perfectionism and - Obsessive-Compulsive Foundation

Assessment and Treatment of Postpartum OCD
IOCDF Annual Conference, July 2013
Licia Freeman, M.A., M.Ed., LMFT, CSAT(c)
www.liciafreeman.com
Obsessions: The same thoughts, images, or impulses come again
and again, and are distressing, frightening, and often shame producing.
The person tries to dismiss them, and that just strengthens
them.
Compulsions: Rituals (actions and thoughts), developed to gain
temporary relief
Assessment and Treatment of Postpartum OCD
1. Etiology:
- Physiology: Abnormalities detected in the frontal lobe and
the basal ganglia, and in some neurotransmitters such as serotonin.
In OCD patients the frontal cortex works extra hard
to tame the impulses of the limbic system
- Environment: An event or thought will often trigger the obsessions
and compulsions
- Genetics: Relatives of OCD patients are more likely than the
average person to develop anxiety/depression. Onset of OCD
in late teens
- Psychological: To prevent a psychologically painful idea from
surfacing into one’s consciousness, one focuses on another
painful yet less disturbing idea. Low self-esteem also plays a
role
Causes of OCD:
- It’s both a learned and a biological disorder
- Neurobiological disorder – dysfunction in the biology of the
brain
- Stress and biological mechanisms play a role in activating the
genes
- Neuropsychiatric illness resulting from a malfunction in the
circuitry of the brain
- Striatum
- Biochemical imbalance in the brain that results in a malfunction
of the brain’s gearshift – the brain gets stuck
- Changing one’s behavioral responses to the uncomfortable
feelings and shifting to useful and constructive behaviors
will, over time, make the broken gearshift come unstuck
- Fluctuation in hormones – especially progesterone and oxytocin
- Personal and family history of mood and anxiety disorders
- Excessive and overwhelming sense of responsibility for another
much more fragile human being
- Glitch in the brain which sends our false message
Uncertainty is at the core of OCD
2. Symptoms and Assessment Tools
- Most common types of PPOCD:
Contamination, Checking, Primary Mental Obsessions
- Assessment Tools: YBOCS Symptoms Checklist, YBOCS, EPDS,
PDSS, Perinatal/Postpartum Checklist (make your own)
OCD vs. PSYCHOSIS
OCD
Psychosis
Thoughts repulsive
Thoughts pleasurable
Try to dismiss obsessions Agree with obsessions
Ego dystonic
Ego syntonic
Avoidance
Thoughts consistent
with world view
Aware of irrationality
Thoughts part of delusions
Warped reality
3. Treatment
Goal of treatment not to stop the intrusive thoughts or even to
know what they mean about her, but to learn to let the thoughts
be there without anxiety – that is normal.
- Medication: very effective in decreasing the anxiety level by
suppressing the intrusive urges so that one can be available
for therapy. At least 10 weeks to see the benefits for OCD.
Luvox, Prozac, Zoloft, Paxil, Celexa, Lexapro, especially helpful
- ERP (Exposure Response Prevention)
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