Is this OCD or something more?

By Kristina Randle, Ph.D., LCSW

Q. My nephew’s wife was recently diagnosed with OCD. Her pregnancy exacerbated the symptoms and following the delivery of her first child in March, she went into full-blown OCD. After being hospitalized for a brief time, she was released to the home of a relative. She is taking medications, receiving some therapy and has tremendous family help. This has been devastating to everyone, but the support system of her in-laws is incredible. Currently, she is unable to care for the baby herself, so her mother-in-law has stepped in as primary care-giver. In order to keep the mother and baby near one another, all (including care-giver) are staying in a kind relative’s home. My concern is this. The OCD female often can’t touch the baby, for fear of personal contamination, or fear of contaminating the baby. She often spends hours washing/bathing herself. However, she cleans nothing else. Is this common of an OCD patient? That they only keep themselves immaculate, refusing to clean house/dishes/baby/etc?…I’m assuming for fear of contamination? Another relative recently went over to help care for the baby while the primary caregiver took a much-needed break. They were amazed at the scenario – the OCD female was well-dressed, very conversational (can talk intelligently about her illness), and sat on the sofa, giving orders to them for everything, i.e. where to change the baby, where the bottles were – “Did you wash the nipple well? Be sure to wash your hands.” She did nothing the whole time they were there. Could there be some other psychological issues tied in with the OCD? It seems the OCD female is controlling the rest of the family – they do her bidding, she does nothing. She is well-cared for and nothing is required of her. Is there a systems problem here? Where is someone helping and where does it become enabling?

A. It is difficult to know what is going on with your nephew’s wife. From my admittedly limited perspective, I do believe there is something more psychologically going on than just OCD. It seems that there is possibly a psychosis-based element to her thinking and behavior, primarily the extreme fear of contamination, spending hours washing herself but nothing much else and the very real and sobering fact that she has not cared for her newly born child. These are worrisome symptoms and indicate to me this is more than an extreme case of OCD. It could be a psychosis brought on, related to or exacerbated by the pregnancy or birthing of the child. There are such illnesses such as post partum psychosis and this could be one such case. Additionally, some researchers speculate that the chemical changes that occur during pregnancy cause brain chemical imbalances, enough to potentially cause or contribute to the symptoms that you wrote about. Again, my view is very limited so I cannot say with any certainty what is going on with your nephew’s wife. Overall, I do think this is more than OCD.

I must also add that I do not believe that your nephew’s wife is putting on a show or trying to manipulate the family into caring for her child. It may be easy, especially because you mentioned that she orders others around on how to care for the child, to blame her or think that she is deliberately manipulating others. It is my belief that this is not a deliberate act; rather, this is a woman who has a serious need for psychiatric treatment. Something is wrong with her psychologically. Please do your best to refrain from blaming her. You must realize that a mother who refuses to care for their newly born child is displaying very abnormal behavior, and probably not behaving in such a manner on purpose.

I am very glad to hear that she has a loving and caring family to help her and the baby through this difficult time. Without their help, the baby may not have been cared for properly. This is a complicated situation– one that requires the good help of a psychiatrist or other mental health professionals who can step in and properly assess and treat her condition. Please do your best to pass this information on to the caring family members. Encourage them to help her into treatment. It is what is needed at this juncture. Write again if you have any more questions.

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Last reviewed: By John M. Grohol, Psy.D. on 30 May 2007

APA Reference
Randle, K. (2007). Is this OCD or something more?. Psych Central. Retrieved on December 28, 2014, from http://psychcentral.com/ask-the-therapist/2007/05/30/is-this-ocd-or-something-more/