Academic journal article Journal of Cognitive Psychotherapy

Thought Control Strategies Used by Parents Reporting Postpartum Obsessions

Academic journal article Journal of Cognitive Psychotherapy

Thought Control Strategies Used by Parents Reporting Postpartum Obsessions

Article excerpt

Previous research has established that parents commonly experience intrusive harm-related thoughts pertaining to their infants (e.g., "My baby might die from SIDS"). Cognitivebehavioral models of obsessive-compulsive disorder (OCD) posit that maladaptive strategies for managing such thoughts play a role in the development and maintenance of obsessional problems. In the present study, we examined (1) the strategies parents used to manage unwanted infant-related thoughts and (2) the relationships between thought control strategies and obsessional and depressive symptoms. Non-treatment-seeking parents (n = 75) of healthy newborns completed measures of intrusive thoughts, thought control strategies, and obsessional and depressive symptoms. Mothers and fathers did not differ in their use of various thought control strategies. Strategies involving distraction, self-punishment, and reappraisal of the intrusive thought were positively related to the severity of obsessional symptoms. Punishment was also positively associated with depressive symptoms. Results are discussed in terms cognitive-behavioral models of OCD.

Keywords: obsessions; postpartum; thought control; cognitive-behavioral theory; depression; postpartum depression

Although obsessive-compulsive disorder (OCD) affects about 2.5% of the adult population (Karno, Golding, Sorenson, & Burnam, 1988), a growing number of studies suggests that this disorder occurs at a higher than expected rate among postpartum females (for a review, see Abramowitz, Schwartz, Moore, & Luenzmann, 2003). Despite this increased attention from researchers, the exact incidence or prevalence rates of postpartum-onset OCD remain unknown. The main symptoms of OCD are persistent intrusive thoughts, images, or impulses that evoke anxiety (i.e., obsessions) and the deliberate performance of behavioral or mental acts to neutralize this anxiety (i.e., compulsive rituals). Although the themes of obsessions and compulsions vary widely and typically concern contamination, violence, sex, religion, morality, or orderliness/symmetry (McKay et al, 2004), researchers have recognized that when it occurs during the postpartum period, OCD most often involves repugnant obsessional thoughts concerning harm befalling the infant (Abramowitz, Schwartz, & Moore, 2003; Jennings, Ross, Popper, & Elmore, 1999; Wisner, Peindl, Gigliotti, & Hanusa, 1999). Given that postpartum-onset OCD may place a strain on the infant-parent relationship (e.g., because of related avoidance) and is associated with an increased risk of postpartum depression (Williams & Koran, 1997), there is a need to detect and treat this form of OCD.

Research indicates that most healthy parents of infants-mothers and fathers alike-experience unpleasant or senseless intrusive thoughts pertaining to their babies (Abramowitz, Schwartz, & Moore, 2003; Abramowitz et al., 2006). Examples of postpartum intrusions reported by nonpatients included unacceptable impulses to look at the baby's genitals when changing a diaper, 1 unwanted thoughts about the neighbor's dog attacking the infant, and unwelcome images of the baby lying dead in her crib. Although the composition of such intrusions appears identical to clinical obsessions reported by individuals with OCD, the so-called normal postpartum intrusions were fairly infrequent and associated with minimal distress. These findings are consistent with numerous studies demonstrating that 80% to 99% of mentally healthy individuals experience intrusive thoughts that are indistinguishable from clinical obsessions in terms of their form and content (e.g., Rachman & deSilva, 1978), and the occurrence of such normal intrusions is precipitated by life experiences (deSilva & Marks, 1999; Horowitz, 1975).

The study of postpartum obsessional symptoms is of interest for at least two reasons. First, OCD occurring in the postpartum period has captured only scant research attention, which likely contributes to the fact that it is often undetected and untreated. …

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