ORIGINAL ARTICLE Obsessional thoughts and compulsive behaviors in a sample of women with postpartum mood symptoms Jonathan S. Abramowitz & Samantha Meltzer-Brody & Jane Leserman & Susan Killenberg & Katherine Rinaldi & Brittain L. Mahaffey & Cort Pedersen Received: 28 December 2009 / Accepted: 14 June 2010 / Published online: 6 July 2010 # Springer-Verlag 2010 Abstract Postpartum psychiatric disorders are widely recog- nized by clinicians and researchers, yet while much attention has been paid to perinatal mood disorders, considerably less has been given to anxiety and obsessive–compulsive symp- toms in this population. The present study examined anxiety and obsessive–compulsive symptoms among postpartum women with mood complaints, with the aim of delineating the relationship between these symptoms. Sixty postpartum women seeking treatment in a perinatal mood disorders clinic completed measures of depression, anxiety, and obsessive– compulsive symptoms. Obsession-like thoughts and compulsive-like (“neutralizing”) strategies were present among the majority of the sample, yet the severity of these symptoms ranged widely. Depressive and anxiety symptoms were associated with obsessive and neutralizing compulsive symptoms. It may be helpful to consider anxiety and depressive symptoms as part of a broad spectrum of perinatal psychiatric illness. Clinicians should assess for anxiety and obsessive–compulsive symptoms as routinely as they assess for depressive symptoms in the perinatal period. Keywords Postpartum . Obsessive–compulsive . Anxiety . Depression Introduction Psychiatric disorders during pregnancy and following child- birth are widely recognized by clinicians and researchers. While a good deal of attention has been paid to the course and treatment of mood disorders in the perinatal period (Cohen and Altshuler 2006; Nunacs and Cohen 1998; Viguera et al. 2007; Wisner et al. 2002), considerably less has been given to characterizing anxiety symptoms during this period. Identifying women who are vulnerable to anxiety symptoms in the perinatal period, however, is of great clinical importance. Untreated maternal anxiety, for example, may adversely impact fetal development, postnatal maternal/infant bonding, and child growth and development. Indeed, babies of anxious mothers tend to be born prematurely and have a significantly lower than average birth weight for their gestational age (Perkin et al. 1993; Wadwa et al. 1993). Moreover, anxiety disorders in pregnancy constitute an independent risk factor for the development of postpartum depression (Lee et al. 2007; Rambelli et al. 2010). Following delivery, depressed and anxious mothers, relative to healthy mothers, tend to be less engaged with their infants and less able to regulate their emotional respon- siveness, and their infants show compromised social and emotional functioning (Weinberg and Tronick 1998). Anxious mothers also struggle with breast feeding their infants (Britton 2007). Given that symptoms of depression and anxiety frequently overlap, including in the perinatal period, it is not surprising that the term “postpartum depression” is often used as a catch-all phrase to describe a myriad of perinatal emotional symptoms. In fact, the Edinburgh Postnatal Depression Scale (EPDS), a well-validated screening tool used to monitor depression in pregnancy and postpartum, includes several items that quantify levels of anxiety, worry, fear, and panic in peripartum women (Cox et al. 1987). More recent work comparing depression in postpartum women versus depression in women outside J. S. Abramowitz (*) : S. Meltzer-Brody : J. Leserman : S. Killenberg : K. Rinaldi : B. L. Mahaffey : C. Pedersen University of North Carolina at Chapel Hill, CB # 3270, Chapel Hill, NC 27599, USA e-mail: jabramowitz@unc.edu Arch Womens Ment Health (2010) 13:523–530 DOI 10.1007/s00737-010-0172-4