Perinatal Timing of Obsessive-Compulsive Disorder Onset

Objectives: The purpose of this research was to assess the timing and characteristics of the onset of perinatally occurring obsessive-compulsive disorder (OCD). OCD is a potentially disabling anxiety-related mental health condition for which the perinatal period represents a time of increased risk for onset, recurrence, and exacerbation.

Methods: This was a prospective cohort study conducted in British Columbia, Canada. Recruitment took place from January 23, 2014, to September 9, 2016. Participants provided information on reproductive and demographic questionnaires and diagnostic interviews (using the Structured Clinical Interview for DSM-5) in late pregnancy and at 2 postpartum time points. Only participants who reported symptoms meeting full criteria for OCD during their current perinatal period were included in this report of findings (N = 97). Analyses were primarily descriptive in nature, with χ² tests employed to test differences in onset (pregnancy vs postpartum) and perinatal OCD development based on age first symptom onset (childhood/ adolescence vs adulthood).

Results: Over two-thirds (71%) of participants whose symptoms met full criteria for OCD at some point in their most recent perinatal period reported perinatal disorder onset. The majority of these (74%) reported onset during their first perinatal period. Perinatal disorder onset was much more likely to occur in the postpartum (83%), compared with in pregnancy (17%), χ² (1, N = 69) = 29.3, P < .001. Symptom exacerbations were more likely to occur in the postpartum (77%) compared with prenatally (35%). Further, the lag time from symptom onset to disorder onset was shorter among participants who experienced a perinatal compared with a nonperinatal onset of their OCD.

Conclusion: Findings contribute to our understanding of perinatal OCD onset, emphasize the vulnerability to OCD during the perinatal period, and provide one of the first assessments in which symptom onset is distinguished from disorder onset. This work underscores the importance of recognizing the distinct nature of perinatal OCD.