Diagnosis and Treatment of Postpartum Obsessions and Compulsions That Involve Infant Harm

For women who develop intrusive thoughts of harming their infants and rituals that result in avoidance of their babies, differential diagnosis includes postpartum major mood disorders, obsessive-compulsive disorder, and psychosis with infanticidal thoughts. Rapid onset in the postpartum period of anxiety and obsession is common. Insight into the obsessive unreality of rituals to avoid harm is a key diagnostic feature. Treatment includes serotonergic drugs, psychoeducation to help the woman understand that she is unlikely to harm her infant, and exposure with response prevention therapy.

Obsessive-compulsive symptoms in the postpartum period often include intrusive thoughts of harming the infant and rituals that result in avoidance of the baby. The differential diagnosis of women who develop these symptoms includes postpartum major mood disorders, obsessive-compulsive disorder, and psychosis with infanticidal thoughts. The treatment of the most common diagnoses, mood disorders and obsessive-compulsive disorder, includes serotonergic drugs, psychoeducation to help the patient understand that she is highly unlikely to harm her infant, and exposure with response prevention therapy. This intervention involves exposure of the patient to the feared situations, which are usually related to infant care, while simultaneously preventing the compulsive rituals.