Help-Seeking Among Mothers with Postpartum Obsessive-Compulsive Disorder: A Phenomenological Exploration

Background and Purpose: Clinically significant peripartum mental illness affects an estimated 15-20 percent of the global childbearing population. Compared with the most commonly diagnosed peripartum mental illnesses such as depression and anxiety, postpartum Obsessive-Compulsive Disorder (ppOCD) is less well understood and often under- or misdiagnosed. A corresponding lack of research on common clinical manifestations of ppOCD further limits public and professional understanding, perpetuates illness-associated stigma, and inhibits help-seeking. The purpose of this exploratory qualitative study was to gain a beginning understanding of mothers' lived experience of ppOCD, as well as their help-seeking experiences.

Methods:Using interpretive phenomenological research methods, we conducted in-depth face-to-face interviews with 6 female participants who met diagnostic criteria for ppOCD. Phenomenological methods are used to achieve a deep understanding of the lived experience of individuals, as well as identify elements common among multiple people who have experienced similar phenomena. These methods are indicated for exploratory studies where little is known about a specific experience. Due to the in-depth nature of the research process and the specificity of the lived experience, these methods require fewer participants (e.g., 2 to 10) than other qualitative methods. Purposive sampling was used to recruit women from local specialized mental health clinics and via social media. Interviewed participants were between ages 33 and 39, and had 1-3 children under age 5. We used NVivo software to analyze transcripts and field notes using van Manen's approach to phenomenological analysis, guided by Ricoeur's Interpretation Theory. Following initial coding and thematic development, we conducted member checks with each participant, shared findings, elicited feedback, and modified the thematic structure accordingly.

Findings: Three predominant experiential themes emerged from these analyses: shame and stigma; knowledge-seeking and understanding; and acceptance and resilience. Mothers experienced persistent intrusive thoughts of their child(ren) being seriously harmed or killed, either intentionally or accidentally. At symptom onset, mothers had no existing knowledge about ppOCD, and struggled to make sense of their postpartum experiences. Feelings of shame about the content of ppOCD intrusive thoughts, as well as perceived public- and self-stigma, impeded their help-seeking process. Mothers perceived the mental health referrals given by hospital systems to be largely inappropriate for their needs. In some cases, early encounters with mental health providers unfamiliar with ppOCD resulted in initial misdiagnosis and further stigmatization. Alternatively, self-directed processes of knowledge and resource seeking via independent internet-based research and social networking promoted feelings of personal empowerment, facilitating professional help-seeking. Obtaining an accurate diagnosis, working with a mental health practitioner who "understood" ppOCD, and having a strong social support network all facilitated having a greater understanding of symptoms, decreased psychological distress, and promoted resilience.

Conclusion and Implications: The findings emphasize the need to carefully screen for and identify ppOCD among postpartum women, and to provide adequate training for medical and mental health providers caring for this population to: better understand the clinical presentation, provide effective, non-stigmatizing treatment services, and promote social network support. Research on the prevalence and severity of ppOCD and development of clinical evidence-based practices are also strongly needed.