Date of Award


Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Cynthia Neill Epperson


The overarching goal of this study was two-fold; to determine the prevalence of perinatal onset or worsening of OCD symptoms in women attending a university-based research program, and to determine whether there is a continuity between perinatal onset or worsening of OCD and premenstrual exacerbation of such symptoms. Women ages 18 to 69 years old that were enrolled in the Yale OCD Research Program between 1990 and 1995 were interviewed by phone or in person regarding demographics, onset and course of OCD, types of primary OCD symptoms, treatment history, comorbid diagnoses including substance use/abuse, and the impact of pregnancy and menstruation on OCD onset and symptoms. Those who had at least one pregnancy were placed into the Preg group and those who had never been pregnant into the NPreg group. The Preg group was further subdivided; those who reported onset of OCD during pregnancy or the puerperium were assigned to the Puerperal Related (PR) group while those that denied onset of OCD related to pregnancy were assigned to the Non-Puerperal (NP) group. For our secondary aim addressing premenstrual worsening, those women who were in the PR group were combined with women with pre-existing OCD that worsened during pregnancy or the postnatal period. All data were summarized using descriptive statistics (means, SDs, frequencies). Continuous measures were compared between groups using a Student's t-test and categorical variables were assessed using the chi-square test. All analyses were considered statistically significant at P <0 >.05 and performed using SAS, version 9.1. Of the Preg group, 24 (30.8%) fell into the PR subgroup; 11 (14.1%) reported onset during pregnancy, 1 (1.3%) had onset after a miscarriage, and 12 (15.4%) had onset during the postpartum period. Out of 132 total pregnancies, 29 (22.0%) involved an improvement in OCD symptoms, 45 (34.1%) involved an exacerbation of symptoms, and 58 (43.9%) did not change symptom severity in women with pre-existing illness. Although worsening of symptoms prior to menses was reported by the same proportion of women in the Preg group as in the NPreg group, women in the PR group and those with perinatal exacerbation were more likely to report premenstrual worsening of OCD symptoms compared to all others. Findings from this study provide additional evidence that pregnancy and childbirth are frequently associated with the onset of OCD or worsening of symptoms in those with pre-existing disorder. In addition, there appears to be continuity between OCD onset and/or exacerbation across the reproductive life cycle, at least with menstruation and pregnancy. These data can not address the impact of menopause on OCD symptoms. Our findings are consistent with those from other groups, but all need to be confirmed in prospective studies.

Open Access

This Article is Open Access