes of feeling like “I wasn’t myself.” Like, “someone else took over,” as many women describe it. Not all mothers with postpartum psychosis harm their babies or themselves, but 11% do, making it essential these women are immediately hospitalized and put on antipsychotic medications to bring them back to reality.

Yes, this is what this woman, this friend of mine (as she has become over the years), was experiencing all those years ago. And to punish someone with, essentially, a life sentence for suffering such trauma at the hands of postpartum psychosis is a tragedy. It is appalling.

 

Today…

I get it if we fail a soul one time. There was little education and understanding back then, and clearly no one understood what was really happening at the time. One time, maybe, though even that is a tragedy and can wreck a life.

But to fail a soul time after time, despite the education and understanding now available, to have a recognized top expert in postpartum mental health standing right in front of you, explaining every detail as clearly as humanly possible and yet to dismiss that expert’s years of work and data and clinical expertise in favor of one’s own opinions; to say, “While I highly respect the good doctor, and even commend her on her excellent report and work,” to state, “I agree 40 years is a very long time,” and then to state, “but…” and recount one’s own preconceived judgments with blatant disregard for all that was said those past 6 hours, and to ultimately “deny” the clemency, is a tragedy. And it fires me up. It fires me to speak up.

 

Right now…

We must not sit idly by as injustices abound around us. We have a voice, and we must use it. Especially those who have experienced mental illness, suicide, pregnancy/postpartum depression, anxiety, OCD, psychosis, etc., first- or even second-hand—we must share our stories. We must advocate for those who no longer have a voice. We must love greatly.

And perhaps, some blessed day, this world will open, and understanding will be the norm, and compassion will be our language, and we will hold off judgment so we may instead exercise that great love.

This is my hope, and my prayer, and my life’s work. In honor of this dear woman whom we have failed again, may we speak up now so perhaps next time, we, she, and those like her, will succeed.

 

 

 

Has your life ever been touched by mental illness, suicide, or the stigma that covers these things? If so, I’d love to hear your experiences and insights. If not, I’d love to hear your thoughts. Let’s speak up, everybody! It’s more than time. 

Please leave a comment, below.

 
 

#1 Amazon Bestseller, This Is How We Grow, by Dr. Christina Hibbert, Available now on Amazon.com! www.ThisIsHowWeGrow.com
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Beyond Depression: Postpartum OCD Treatment–part 3 (& video)

Beyond Depression: Postpartum OCD Treatment--part 3 (& video); www.DrChristinaHibbert.com #PPD #pregnancy #postpartum #mentalhealthIn this 3-part series we’ve been discussing Pregnancy/Postpartum Obsessive-Complusive Disorder (PPOCD). In part 1 we took a good look at the symptoms of PPOCD and why it is so misunderstood. In part 2 we discussed why PPOCD is so misdiagnosed and how to make a proper diagnosis. In this final part we take a look at treatment for Postpartum OCD. 

 

Postpartum OCD Treatment: Best Options

When it comes to pregnancy and postpartum mood/anxiety disorders, there are a variety of treatment options, including medication, psychotherapy, self-help, and complementary and alternative modalities. It’s also helpful to consider addressing/treating sleep issues, couples’ and relationship issues, and making sure dads and partners get the treatment they need. (Please see my Postpartum Depression Treatment series for more.)

 

(For a quick overview, watch this 3-Minute Therapy YouTube video, Beyond PPD: Postpartum OCD Treatment. Then, read on, below.)

[stream provider=youtube flv=http%3A//www.youtube.com/watch%3Fv%3D6kReyGHJMVo%26feature%3Dyoutu.be img=x:/img.youtube.com/vi/6kReyGHJMVo/0.jpg embed=false share=false width=640 height=360 dock=true controlbar=over bandwidth=high autostart=false responsive=16:9 /]

 

However, when looking specifically at Postpartum OCD, the following treatment options are considered the “gold standard of care”:

Psychotropic Medication

Antidepressant/antianxiety medications are highly recommended for PPOCD. These medications heal the misfiring of the brain chemistry that is causing the intrusive images/thoughts. They help reduce symptoms of anxiety, worry, and fear, and can also treat the symptoms of depression that may accompany postpartum OCD. (More on medication: Postpartum Depression Treatment: Medication; Antidepressant? Or not? 12 Facts on Depression & Medication)

 

Psychotherapy

Psychotherapy aims to teach new, healthy coping strategies. This can be especially helpful for women struggling with Postpartum OCD. Working with a therapist, counselor, psychologist, or psychiatrist who understands your symptoms and can offer reassurance, encouragement, sound advice, and new ways to deal with the troubling symptoms of PPOCD is a highly effective treatment approach. (More on postpartum psychotherapy, here.)

 

Cognitive-behavioral therapy is considered one of the best treatment methods for PPOCD because of its focus on helping mothers identify and alter unhealthy thoughts and beliefs.

 

Couple’s therapy is also helpful, for it addresses not only the mother’s concerns, but the couple’s relationship. It allows fathers to get involved in treatment and also addresses any issues he may be facing. (More here for Dads/Partners or on  Paternal Postnatal Depression)

 

Social Support

Social support may involve support from your partner, friends, family, and faith community. Reaching out and letting others help and support you through PPOCD is important to your recovery. (More on social support, here.)

 

Support groups specifically for pregnant/postpartum women can also be a great help to PPOCD moms. Many communities around the world now have Postpartum Adjustment support groups, and the camaraderie, support, and encouragement these provide can help women with Postpartum OCD realize they are not alone. Hearing another mother say, “I’ve experienced that, too,” is often the thing you need most. (Find a support group near you here.)

 

Combination Treatment

Of course, research shows the very best treatment for Postpartum OCD, Depression, and most of the perinatal mood/anxiety disorders is a combination of medication, psychotherapy, and social support. Combined, these treatments provide the PPOCD mom with the physical, mental, and emotional support and care she needs.

 

Postpartum OCD Treatment: Things to ConsiderPostpartum Depression & OCD Treatment; www.DrChristinaHibbert.com

For moms/dads/families:

1)   It’s important, when possible, to seek treatment from a medical/mental health provider who has been trained in the diagnosis and treatment of perinatal mood/anxiety disorders. Postpartum Support International is a wonderful resource for finding experienced providers in your area.

 

2)   If you can’t find someone who specializes in pregnancy/postpartum mental health, then look for a provider who is at least understanding and willing to learn about PPOCD and consult with others, as needed.

 

3)   It can be very helpful to have your husband/partner/parent/friend go with you to your first treatment session. This can give you support and a second opinion on the treatment. It can also help the provider to obtain information from another person who is close to you, in order to make a more thorough diagnosis and treatment plan.

 

4)   While it’s important to find an educated, understanding provider, it’s just as important to find somebody you like and trust.

 

5)   It’s okay and even recommended to seek a second (or third or fourth) opinion until you find the provider(s) that is right for you.

 

For Providers:

1)  Part of the treatment for women with PPOCD is providing understanding and reassurance. I’ve had mothers call just to hear me remind them they are not going crazy, to help validate these thoughts are not their fault, and remind them of the coping strategies they have learned. This, along with making a proper diagnosis, is one reason providers must seek as much education and training on this issue as possible. There are wonderful educational courses on perinatal mood/anxiety disorders, so please consider learning more, as needed. (See the resources section below for more information.)

 

2)  If you do not feel comfortable diagnosing and/or treating PPOCD (trained or not), please seek supervision or consultation from a provider who specializes in pregnancy/postpartum mental health. This is imperative in making the proper diagnosis and protecting the health and safety of the mother and the child. You may also consider referring the mother to a provider who specializes in perinatal mood/anxiety disorders, if that feels like the best option.

 

3)   As mentioned above, it is very helpful when diagnosing Postpartum OCD for you, the provider, to involve the client’s husband/partner/parents/friends in the assessment process. It may also be helpful to obtain a signed release to speak with the mother’s obstetrician or other care providers. A team approach is an ideal way to ensure the safety of the baby while also giving the mother the diagnosis and treatment she needs.

 

Bottom Line…

Together, we can reduce the stigma, misunderstanding, and mistreatment associated with Postpartum Obsessive-Compulsive Disorder. The more educated mothers, fathers, families, and providers become on this disorder, the better the diagnosis and treatment.

Mothers, remember you are not alone. Remember, this is highly treatable, and with patience and proper treatment, you will be well.  Trust me–you will.

 

Please share your thoughts/suggestions/questions by leaving a comment, below! 

#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: Postpartum OCD Treatment--part 3 (& video); www.DrChristinaHibbert.com #PPD #pregnancy #postpartum #mentalhealth

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Related Articles/Posts:

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

Beyond Depression: Diagnosing Postpartum OCD (part 2) (& video)

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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. PSI also provides educational courses on Perinatal Mood/Anxiety Disorders.

Postpartum Progress Blog

-Excellent source of education and support for mothers and families.

Arizona Postpartum Wellness Coalition

-Support for AZ families: Support Warmline, Brochures, & Provider/Family Education.

Postpartum Stress Center

-Education & support for Providers and Families)

Postpartum Couples Website

Pregnancy & Postpartum Resources

 

**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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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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