Correlates and Predictors of New Mothers' Responses to Postpartum Thoughts of Accidental and Intentional Harm and Obsessive Compulsive Symptoms

Perceived worsening of obsessive-compulsive disorder symptoms after childbirth in women and men: An understudied phenomenon

The aim of this study was to examine worsening of OCD symptoms after childbirth in individuals seeking assessment or treatment of OCD. The postpartum period may make parents biologically and psychologically vulnerable to OCD symptoms. Participants included 222 parents with OCD who completed surveys through a self-help website. Most women and almost half of men with self-reported OCD reported an increase in OCD symptoms following childbirth. Retrospective report of perceived worsening of OCD symptoms after childbirth was associated with more aggressive obsessions for both men and women, in comparison to individuals whose OCD symptoms did not worsen around childbirth. Women whose OCD symptoms worsened after childbirth reported more impairment in social functioning than individuals whose symptoms did not worsen. These results highlight the need to develop a better understanding of aggressive obsessions in parents, and improve education about prevalence, content, assessment, and intervention for aggression-focused intrusive thoughts.

An online self-guided cognitive intervention for unwanted intrusive thoughts about harming infants in new parents: initial randomised controlled trial with mediation analysis

Approximately one-fifth of new parents struggle with unwanted intrusive thoughts (UITs) about intentionally harming their child. This study evaluated the initial efficacy, feasibility and acceptability of a novel online self-guided cognitive intervention for new parents with distressing UITs. Self-recruited parents (N = 43, 93% female, age 23-43 years) of children 0-3 years reporting daily distressing and impairing UITs were randomized to the 8-week self-guided online cognitive intervention or to waiting-list. The primary outcome was change on the Parental Thoughts and Behaviour Checklist (PTBC) from baseline to week 8 (post-intervention). The PTBC and negative appraisals (mediator) were assessed at baseline, weekly, post-intervention and at the 1-month follow-up. Results showed that the intervention led to statistically significant reductions in distress and impairment associated with UITs at post-intervention (controlled between-group d = 0.99, 95% CI 0.56 to 1.43), which were maintained at the 1-month follow-up (controlled between-group d = 0.90, 95% CI 0.41 to 1.39). The intervention was deemed to be feasible and acceptable by the participants. Change in negative appraisals mediated reductions in UITs but the model was sensitive to mediator-outcome confounders. We conclude that this novel online self-guided cognitive intervention can potentially reduce the distress and impairment associated with UITs in new parents. Large-scale trials are warranted.Abbreviations: UITs: Unwanted Intrusive Thoughts PTBC: Parental Thoughts and Behaviour Checklist.

"I'm a Horrible Mother": The Relationship Between Psychoeducation, Disclosure, and Shame Surrounding Postpartum Intrusive Thoughts

The current study explored whether women who had experienced Postpartum Intrusive Thoughts of Intentional Harm (PPITIH) were more likely to disclose these thoughts and less likely to experience shame about such thoughts after being exposed to psychoeducation about PPITIH. The study also examined whether shame was a significant predictor of the number of people to whom the participant had disclosed their PPITIH. Additionally, a content analysis was used to explore participants' responses to the psychoeducation. One hundred and thirty-nine women completed the web-based study. The number of participants reporting PPITIH significantly increased following the exposure to the psychoeducation and participants' levels of shame significantly decreased. No relationship was found between participants' level of shame and the number of people to whom they had disclosed their experiences with PPITIH prior to the study. Themes of relatability, reassurance, and resonance emerged from the responses of participants who reported having experienced PPITIH; whereas those of surprise/sadness/shock and similarities emerged from those who denied having experienced them.

The Maternal Disintegrative Responses Scale (MDRS): Development and initial validation

OBJECTIVE

This study aimed to design and examine the validity of the Maternal Disintegrative Responses Scale (MDRS) to assess intrusive thoughts and dissociative experiences in the postpartum period.

METHOD

A convenience sample of 455 mothers whose babies were up to 12 months old completed the MDRS and a series of questionnaires assessing postnatal depression (Edinburgh Postnatal Depression Scale [EPDS]), childbirth-related post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and general symptoms of dissociation.

RESULTS

The final scale consists of eight items tapping two dimensions, intrusive thoughts and dissociative experiences, and displays good psychometric properties. Both factors were found to be related to EPDS, PTSD OCD, and general symptoms of dissociation. Primiparous women scored higher than multiparous women on both dimensions, and mothers of infants up to 3 months old scored higher on dissociative experiences than those whose infants were aged 4-12 months.

CONCLUSIONS

The MDRS can contribute to the theoretical and practical conceptualization and assessment of these phenomena.

Maternal Obsessive-Compulsive Symptoms and Infant Feeding Practices

Purpose: The purpose of this study was to examine associations between postpartum obsessive-compulsive (OC) symptoms, infant care and feeding worries, and breastfeeding experiences in a sample of postpartum women. Materials and Methods: Women were recruited via an online U.S. research volunteer database and were eligible if they were aged 18-47 years, their primary language was English, they had an infant 2-6 months old, and tried breastfeeding the infant at least once. Participants completed a survey to assess breastfeeding experiences and practices, OC symptoms and other mental health conditions, and demographics. Modified Poisson regression and linear regression were used to estimate associations between clinically elevated OC symptoms, reported thoughts or worries about infant feeding and care, and breastfeeding experiences, problems, and duration. Results: Of 232 participants, 32 (14%) had clinically elevated OC symptoms. These women had more perinatal OC symptoms (scoring 3.6 points higher on perinatal OC symptoms score [95% confidence interval {CI}: 0.4 to 6.9]), including symptoms specific to infant care and feeding [e.g., adjusted relative risk_{(repeated washing of baby's bottles, bowl, or plate)} = 2.37, 95% CI:1.55 to 3.64], and more breastfeeding problems (adjusted β = 0.3, 95% CI: 0.0 to 0.2) than women with fewer OC symptoms. However, they did not report an overall worse breastfeeding experience (adjusted β = 0.4, 95% CI: -9.3 to 10.1). Adjusted models controlled for depressive symptoms. Conclusions: Obsessive thoughts and compulsions were common in this sample and extended to infant feeding activities. These symptoms were associated with more breastfeeding problems. Interactions in mother-infant dyads are critical because of lasting impacts on parent-child relationships and child development. Treating OC symptoms may foster healthier mother-infant relationships.

Obsessive-compulsive symptoms, intrusive thoughts and depressive symptoms: a longitudinal study examining relation to maternal responsiveness

BACKGROUND

The postpartum period is a vulnerable time for the development of depression. While perinatal depression has been well studied, intrusive thoughts related to the infant and classic obsessive-compulsive (OC) symptoms (e.g. chequering, ordering and cleaning) are also common in the postpartum and less well understood.

OBJECTIVE

The present study investigated the associations among depressive symptoms, intrusive thoughts, and OC symptoms and their relation to the quality of the mother-infant relationship, particularly in the realm of maternal responsiveness.

METHODS

Participants (N = 228) were recruited after delivery from a large Midwestern academic medical centre. At 2 and 12-week postpartum, participants completed self-report questionnaires that assessed demographics, depressive and OC symptoms, postpartum-specific intrusive thoughts and accompanying neutralising strategies, and maternal responsiveness.

RESULTS

At 12-week postpartum, maternal responsiveness was significantly lower for participants that endorsed intrusive thoughts, neutralising strategies or OC symptoms of clinical significance. More severe intrusive thoughts and neutralising strategies were associated with maternal responsiveness but not predictive after accounting for depressive symptoms; depressive symptoms were associated with lower levels of maternal responsiveness across the postpartum.

CONCLUSIONS

A sizable number of postpartum women experience clinically significant postpartum-specific intrusive thoughts and utilise neutralising strategies, especially in the context of postpartum depressive symptoms. Depressive symptoms have the most influence on maternal responsiveness but it is also important to target intrusive thoughts and OC symptoms in the context of postpartum depression to promote the welfare of new mothers and their offspring.

Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol

BACKGROUND

Unwanted, intrusive thoughts of harm-related to the infant are reported by the vast majority of new mothers, with half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose. Thoughts of intentional harm, in particular, are distressing to women, their partners and the people who care for them. While maternal, unwanted and intrusive thoughts of infant-related harm are known to be associated with obsessive compulsive disorder (OCD) and depression, preliminary evidence suggests that they are not associated with an increased risk of harm to infants. Perinatal care providers and policy makers, as well as new mothers and their partners require evidence-based information in order to respond appropriately to these types of thoughts. The purpose of this research is to address important gaps regarding the (a) prevalence and characteristics of intrusive, unwanted thoughts of baby-related harm, (b) their association (or lack thereof) with child abuse, and (c) the prevalence and course of obsessive-compulsive disorder and depression in the perinatal period.

METHODS

Participant were 763 English-speaking women and recruited during pregnancy. In this province-wide study in British Columbia, participants were recruited proportionally from hospitals, city centers and rural communities between January 23, 2014 and September 09, 2016. Participants were administered online questionnaires and diagnostic interviews over the phone at 33-weeks gestation, 7-weeks postpartum and 4-months postpartum. The study assessed intrusive and unwanted thoughts of harm related to the infant, obsessive-compulsive disorder (OCD) and major depressive episode (MDE) disorders and symptomatology, sleep, medical outcomes, parenting attitudes, and infant abuse.

DISCUSSION

There is a scarcity of literature concerning maternal unwanted, intrusive, postpartum thoughts of infant-related harm and their relationship to child harming behaviors, OCD and depression. This longitudinal cohort study was designed to build on the existing research base to ensure that policy developers, child protection workers and health-care providers have the guidance they need to respond appropriately to the disclosure of infant-related harm thoughts. Thus, its main goals will be to investigate whether intrusive postpartum thoughts of infant-related harm are a risk factor for child abuse or the development of OCD.