Intended for healthcare professionals

Practice Practice Pointer

Intrusive thoughts in perinatal obsessive-compulsive disorder

BMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6574 (Published 05 December 2019) Cite this as: BMJ 2019;367:l6574
  1. Fiona L Challacombe, clinical psychologist1,
  2. Maria Bavetta, patient author2,
  3. Stephanie DeGiorgio, general practitioner3
  1. 1King’s College London, IOPPN & Centre for Anxiety Disorders & Trauma, South London & Maudsley Trust, London, UK
  2. 2Co-founder, Maternal OCD & Champion Network Manager, Maternal Mental Health Alliance, UK
  3. 3GP Perinatal Mental Health Lead, South Kent Coast, UK
  1. Correspondence to F Challacombe fiona.challacombe{at}kcl.ac.uk

What you need to know

  • Intrusive thoughts are distressing, unwanted thoughts, images, impulses, or urges that pop into our minds in an unbidden and unplanned way

  • Consider perinatal obsessive-compulsive disorder (OCD) in women who are pregnant or in new parents when the thoughts are unwanted, distressing, or repetitive and interfere with functioning

  • People with OCD do not act on any violent distressing or intrusive thoughts associated with the condition

A 25 year old woman with a four month old baby presents with severe anxiety. She is experiencing intrusive thoughts of deliberately harming her child. She is reluctant to disclose details of her symptoms. She tells you that she is currently avoiding time with the baby if possible and does not change his nappy alone for fear of harming him. Her partner is aware that she is struggling but does not understand what she is experiencing.

Obsessive-compulsive disorder (OCD) affects 2-4% of women during pregnancy and postnatally, and is thought to be more common during this period.1 It can also affect fathers. Intrusive thoughts are a characteristic feature of OCD, and may lead to compulsive behaviour and high levels of anxiety (box 1). Intrusive thoughts in OCD are unwanted and distressing to the patient, and are particularly frightening if the thoughts become focused on a parent harming their baby. Assessing a woman who is pregnant or postnatal or their partner presenting with intrusive thoughts involves sensitive communication and a careful consideration of risks. This article describes the specific challenges in the assessment and management of intrusive thoughts and OCD in the perinatal period.

Box 1

Intrusive thoughts

“Intrusive thoughts” is the term for a range of mental phenomena including thoughts, images, doubts, and urges that are experienced as unwanted and distressing. The content of the thoughts typically relates to some form of threat. This threat may be external (for …

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