A 30-Year-Old Woman with Postpartum Anxiety and Intrusive Thoughts

This case study details the presentation, differential diagnosis, and management of a 30-year-old woman experiencing postpartum obsessive-compulsive disorder (OCD) with intrusive thoughts of infant harm. Symptoms began weeks after delivery and included insomnia, anxiety, unwanted visual imagery, and compulsive checking behaviors. The patient was distressed but retained insight, distinguishing OCD from postpartum psychosis. Diagnosis was supported by the egodystonic nature of the thoughts, their postpartum onset, and the absence of psychotic features. Multidisciplinary management included psychoeducation, pharmacologic treatment (sertraline, then fluoxetine, and later olanzapine), and cognitive behavioral therapy with exposure and response prevention. The article discusses gaps in postpartum mental health screening and care integration, emphasizing collaborative models and tailored peripartum psychiatric support.

This case study details the presentation, differential diagnosis, and management of a 30-year-old woman experiencing postpartum obsessive-compulsive disorder (OCD) with intrusive thoughts of infant harm. Symptoms began weeks after delivery and included insomnia, anxiety, unwanted visual imagery, and compulsive checking behaviors. The patient was distressed but retained insight, distinguishing OCD from postpartum psychosis. Diagnosis was supported by the egodystonic nature of the thoughts, their postpartum onset, and the absence of psychotic features. Multidisciplinary management included psychoeducation, pharmacologic treatment (sertraline, then fluoxetine, and later olanzapine), and cognitive behavioral therapy with exposure and response prevention. The article discusses gaps in postpartum mental health screening and care integration, emphasizing collaborative models and tailored peripartum psychiatric support.