Infant-Related Intrusive Thoughts of Harm in the Postpartum Period: A Critical Review

Background: Besides the expected warm and joyful thoughts, a new mother can be disturbed by sudden frightening thoughts or images of harm done to her baby: harming intrusions, an obsessive phenomenon. Its high prevalence and possible consequences in functioning and in mother-child bonding makes it desirable that clinicians are well informed regarding the current state of knowledge about harming intrusions.

Objective: To provide a comprehensive review of all studies that have investigated harming intrusions in postpartum women.

Data Sources: A systematic search was performed for primary (MEDLINE, PsycINFO) and secondary (Cochrane Library, National Guideline Clearinghouse, American Psychiatric Association) literature, with data range from inception to April 2015. To provide a complete overview, the approach of the topic by Medical Subject Headings (MeSH) terms and keywords was broad.

Study Selection: Studies in Dutch or English with a clear description of method, covering 1 of our main domains of interestprevalence, assessment, differential diagnosis, etiology, consequences, and treatmentwere selected.

Data Extraction: Two authors extracted quantitative and qualitative data fitting in the domains of interest.

Results and Conclusions: Fifty articles were included. The prevalence of harming intrusions is up to 100% in both women with and without psychiatric disorders. Stress and cognitive misinterpretation are important keys in its appearance and severity. Literature consistently states that isolated harming intrusions contain no increased risk of violence; instead, compulsive behavior is very common. Psychoeducation is found to release a lot of distress; so might cognitive-behavioral therapy and psychotropic medications.

J Clin Psychiatry 2017;78(8):e913–e923

https://doi.org/10.4088/JCP.16r11083