Understanding Postpartum OCD and Intrusive Thoughts in Motherhood

 

Mental health conditions in the perinatal period (from time of gestation - up to 1 year postpartum) are greatly misunderstood. What is top of mind when the term maternal mental health comes up? For most people, it is the baby blues or postpartum depression, which in and of itself is debilitating.

However, what is less known is that anxiety disorders are more prevalent in the perinatal period than depression. This was unbeknownst to me as someone with a background in psychology, research and therapy.

My first ‘exposure’ to postpartum anxiety came shortly after becoming a mom myself and realizing there was so much I was unprepared for.

What is even less understood, is a condition called Perinatal Obsessive-Compulsive Disorder (OCD). It can also be referred to as Postpartum OCD. For those with a prior history of OCD, it can reappear and intensify in the time of pregnancy & postpartum, and even more astonishing, is that in some cases of perinatal OCD, the individual had no prior history of OCD. Because OCD is a condition that is stress responsive, we tend to see a significant jump in symptoms associated with the life transition of becoming a parent. To learn more about OCD in general, click here.

Intrusive thoughts and Parenthood

Most new moms and dads, with and without a psychiatric condition like OCD, will actually experience unwanted intrusive thoughts about their baby. Some surveys show up to 80% of new mothers have intrusive harm-related thoughts. Some of the typical examples are “what if I drop the baby down the stairs?” or “what if my baby drowns in the bath?”. The nature of these thoughts are scary and typically involve intense fears and visual images of your baby dying. These thoughts and images can be hard to “shake off” and lead to an increase in anxiety or fear-based behaviors. Some parents have the capacity to interpret these thoughts as “just thoughts” and go on about their day. 

Perinatal / Postpartum OCD

What distinguishes the “regular” intrusive thoughts in parenthood from the more pervasive Perinatal OCD diagnosis?
As we learned, most parents experience these intrusive thoughts. However, those who go on to develop OCD are those who over-interpret these thoughts, attach meaning to it, and feel distress because the thoughts came up in the first place. Here are some additional signs that it may be more than just intrusive thoughts:

  • Rituals/compulsions are taking up more than an hour a day

  • The person is unable to care for themselves and/or the baby due to OCD symptoms

  • Other people are used for reassurance and completing rituals: asking other caregivers to take over anxiety provoking activities (accommodation), like diaper changes, bath time, bedtime

  • Experiencing a lot of fear/dread/hypervigilance about being alone with the baby

  • Experiencing a lot of fear/hypervigilance about leaving baby under the care of other trusted adults

  • Difficulty sharing intrusive thoughts with others

  • Feeling like their brain is restless and they can’t relax

How does Perinatal or Postpartum OCD look to an outside observer?

Let’s say you are the partner or a family member, and you suspect some of this is going on for the new parent in your household. Perinatal OCD can come in many forms, but I will outline some common examples.

The parent may experience thoughts/images about harm coming to the baby - “what if the baby stops breathing?”. What you may spot is the parent spending long periods of time checking and rechecking the baby monitor or physically going into the nursery and checking the baby's breathing, again and again. Never feeling certain enough.

The parent may experience thoughts/images of the baby drowning in the bathtub or thoughts/images of molestation. What you may notice is, the parent may start asking others to do bathtime or diaper changes, and attempt to avoid these situations. Or they may only be willing to engage in caretaking tasks if there are other caretakers around. If they do engage in the caretaking task, it may be completed as quickly as possible because the parent experiences distress. The same pattern applies to thoughts of dropping the baby down the stairs. If there isn't another caretaker around, the parent may engage in compulsions like only going down the stairs in a specific way (going down on their bum, step by step) or they may engage in mental rituals (i.e., saying something reassuring over and over, praying).

Other common harm themes include imagining a car crash that kills your baby. Or imagining losing your grip of the stroller and imagining the stroller rolling onto oncoming traffic. Parents may try to avoid driving altogether. If they continue to take the baby in the stroller, they may be holding on to the handle for dear life, and excessively scan the environment for cars or threats. Again, mental rituals, which are harder to spot, may be occurring as well. This can look like praying or replaying scenarios in their head over and over to make sure they didn’t do anything that could cause harm. But, of course, OCD is a doubting disorder and many with OCD struggle with tolerating uncertainty. So the parent may continue to doubt and get stuck in this cycle, never feeling secure enough. 

Contamination fears may show up as well. Excessive fear about the baby getting sick and dying may trigger behaviors like excessive washing of bottles or washing them in a very particular way that is “just right”. The parent struggling with OCD may not allow the other caregivers to take on this task, out of fear they will not do it right – and the potential consequence is too painful. The parent may not engage in typical activities with the baby (mommy and me classes, daycare, playdates, running errands) out of fear of contamination. The parent may even limit a partner or grandparents from touching the baby.

As an outside observer, partner or family member, it may be scary to hear that your loved one is experiencing such morbid thoughts and it may be difficult to understand why this is happening. It is important to remind yourself that the affected family member sees these thoughts as unwanted and intrusive. These OCD thoughts are also not in line with the persons’ values/wishes. The research shows that postpartum OCD does not predict harm behaviors toward the infant! These thoughts do not equal action. 

The best thing you can do as a family member is to educate yourself on OCD, encourage your loved one to see an OCD specialist, and learn how your behaviors and current ways of responding to the OCD can add fuel to the fire.

Resources for patients and families

 
Postpartum CounselingEva S. Reichel, RCSWI