A Case Series of Women With Postpartum-Onset Obsessive-Compulsive Disorder

BACKGROUND: There is emerging evidence that postpartum women are at risk for the development or worsening of obsessive-compulsive disorder. The purpose of this study was to provide data regarding the demographics, phenomenology, associated psychiatric comorbidity, family history, and response to open treatment with fluvoxamine in subjects with postpartum-onset obsessive-compulsive disorder. METHOD: Seven consecutive subjects were recruited from an outpatient obstetrical practice and by advertisement. Subjects completed the Structured Clinical Interview for DSM-IV, the Yale-Brown Obsessive Compulsive Scale, and a semistructured interview for family history, demographic data, and clinical features. Three of the 7 subjects participated in a 12-week, open-label trial of fluvoxamine treatment of postpartum-onset DSM-IV obsessive-compulsive disorder. RESULTS: The women described a mean age at onset of 28 years, and 4 subjects had a chronic course. Six subjects reported onset after the birth of their first child, and the mean time to onset was 3.7 weeks postpartum. All subjects experienced both obsessions and compulsions and reported aggressive obsessions that involved their children. None of the subjects acted on their obsessions to harm the children, but 5 reported dysfunctional mother-child behavior. All 7 subjects met criteria for at least 1 comorbid psychiatric disorder, with a mood disorder the most common. Family histories were notable for high rates of mood disorders and psychoactive substance use disorders in first-degree relatives. Two of the 3 subjects who entered the open-label trial of fluvoxamine experienced a positive response, defined as a 30% or greater decrease in the total score of the Yale-Brown Obsessive Compulsive Scale. CONCLUSION: Obsessive-compulsive disorder may present in the postpartum period and become chronic. Symptoms of the disorder may adversely affect the mother-child relationship, and it is important to assess for obsessions and compulsions in postpartum women who present with anxiety and/or depression. Fluvoxamine may be effective in reducing the symptoms of postpartum-onset obsessive-compulsive disorder. Controlled studies are needed to confirm these findings.