Perinatal obsessive–compulsive disorder

I found this article by Challacombe and Roe interesting and timely.1 The idea of harming your baby can be terrifying for a new mother and the distress is aggravated by the fact that such thoughts ‘should not be felt’ by a caring mother. Clearly the difference between obsessive–compulsive disorder (OCD) and other more serious forms of mental illness is that with OCD there is no desire to carry out the thoughts.

I have been in practice for over 30 years in Derby and feel OCD in general is underdiagnosed. When I see a patient with anxiety, problem drinking, or depression, I ask if they have problems with excessive checking or contamination fears. Although I have not kept any figures, a significant number have OCD; some for years and there is often well-meant collusion with friends or relatives. Questions about OCD could be incorporated into anxiety/depression health questionnaires.

OCD is often a chronic illness. Even after appropriate referral and therapy, I find relapse is common. I now negotiate treatment goals with the aim of ‘minimising its effects on everyday living’. Patients seem relieved about this, as they get frustrated and disappointed that their problem was not ‘cured’ by therapy. They are often thorough and conscientious and can make excellent parents and valued workers.

• © British Journal of General Practice 2013