Skip to main content Accessibility help

OCD in the Perinatal Period: Is Postpartum OCD (ppOCD) a Distinct Subtype? A Review of the Literature

  • Mary McGuinness (a1), Jackie Blissett (a2) and Chris Jones (a2)


Background: It has been suggested that the perinatal period is a period of increased risk for the development and/or exacerbation of OCD and that postpartum OCD (ppOCD) presents a distinct clinical picture. This raises the possibility that ppOCD might be a distinct subtype of OCD. This review examines this contention. Method: A search using Ovid (Medline, PsycINFO and Embase), EBSCO, Cochrane Library, Web of Science (ISI), Pubmed databases and Google Scholar was carried out using the key words: “obsessive compulsive disorder” (and derivatives), “perinatal”, “pregnancy”, “postnatal”, “postpartum”, “mothers” (and derivatives), “anxiety disorders” and “subtypes.” These articles and their references were reviewed. Results: The majority of studies reviewed were retrospective, which makes it impossible to infer causality. Two prospective studies found a higher incidence of OCD in the postpartum period. These were carried out in Turkey and Brazil and, as such, may be limited in their applicability to other cultural groups. Conclusion: The concept of ppOCD as a specific subtype has not been robustly demonstrated. The evidence that OCD is more prevalent in the postpartum period is mixed. The evidence that OCD in the postpartum period presents a distinctive clinical picture with specific symptomatology and course is more compelling. In view of the impact of culture and religion on the expression of OCD, collaborative, international, prospective studies that take into account the methodological and definitional issues raised in this review are necessary to provide clarification.


Corresponding author

Reprint requests to Mary McGuinness, BSMHFT - Perinatal Mental Health Service, Chamomile Suite, The Barberry, 25 Vincent Drive, Edgbaston, Birmingham B15 2SG, UK. E-mail:


Hide All
Abramowitz, J. S. and Fairbrother, N. (2008). Postpartum obsessive compulsive disorder. In Abramowitz, J., McKay, D. and Taylor, S. (Eds.), Clinical Handbook of Obsessive Compulsive Disorder and Related Problems (pp. 139155). Baltimore, MD: John Hopkins Press.
Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J. and Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: a prospective study. Behaviour Research and Therapy, 44, 13611374.
Abramowitz, J. S., McKay, D. and Taylor, S. (2005). Special series: subtypes of obsessive compulsive disorder. Introduction. Behaviour Therapy, 36, 367369.
Abramowitz, J. S., Nelson, C., Rygwall, R. and Khandker, M. (2007). The cognitive mediation of obsessive-compulsive symptoms: a longitudinal study. Journal of Anxiety Disorders, 21, 91104.
Abramowitz, J. S., Schwartz, S. A. and Moore, K. M. (2003a). Obsessional thoughts in postpartum females and their partners: content, severity and relationship with depression. Journal of Clinical Psychology in Medical Settings, 10, 157164.
Abramowitz, J. S., Schwartz, S., Moore, K. and Luenzmann, K. (2003b). Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature. Journal of Anxiety Disorders, 17, 461478.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders 4th ed., (text revision). Washington, DC: American Psychiatric Association.
Andersson, L., Sundström-Poromaa, I., Bixo, M., Wulff, M., Bondestam, K. and Åström, M. (2003). Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. American Journal of Obstetrics and Gynecology, 189, 148154.
Arnold, L. M. (1999). A case series of women with postpartum-onset obsessive-compulsive disorder. Primary Care Companion to the Journal of Clinical Psychiatry, 1, 103108.
Belloch, A., Del Valle, G., Morillo, C., Carrio, C. and Cabedo, E. (2009). To seek advice or not seek advice about the problem: the help seeking dilemma for obsessive-compulsive disorder. Social Psychiatry and Psychiatric Epidemiology, 44, 257264.
Bhagwanani, S. G., Seagraves, K., Dierker, L. J. and Lax, M. (1997) Relationship between prenatal anxiety and perinatal outcome in nulliparous women: a prospective study. Journal of the National Medical Association, 89, 9398.
Blashfield, R. K. and Livesley, W. J. (1999). Classification. In Millon, T., Blaney, P.H. and Davies, R.D. (Eds.), Oxford Textbook of Psychopathology (pp. 328). New York: Oxford University Press.
Brandt, K. R. and Mackenzie, T. B. (1987). Obsessive-compulsive disorder exacerbated during pregnancy: a case report. International Journal of Psychiatry in Medicine, 17, 361366.
Buttolph, M. L. and Holland, A. D. (1990). Obsessive compulsive disorders in pregnancy and childbirth. In Jenicke, M., Baer, L. and Minichiello, W. E. (Eds.), Obsessive Compulsive Disorders: theory and management (pp. 8997). Chicago: Year Book Medical.
Chelmow, D. and Halfin, V. P. (1997). Pregnancy complicated by obsessive compulsive disorder. The Journal of Maternal Fetal Medicine, 6, 3134.
Christian, L. M. and Storch, E. A. (2009). Cognitive behavioral treatment of postpartum onset obsessive compulsive disorder with aggressive obsessions. Clinical Case Studies, 8, 7283.
Cilli, A. S., Telcioglu, M., Askin, R., Kaya, N., Bodur, S. and Kucur, R. (2004). Twelve month prevalence rate of obsessive compulsive disorder in Koya, Turkey. Comprehensive Psychiatry, 45, 367374.
Cooper, C., Jones, L., Dunn, E., Forty, L, Haque, S., Oyebode, F., Craddock, N. and Jones, I. (2007). Clinical presentation of postnatal and non-postnatal depressive episodes. Psychological Medicine, 37, 12731280.
Crino, R., Slade, T. and Andrews, G. (2005). The changing prevalence and severity of obsessive compulsive disorder criteria from DSM-III to DSM-IV. American Journal of Psychiatry, 162, 876882.
Dennis, C. L. (2004). Treatment of postpartum depression, Part 2: a critical review of non-biological interventions. Journal of Clinical Psychiatry, 65, 12521265.
Dennis, C. L. and Stewart, D. E. (2004). Treatment of postpartum depression, Part 1: a critical review of biological interventions. Journal of Clinical Psychiatry, 65, 12421251.
Diaz, S. F., Grush, L. R., Sichel, D. A. and Cohen, L. S. (1997). In Dicstein, L.J., Riba, M. B. and Oldham, J. M. (Eds.). Review of Psychiatry 16, 97112. Washington, DC: American Psychiatric Press.
Fairbrother, N. and Abramowitz, J. S. (2007). New parenthood as a risk factor for the development of obsessional problems. Behaviour Research and Therapy, 45, 21552163.
Fairbrother, N. and Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women's Mental Health, 11, 221229.
Fireman, B., Koran, L. M., Leventhal, J. L. and Jacobson, A. (2001). The prevalence of clinically recognised obsessive-compulsive disorder in a large health maintenance organisation. American Journal of Psychiatry, 158, 19041910.
Fontenelle, L. F. and Hasler, G. (2008). The analytical epidemiology of obsessive compulsive disorder: risk factors and correlates. Progress in Neuropsychopharmocology and Biological Psychiatry, 32, 115.
Fontenelle, L. F., Mendlowicz, M. V. and Versiana, M. (2006). The descriptive epidemiology of obsessive compulsive disorder. Progress in Neuropsychopharmocology and Biological Psychiatry, 30, 327337.
Fridell, M. and Hesse, M. (2006). Clinical diagnosis and SCID-II assessment of DSM–III-R personality disorders. European Journal of Psychological Assessment, 22, 104108.
Geller, P., Klier, C. and Neugebauer, R. (2002) Anxiety disorders following miscarriage. Journal of Clinical Psychiatry: 62, 432438.
Horwath, E. and Weissman, M. M. (2000). The epidemiology and cross national presentation of obsessive-compulsive disorder. Psychiatric Clinics of North America, 23, 493507.
Iancu, I., Lepkifker, E., Dannon, P. and Kotler, M. (1995). Obsessive compulsive disorder limited to pregnancy. Psychotherapy and Psychosomatics, 64, 109112.
Ingram, I. M. (1961). Obsessional illness in mental hospital patients. Journal of Mental Science, 107, 382402.
Jennings, K. D., Ross, S., Popper, S. and Elmore, M. (1999). Thoughts of harming infants in depressed and non-depressed mothers. Journal of Affective Disorders, 54, 2128.
Julien, D., O'Connor, K. P. and Aardema, F. (2009). Intrusions related to obsessive-compulsive disorder: a question of content or context? Journal of Clinical Psychology, 65, 709722.
Kalra, H., Tandon, R., Trivedi, J. K. and Janca, A. (2005). Pregnancy induced obsessive compulsive disorder: a case report. Annals of General Psychiatry, 4, 1214.
Karadag, F., Oguzhanoglu, N. K., Ozdel, O., Atesci, F. C. and Amuk, T. (2006). OCD symptoms in a sample of Turkish patients: a phenomenological picture. Depression and Anxiety, 23, 145152.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R. and Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593602.
Kessler, R. C., Chiu, W. T., Delmer, O. and Walters, M. S. (2005). Prevalence, severity and comorbidity of 12 month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 618709.
Labad, J., Alonso, P., Segalas, C., Real, E., Jimenez, S., Bueno, B., Vallejo, J. and Menchon, J. M. (2010). Distinct correlates of hoarding and cleaning symptom dimensions in relations to onset of obsessive compulsive disorder at menarche or the perinatal period. Archives of Women's Mental Health, 13, 7581.
Labad, J., Menchón, J. M., Alonso, P., Segalas, C., Jimenez, S. and Vallejo, J. (2005). Female reproductive cycle and obsessive-compulsive disorder. Journal of Clinical Psychiatry, 66, 428435.
Larsen, K., Schwartz, S. A., Whiteside, S. P., Khandker, M., Moore, K. M. and Abramowitz, J. S. (2006). Thought control strategies used by parents reporting postpartum obsessions. Journal of Cognitive Psychotherapy, 20, 435445.
Leckman, D., Mayes, L. C., Feldman, R., Evans, D. W. and Cohen, D. J. (1999). Early parental preoccupations and behaviours and their possible relationship to the symptoms of obsessive-compulsive disorder. Acta Psychiatrica Scandinavia, 100, 126.
Lee, H. J., Lee, S. H, Kim, H. S., Kwon, S. M. and Telch, M. J. (2005). A comparison of autogenous/reactive obsessions and worry in a nonclinical population: a test of the continuum hypothesis. Behaviour Research and Therapy, 43, 9991010.
Levine, R. E., Oandasan, A. P., Primeau, L. A. and Berenson, A. B. (2003). Anxiety disorders during pregnancy and postpartum. American Journal of Perinatology. 20, 239248.
Lo, W. H. (1967). A follow-up study of obsessional neurotics in Hong Kong Chinese. British Journal of Psychiatry, 113, 823832.
Maina, G., Albert, U., Bogetto, F. and Vaschetto, L. R. (1999). Recent life events and obsessive-compulsive disorder (OCD): the role of pregnancy/delivery. Psychiatry Research, 89, 4958.
National Institute of Clinical Excellence (2007). Antenatal and Postnatal Mental Health: the NICE clinical, management and service guidance. London: National Collaborating Centre for Mental Health.
Nestadt, G., Samuel, J., Riddle, M., Bienvenu, O. J. III, Liang, K. Y., Labuda, M., Walkup, J., Grados, M. D. and Hoehn-Saric, R. (2000). A family study of obsessive compulsive disorder. Archives of General Psychiatry, 57, 358363.
Neziroglu, F., Anemone, R. and Yaryura-Tobia, J. (1992). Onset of obsessive-compulsive disorder in pregnancy. American Journal of Psychiatry, 149, 947950.
O'Connor, T. G., Heron, J., Golding, J., Beveridge, M. and Glover, V. (2002). Maternal antenatal anxiety and children's behavioural/emotional problems at 4 years. British Journal of Psychiatry, 180, 502508.
Pollitt, J. (1957). Natural history of obsessional states: a study of 150 cases. British Medical Journal, 32, 194198.
Purdon, C. and Clark, D. A. (1993). Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms. Behaviour Research and Therapy, 31, 713720.
Rachman, S. J. (2003). The Treatment of Obsessions. Oxford: Oxford University Press.
Rachman, S. and De Silva, P. (1978). Abnormal and normal obsessions, Behaviour Research and Therapy, 16, 233248.
Rasmussen, S. A. and Eisen, J. I. (1989). Clinical features and phenomenology of obsessive compulsive disorder. American Journal of Psychiatry, 143, 317322.
Rasmussen, S. A. and Eisen, J. I. (2002). The course and clinical features of obsessive compulsive disorder. In Davis, K. L., Charney, D., Coyle, J. T. and Nemeroff, C. (Eds.), Psychopharmacology: a fifth generation of progress. Philadelphia: Williams and Williams.
Rassin, E., Cougle, R. J. and Muris, P. (2007), Content difference between normal and abnormal obsessions. Behaviour Research and Therapy, 45, 28002803.
Rassin, E. and Muris, P. (2006). Abnormal and normal obsessions: a reconsideration. Behaviour Research and Therapy, 45, 10651070.
Robins, E. R. and Guze, S. B. (1970). Establishment of diagnostic validity in psychiatric illness: it's application to schizophrenia. The American Journal of Psychiatry, 126, 983987.
Rojansky, N., Brzezinski, A. and Schenker, J. G. (1992). Seasonality in human reproduction: an update. Human Reproduction, 7, 735745.
Ross, L. E. and McLean, L. M. (2006). Anxiety disorders during pregnancy and the post partum period: a systematic review. Journal of Clinical Psychiatry, 67, 12851298.
Rowa, K., Purdon, C., Summerfeldt, L. J. and Antony, M. M. (2005). Why are some obsessions more upsetting than others? Behaviour, Research and Therapy, 43, 14531465.
Ruscio, A. M., Stein, D. J., Chiu, W. T. and Kessler, R. C. (2008). The epidemiology of obsessive compulsive disorder in the national comorbidity survey replication. Molecular Psychiatry: advance online publication 26 August 2008; doi: 10.1038/mp.2008.94
Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, S29S52.
Sasson, Y., Zohar, J., Chopra, M., Lustig, M., Iancu, I. and Hendler, T. (1997). Epidemiology of world obsessive compulsive disorder: a view. Journal of Clinical Psychiatry, 58, (Suppl 12), 710.
Sichel, D. A., Cohen, L. S., Dimmock, J. A. and Rosenbaum, J. F. (1993a). Postpartum obsessive-compulsive disorder: a case series. Journal of Clinical Psychiatry, 54, 156159.
Sichel, D. A., Cohen, L. S., Rosenbaum, J. F. and Driscoll, J. D. (1993b). Postpartum onset of obsessive-compulsive disorder. Psychosomatics, 34, 277279.
Sutter-Dallay, A. L., Giaconne-Marcesche, V., Glatigny-Dallay, E. and Verdoux, H. (2004). Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. European Psychiatry, 19, 459463.
Taylor, S. (2005). Dimensional and subtype models of OCD. In Abramowitz, J. S. and Houts, A. C., (Eds.), (Concepts and Controversies in Obsessive-Compulsive Disorder (pp. 2741). New York: Springer.
Teixeira, J. M. A., Fisk, N. M. and Glover, V. (1999). Association between maternal anxiety in pregnancy and increased uterine artery resistance index: cohort based study. British Medical Journal, 318, 153157.
Uguz, F., Akman, C., Kaya, N. and Cilli, A. S. (2007). Postpartum-onset obsessive compulsive disorder: incidence, clinical features and related factors. Journal of Clinical Psychiatry, 68, 132138.
Uguz, F., Gezginc, K., Zeytinci, I. E., Karatayli, S., Askin, R., Guler, O., Sahin, F. K., Emul, M., Ozbulut, O. and Gecici, O. (2007a). Course of obsessive-compulsive disorder during early postpartum period: a prospective analysis of 16 cases. Comprehensive Psychiatry, 48, 558561.
Uguz, F., Gezginc, K., Zeytinci, I. E., Karatayli, S., Askin, R., Guler, O., Sahin, F. K., Emul, M., Ozbulut, O. and Gecici, O. (2007b). Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy. Comprehensive Psychiatry, 48, 441445.
Uguz, F., Kaya, N., Sahingoz, M. and Cilli, A. S. (2008). One year follow-up of postpartum onset obsessive compulsive disorder: a case series. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 32, 10911092.
Weissman, M. M., Prusoff, B. A., Thompson, D. W., Harding, P. S. and Myers, J. K. (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients, Journal of Nervous and Mental Disorders, 16, 317326.
Wenzel, A., Gorman, L. L., O'Hara, M. W. and Stuart, S. (2001). The occurrence of panic and obsessive compulsive symptoms in women with postpartum dysphoria: a prospective study. Archives of Women's Mental Health, 4, 512.
Wenzel, A., Haugen, E. N., Jackson, L. C. and Brendle, J. R. (2005). Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders, 19, 295311.
Woodward, K. (1997). Motherhood identities, meanings and myths. In Woodward, K. (Ed.), Identity and Difference (pp 239298). London: SAGE.
World Health Organization (1993). The ICD-10 Classification of Mental and Behavioral Disorders: diagnostic criteria for research. Geneva: World Health Organization.
Williams, K. and Koran, L. (1997). Obsessive-compulsive disorder in pregnancy, the puerperium and the premenstrual. Journal of Clinical Psychiatry, 58, 330334.
Wisner, K. L., Peindl, K. S., Gigliotti, T. and Hanusa, B. H. (1999). Obsessions and compulsions in women with postpartum depression. Journal of Clinical Psychiatry, 60, 176180.
Zar, M., Wijma, K. and Wijma, B. (2002). Relations between anxiety disorders and fear of childbirth during late pregnancy. Clinical Psychology and Psychotherapy, 9, 122130.
Zambaldi, C. F., Cantilino, A., Montenegro, A. C., Paes, J. A., de Aluquerque, T. L. C. and Sougey, A. B. (2009). Postpartum obsessive compulsive disorder: prevalence and clinical characteristics. Comprehensive Psychiatry, 50, 503509.


OCD in the Perinatal Period: Is Postpartum OCD (ppOCD) a Distinct Subtype? A Review of the Literature

  • Mary McGuinness (a1), Jackie Blissett (a2) and Chris Jones (a2)


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

OCD in the Perinatal Period: Is Postpartum OCD (ppOCD) a Distinct Subtype? A Review of the Literature

  • Mary McGuinness (a1), Jackie Blissett (a2) and Chris Jones (a2)
Submit a response


No Comments have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *