A 31-year-old woman, 5 weeks postpartum, describes repeated intrusive images of smothering her infant. She finds these thoughts abhorrent, prays they will stop, has removed all pillows from the cot, and has told no one because she fears being called a bad mother. She denies hearing voices and has no fixed false beliefs. What is the most likely diagnosis?
- A Postpartum psychosis with homicidal ideation
- B Postpartum depression with infanticidal intent
- C Postpartum obsessive-compulsive disorder with harm obsessions ✓
- D Adjustment disorder with disturbed conduct
Correct answer: C. Postpartum obsessive-compulsive disorder with harm obsessions
Explanation
Ego-dystonic, intrusive, repetitive thoughts of harming the infant that are actively resisted, accompanied by avoidance behaviours such as removing objects, define postpartum OCD with harm obsessions. Insight is preserved and the risk of enacted violence is very low. In psychosis the thoughts are delusional or command driven and ego-syntonic, while infanticidal intent in depression arises from delusional beliefs that killing saves the child from suffering.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.