Initial Evidence for Symptoms of Postpartum Parent-Infant Relationship Obsessive Compulsive Disorder (PI-ROCD) and Associated Risk for Perturbed Maternal Behavior and Infant Social Disengagement From Mother

Abstract

Infant socioemotional development and underlying brain maturation occur primarily within the context of early caregiver-infant relationships. Perinatal research demonstrates detrimental impact of postpartum pathology, including postnatal onset of maternal OCD—on the mother-infant relationship. The present study is the first to examine postnatal onset of a particular dimension of OCD symptoms focusing on close interpersonal relationships (relationship-OCD, i.e., ROCD) within a general population sample. Specifically, we assessed whether symptoms of Parent-Child ROCD (PC-ROCD), may onset postnatally, thus yielding symptoms of Parent-Infant ROCD (PI-ROCD). We adapted the previously validated Parent-Child ROCD measure for use during infancy to assess symptoms of PI-ROCD. The adapted measure, Parent-Infant Relationship Obsessive Compulsive Symptoms Inventory (PI-PROCSI), was administered to 143 mothers from the general population at 4-months postpartum. We investigated concurrent associations between postnatal onset of PI-ROCD, maternal depression and bonding, as well as longitudinal predictive associations with observed maternal and infant behaviors in dyadic interactions at 10 months. Due to dropout across the 1st year postpartum, the subsample with longitudinal data was substantially reduced compared to the full sample. PI-PROCSI scores explained unique variance in concurrent maternal depression over and above concurrent anxiety. PI-PROCSI scores also associated with concurrent impairments of maternal bonding. Moreover, unique associations emerged between maternal PI-ROCD scores and perturbations in both maternal and infant observable behaviors at 10-months. Specifically, observable perturbations in maternal behaviors mediated associations between symptoms of PI-ROCD at 4-months and observable infant avoidance of social engagement behaviors at 10-months. Findings suggest that parent-child ROCD symptoms may onset during the postnatal period, and that such symptoms may play a significant role in shaping quality of reciprocal caregiver-infant interactions. Theoretical and clinical implications are discussed.

The impact of postpartum obsessive-compulsive symptoms on child development and the mediating role of the parent–child relationship: A prospective longitudinal study

“…These findings are somewhat surprising given the fact that obsessions and compulsions in the postpartum period often revolve around the health and well-being of the newborn child ( 68 , 70 , 75 – 77 ) and that other studies have demonstrated that mothers experiencing postpartum obsessive-compulsive symptoms are less sensitive in their interaction behavior with their infants compared to healthy mothers ( 65 , 101 ). Indeed, a recent population-based study among Israeli women indicates that maternal postpartum obsessive-compulsive symptoms are associated with poorer mother–child relationship 4 months after delivery ( 102 ). One possible explanation for this unexpected result could be the fact that Ratzoni et al focused on a specific subtype/manifestation of postpartum obsessive-compulsive disorder, namely parent–child relationship obsessive-compulsive disorder.…”

Narrating Perinatal Obsessive-Compulsive Disorder Through Blogs

“…Women with OCD symptoms displayed lower responsiveness toward their infants than mothers without symptoms. In a sample of 143 mothers, Ratzoni et al (2021) reported higher OCD symptom scores were significantly negatively associated with maternal bonding at 4 months after birth.…”

“…There is only one scale developed that measures OCD symptoms during the perinatal period, the Perinatal Obsessive-Compulsive Scale (POCS; Lord et al, 2011), which consists of two Likert subscales: a symptom severity subscale and an interference subscale. The fi rst scale to assess symptoms of postpartum Parent-Infant Relationship Obsessive-Compulsive Disorder (PI-ROCD) and its risk for impaired maternal bonding (Ratzoni et al, 2021) was recently published.…”

Persistent symptoms of maternal post‐traumatic stress following childbirth across the first months postpartum: Associations with perturbations in maternal behavior and infant avoidance of social gaze toward mother

“…Studies primarily focus on maternal postpartum depression and anxiety, demonstrating significant prevalence of these conditions (13% and 8.5%, respectively; Goodman et al, 2016;O'Hara & McCabe, 2013). Research further reveals the negative influence of these and other postpartum conditions such as somatization and obsessive compulsive symptoms on observed maternal behavior and associated infant outcomes (Goodman et al, 2016;Murray et al, 2018;Ratzoni et al, 2021). The well documented risks of postpartum depression/anxiety and other symptoms have generated substantial efforts to target these in preventive policy within perinatal healthcare systems worldwide (e.g., Bringing Postpartum Depression Out of the Shadows Act, 2015The United Nations, 2015).…”

“…Comorbid anxiety has been found to range from 7% for clinical levels of anxiety to 100% for subclinical levels of anxiety, at 4–6 weeks postpartum (Dikmen‐Yildiz et al., 2017; Polachek et al., 2014), with triple co‐morbidity ranging from 2% to 3% (Agius et al., 2016; White et al., 2006). Abundant research has established the adverse impact of postpartum depression, anxiety and other postpartum maternal symptoms on both maternal behavior and infant development (Goodman et al., 2016; Murray et al., 2018; Ratzoni et al., 2021). After controlling for comorbid conditions, one previous study found null effects of PTS‐FC on maternal behavior and infant outcomes (Parfitt et al., 2013).…”