A CASE OF PERIPARTUM OBSESSIVE-COMPULSIVE DISORDER: The Potential Role of Corticosteroids, Gonadal Steroids, and the Neuropeptide Oxytocin in its Pathogenesis.

The perinatal period represents a time of increased vulnerability to psychiatric disorders, including the largely understudied obsessive-compulsive disorder (OCD). In contrast to the gradual onset of typical OCD, postpartum OCD appears to be characterized by the rapid onset of obsessional symptoms after the birth, with onset as early as the second postpartum day with a mean time to onset of 2.2 to 3.7 weeks. We present a case of a patient with prepartum generalized anxiety disorder (GAD) and new-onset postpartum OCD. The patient's ego-dystonic obsessions were aggressive in nature ("harm to newborn") with pathological checking compulsions requiring reassurance that she would not engage in this activity. Neurobiologically, there has been speculation that changes in estrogen and progesterone in the puerperium might alter serotoninergic function, placing some women at risk for this subtype of OCD. Some research studies have found evidence to suggest that oxytocin is associated with OCD. We review the growing evidence that suggests oxytocin and gonadal steroids might play a role in the pathogenesis of some forms of OCD.