The Problem -- and Treatment, in Brief

Risk Factors People with a personal or family history of anxiety or obsessive-compulsive disorder (OCD) may be especially vulnerable to OCD during the postpartum period.

In addition, people who have perfectionistic tendencies or psychological rigidity "are more likely to have a brain that plays tricks on itself," says Diana Dell, an assistant professor of psychiatry and obstetrics-gynecology at the Duke University Medical Center. "This [phenomenon] really is a perversion of the ordinary protective thoughts."

Symptoms The obsessive part of OCD is marked by recurrent and persistent thoughts, impulses or images -- in the case of new parents, often about harm coming to the baby -- that are unwanted and cause distress or anxiety. The person recognizes these are a product of her own mind but she is unable to control them.

The compulsive part refers to ritualistic behaviors -- such as repeated hand washing, checking or cleaning -- that the person feels driven to perform to reduce distress or prevent a feared event.

In both cases, the thoughts or acts interfere with the parent's ability to function normally.

Treatment The mainstays of treatment are cognitive behavioral therapy (CBT) and/or medication.

With CBT, "the goal is to interpret and appraise those intrusive thoughts in a more realistic light," explains Jonathan Abramowitz, director of the OCD/Anxiety Disorders Program at the Mayo Clinic.

Therapists help people identify how they've been misinterpreting their intrusive or obsessive thoughts, learn to correct their misinterpretations, then purposely elicit those thoughts in an effort to desensitize themselves to them. People are also helped to refrain from avoidance or checking rituals.

If medication is warranted, deciding which drug to prescribe depends largely on the severity of symptoms and breast-feeding status. Selective serotonin reuptake inhibitors (SSRIs) -- Prozac, Paxil, Zoloft and the like -- are the primary treatment because they are effective at treating OCD and safe to use while breast-feeding, Dell says. (If SSRIs are taken during pregnancy, however, the baby may experience withdrawal effects such as jitteriness and irritability.)

For more severe symptoms, antipsychotic medications such as Seroquel may be warranted, says Shaila Misri, director of the reproductive mental health program at BC Women's Hospital and Health Center in Vancouver, B.C. "Because there is not a lot of published research regarding breast-feeding [while taking antipsychotic drugs], I recommend mixed feedings, using formula to dilute the effect on the baby."

Resources Postpartum Support International ( http://www.postpartum.net ) offers information, a self-assessment test and referrals to local support groups for a variety of postpartum mood disorders.

-- Stacey Colino