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From Bump to Baby: Pregnancy and Postpartum Obsessive Compulsive Disorder Megan Barthle PhD, Danielle Cooke MS, Joseph McNamara PhD, Kay Roussos-Ross MD

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Page 1: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

FromBumptoBaby:PregnancyandPostpartum

ObsessiveCompulsiveDisorder

MeganBarthlePhD,DanielleCookeMS,JosephMcNamaraPhD,KayRoussos-RossMD

Page 2: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

PresentaBonOverview

•  Background•  ClinicalCare•  DisclosureandSelf-Advocacy•  ImpactonRelaBonships•  QuesBons

Page 3: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

Background

Page 4: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

EpidemiologyofOCSymptoms

•  Obsessive-compulsivesymptoms(OCS)arenormalduringpregnancy:– 65%ofthenewparentswhohaveexperiencedarecentbirthreportedobsessionalintrusivethoughts(Abramowitzetal.,2003)

•  Longitudinalstudy:•  37.5%ofwomenreportedexperiencingsubclinicalobsessionsorcompulsionsattwoweekspostpartum

•  29.2%at6months(Milleretal.,2013;Milleretal.,2015)

Page 5: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

EpidemiologyofpOCD

•  RiskFactorsforpOCD– Higherlevelsofoverallanxiety– HigherlevelsofpreexisBngsubclinicalobsessivecompulsivesymptoms

– PresenceofcogniBvedistorBonssuchasthought-acBonfusion.

(Abramowitzetal.,2003;Abramowitzetal.,2006;Timpanoetal.,2011)

Page 6: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

EpidemiologyofpOCD

•  World-widemeta-analysissuggestswomenwhoarepregnantorwhohavegivenbirthare1.79BmesmorelikelytoexperienceOCDthanregionallyandBmematchedwomen– Womenintheprenatalperiodare1.45Bmesmorelikely

– Womeninthepostpartumare2.38Bmesmorelikely

(Russelletal.,2013)

Page 7: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

OnsetAmongPregnant

orPostpartumWomen

Prenatal

%(N)

Postpartum

%(N)

Peripartum

%(N)

ProspecBveSamplesUguzetal.,2007a* 3.9(12)

Milleretal.,2013 5.5(18)

Chaudron&Nirodi,2010* 31.3(5)

RetrospecBveSamplesFairbrotheretal.,2016 2.9(9) 3.6(11) 3.9(12)Uguzetal.,2007b* 0.5(2) *indicatesclinicalinterviewversusself-report

Page 8: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

ExacerbaBonofSymptoms

AmongwomenwithOCDorOCSpriortopregnancy:•  Between30-50%willexperienceexacerbaBonofsymptomsduringorfollowingpregnancy

•  Between8-20%willexperienceimprovement•  Roughly50%willexperiencenochange(Forrayetal.,2010;Guglielmietal.,2014;Labadetal.,2005;Mainaetal.,1997;Uguzetal.,2011;Williams&Koran,1997)

Page 9: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

SymptomType

ChildSafety

Aggressive

Taboo/Unacceptable

Symmetry

ContaminaBon

“I’mafraidthatIcouldgetmybabysick!”

“I’mafraidIwanttohurtmybaby!”

“I’mafraidIwanttomolest

mybaby!”

“I’mafraidifthingsaren’tjustright,mybabywillget

hurt!”

Page 10: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

Depression

•  15-40%ofpostpartumwomenwithOCDexperiencepostpartumdepression(Kayaetal.,2013,Labadetal.,2005;Milleretal.,2013;Williams&Koran,1997;Wenzeletal.,2005;Zambaldietal.,2009).

•  PostpartumdepressionandpOCDarecloselylinkedandcanlooksimilarlyclinically(Maurietal.,2010)

– ManywomenwithpostpartumdepressionwillendorseOCS,withsimilarsymptomcontent(Humenik&

Fingerhut,2007;Milleretal.,2013;Wenzel,Gorman,O’Hara&Stuart,2001)

•  WomenwithpOCDexperiencesignificantlymoredistress,anxietyanddepressionwhencomparedtocommunitycontrols(Challacombeetal.,2016)

Page 11: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

Partners

•  Anxietydisorders(Leach,Poyser,Cooklin,&Giallo,2016)–  4.1-16%prenatal–  2.4-18.0%postpartum

•  Depression(Paulson&Bazemore,2010)–  10%postpartum–  Highestriskoccurringduringthe3-6monthpostpartumperiod

•  RetrospecBvestudies–  2.9%(n=1;Mainaetal.,1999)and6.5%(n=23;Torresanetal.,2013)

•  SingleprospecBvestudy(n=726)(Coelhoetal.,2014)–  3.4%inthethirdtrimester–  1.8%duringthepostpartum–  92.3%newonset–  maternalOCDstatusmayincreasetherisk(6Bmesmorelikely)

Page 12: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

ClinicalCare

Page 13: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

POCDandCBT-E/RP

•  CanbeusedaloneorinconjuncBonwithpsychopharmacologicaltreatment

•  EffecBveforpaBentsunwillingtotakemedicaBonsduetoconcernofsideeffectsorcontaminaBon

•  BeoerlongtermOCDtreatmentgainswithlessrelapsethanmedicaBonalone(O’Sullivanetal.,1991;Koranetal.,2002)

Page 14: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

POCDandPrevenBon

•  AsinglerandomizedcontroltrialsuggeststhatpsychoeducaBonregardingpostpartumanxietyandOCS,treatment,exposuretherapyandcogniBverestructuringcanbeeffecBveinprevenBngvulnerableindividualsfromreachingclinicallevels(Timpanoetal.,2011)

Page 15: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

POCDandFamilyAccommodaBon

•  pOCDaffectsparenBngstyle(Abramowitzetal.,2003;Jenningsetal.,1999;Miller&Shah,1999)– Overresponsibleoravoidant

•  MostcommonfamilyaccommodaBons(Stewartetal.,2008)– Providingreassurance– WaiBngforritualcompleBon

•  FamilyinclusivetreatmentforOCDtargeBngaccommodaBonhasbeenassociatedwithgreaterimprovementinpaBentfuncBoning.(Thompson-Hollandsetal.,2014)

Page 16: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

•  UntreatedprenatalOCDissignificantlyassociatedwithpoorqualityoflife(Gezgincetal.,2008)–  Impairmentsinphysicalhealth,psychologicalhealth,socialrelaBonshipsandenvironmentquality

•  MotherswithOCDreportedlessenjoymentofchildinteracBons,greatermaritaldistress,lesssocialsupport,andlessparenBngconfidencecomparedtocommunitycontrols(Challacombeetal.,2016)

ImpactonRelaBonships

Page 17: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

Medicalcare,PsychopharmacologicalCare,Disclosure,andSelf-Advocacy

AshortvideowithDr.Roussos-Ross

Page 18: From Bump to Baby - University of Florida · (Kaya et al., 2013, Labad et al., 2005; Miller et al., 2013; Williams & Koran, 1997; Wenzel et al., 2005; Zambaldi et al., 2009). •

•  CurrentlyrecruiBngcliniciansandresearcherstocompletequalitaBveinterviewsgatheringinformaBontheirperspecBvesonpOCD

•  FutureresearchwillinvolveaskingpaBentssimilarquesBonsabouttheirperspecBvesonpOCDtoseewhereclinicianandpaBentperspecBvesconvergeanddiverge

FutureDirecBons


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