Postpartum OCD symptoms — CCFP MCQ

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HardMental healthPostpartum OCD symptomsCCFP

A 28-year-old woman 6 weeks postpartum reports intrusive thoughts that harm may come to her infant. She is distressed by these thoughts, avoids bathing the baby alone, and explicitly denies delusions, hallucinations, or any intent to harm her infant. She sleeps when the baby sleeps. What is the most likely diagnosis?

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Correct answer: E — Postpartum obsessive-compulsive symptoms

The correct answer is E: Postpartum obsessive-compulsive symptoms. The patient has classic postpartum OCD: ego-dystonic (distressing) intrusive thoughts about harm to the infant, absence of delusions or hallucinations, no intent to harm, and avoidance behavior (not bathing alone)—a compulsive safety behavior. Option C (postpartum psychosis) is excluded by the explicit statement of no delusions/hallucinations. Option B fails because functional avoidance indicates a disorder, not normal adjustment. Option D (mania) lacks cardinal features: no elevated/expansive mood, grandiosity, or flight of ideas. Option A (delirium) requires altered consciousness and disorientation, not present here. Postpartum OCD is common and may be underdiagnosed; CFPC guidance emphasizes screening with the specific question about intrusive harm thoughts.

Reference: College of Family Physicians of Canada, "Safety of treatment of obsessive compulsive disorder in pregnancy and puerperium," Canadian Family Physician 60(2), 2014, https://www.cfp.ca/content/60/2/133; Canadian Network for Mood and Anxiety Treatments 2024 Clinical Practice Guideline for Management of Perinatal Mood, Anxiety, and Related Disorders.