Postnatal OCD - PANDAS Foundation UK

Obsessive-Compulsive Disorder (OCD) is a serious anxiety related condition. People who frequently suffer from this condition experience intrusive and unwelcome obsessive thoughts, often followed by repetitive compulsions.

Sometimes people think you have OCD if you gamble, take street drugs, eat, drink compulsively or even exercise too much, however this isn’t correct as these behaviours can be pleasurable. The compulsions in OCD never give pleasure – they are always felt as an unpleasant demand or burden. Another key clinical difference that makes routines and repetition different from OCD is when the distressing and unwanted experience of obsessions and compulsions impacts to a significant level upon a persons everyday functioning.

OCD is one of the most common mental health conditions. It is estimated that up to 3 in 100 adults and up to 5 in 100 children and teenagers suffer from OCD.

Obsession in general is someone who will experience obessions, and continued presistent and uncontrollable thoughts, images, impulses, worries, fears or doubts. They are intrusive, disturbing, unwanted and are incredibley difficult to ignore.

Compulsions are repetitive physical behavious, actions or mental thought rituals, that are performed over and over again, in an attempt to relieve the anxiety caused by the obsessional thoughts.

OCD comes in many forms and can be much more intense than the common perception of excessive hand washing or turning the light switch on and off a number of times.PerinatalOCDChalk

What is OCD and postnatal depression?

So, in other words, unwanted intrusive thoughts, words, images or impulses are not a symptom of OCD in themselves.  We all have them, however, they become a problem when, they are interpreted by a person as indicating that something bad might happen, and that the sufferer is responsible for preventing them.

Sufferers try to neutralise the ‘bad’ thoughts by thinking other ‘good’ thoughts for example reciting prayers, or repeating ‘safe’ mantras, counting, or trying to suppress the thoughts all together. They may think that having a ‘bad’ thought can actually result in a ‘bad’ consequence, e.g. if I think about harm coming to someone that may make it happen in reality.  Or, that by just having a ‘bad’ thought is morally just as ‘bad’ as carrying out a ‘bad’ action.

To manage this fear the person engages in ‘safety behaviours’ such as avoidance of situations, people, or objects that act as a trigger, reassurance seeking from family, doctors or others, and rituals, such as cleaning, clothes washing, hand washing, or checking and repeating actions.  The trouble with this is that sufferers fail to learn that the worst does not happen and so their beliefs remain in tact, which prevents them from learning that their worries are not ‘accurate’ or that their anxiety will actually decline without them performing the rituals.

Some sufferers may also be inclined to hoard items or self-harm.

The most common obsessional worries relate to

  •  A fear of contamination, such as infection from touching a door handle leading to washing or cleaning rituals.
  • A fear of missing something potentially dangerous such as leaving on electric switches, or worrying that they have left the door unlocked, again this can lead to checking or repeating rituals.
  •  An over concern with orderliness and perfection, leading to repeating actions until things are ‘just right’. The idea that only the best is acceptable or will be effective.
  • A fear of uncontrollable and inappropriate actions such as swearing in public, or sexual or aggressive behaviour, leading to unhelpful attempts to control thoughts.
  • A fear of uncertainty, a belief that things can and must be certain, for example, I ought to be able to be sure 100% that an action is safe.

Thought Processes in OCD

As with other anxiety disorders, thoughts about negative thoughts (e.g. ‘There must be something fundamentally wrong with me for having such thoughts’) can heighten anxiety.  Emotional reasoning (the assumption that feelings are a reliable source of information about a situation i.e. ‘I feel anxious, therefore this must be a dangerous situation.’ Is also common amongst sufferers of OCD.

Therapeutic Treatment for OCD

The NICE Guideline 2005 states that people with OCD should be offered CBT, either in a group or individual format, and depending on severity and symptoms also consider SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant medication. Such as Citalopram/Escitalopram, Fluoxetine, Fluvoxamine, Paroxetine and Sertraline.

Graded Exposure:  This is the most established intervention for OCD.  The aim is for the sufferer to expose himself or herself gradually to the feared situation (e.g. something contaminated) without engaging in their usual safety behaviour (e.g. washing).  This helps to show the person that their predictions of disaster are not justified and they can tolerate distress. It is possible that the sufferer’s partner, friends and family have assisted and ‘allowed’ their safety behaviours in the past, and therefore it may be necessary to include them in this aspect of therapy.

Testing of Unhelpful thoughts and beliefs related to the intrusions such as ‘If I think it, it will happen.” Or “I am responsible for the welfare of everyone.”

Example

Lisa had always been very cautious and was proud of her high standards at work and at home.  However, since the birth of her baby, her safety checks had become exaggerated and she was now struggling to leave the house.  If she did make it out she often returned five or six times to check sometimes even driving back home if she was out.  She tried unsuccessfully to put the worrying thoughts out of her mind.  Her fear was that insufficient caution would result in a catastrophe for her family for which she would shoulder the blame.  She thought that the shame of this would destroy her.

Can OCD be prevented?

As we are not really sure of the causes of OCD it is very difficult to say how it can be prevented.  However, as OCD is classed as an anxiety disorder, it would seem that by living a relatively stress free lifestyle may help to reduce the risks of relapse back into your old behaviour after treatment.  Maintaining change is difficult, and it is useful to be aware of things that help maintain your change and what things for you will trigger a relapse.  Self-care is particularly important in the recovery any disorder, especially when looking at relapse prevention. Things like being aware of your symptoms, taking your medication, getting enough sleep, taking regular exercise, eating well, avoiding drugs and alcohol, trying out relaxation techniques, accepting help, keeping active, staying positive and trying to say goodbye to perfectionism are all excellent ways to help yourself.  Doing what you can to stay free of OCD is as important as the treatment of it when it hits. 

What Support is out there for OCD and postnatal illness?

Your family and friend can play a big part in helping your recovery. For them to be able to help it is important you are honest with your friends and family about how you are feeling, and don’t bottle up your emotions as this can cause tension. Allow them to carry out small tasks for you, such as house work, taking your baby for a walk, or simply looking after your baby for one hour every other day to allow you to do something you want. It is important you allow yourself to have some ‘me time’.

Self-help groups can offer you good advice and support on how to cope with postnatal depression as well as comfort to know that other mums are feeling the same as you, hearing other individuals experiences of postnatal depression can be a huge benefit, as you will be able to discuss techniques on how to cope, and have an understanding of each other’s feelings. PANDAS Support Groups offers just that, in a non-judgmental safe environment.

The most important support aid you can have is being able to talk to someone and be honest about your feeling and emotions.  Ensure you write down on a piece of paper or a notebook the numbers of people you can call when you are feeling your worst, and make sure the list is readily available, so if you feel you are becoming aggressive, upset, angry or anxious you can call someone and no that you are not on your own. You can add PANDAS Help Line on your list 0843 28 98 401, and we will always be here to listen.

References

Core intervention in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. Clinical guidelines 31 (Quick reference guide). National institute for Health and Clinical Excellence, November 2005.

Blenkiron P. Treatment of obessive compulsive disorder (review). Continuing Professional Development Bulletin in Psychiatry. (2001) vol 2 (2)

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