Postpartum Obsessive-Compulsive Disorder (OCD)

Postpartum OCD

Postpartum OCD, which stands for postpartum or perinatal onset obsessive-compulsive disorder, is a rare anxiety disorder that can show up any time during pregnancy or the postpartum period. Postpartum OCD usually shows up rapidly, not gradually. [1] As with other perinatal mood disorders, people who have family history of anxiety or OCD or have experienced these issues themselves in the past are at higher risk for developing postpartum OCD, though it can affect people without prior history, too. [2]

If you have concerns about your mood during pregnancy or any time in your baby’s first few years, it is always a good idea to talk those concerns over with your doctor or midwife. The crucial thing to remember is that postpartum OCD is temporary and treatable. You do not have to suffer. [2]

Signs and Symptoms

Intrusive thoughts, also known as obsessions, are one of the earmarks of postpartum OCD. These repetitive, often scary, unwanted thoughts focus on things that could possibly harm the baby. Sometimes these ideas are more abstract, but they can also reflect concrete dangers such as choking. It is important to note that the majority of new parents, both male and female, have thoughts and worries about ways in which their baby could be hurt, which can be a normal response to the stress of impending or early parenthood. For people with postpartum OCD, however, the thoughts are persistent, repetitive, and extremely distressing. [1, 3]

Compulsions are behaviors that someone performs over and over again because the repetition feels like it offers protection against intrusive thoughts. Compulsive behaviors can be action-oriented, such as a new mom who checks on her sleeping baby many times or cleans baby bottles over and over again. They can also be mental, such as constant prayer or repetition of a wish that baby be safe. [1, 2]

Other signs of postpartum OCD can include extreme watchfulness over baby, worries about what will happen if you are left alone with baby that lead to avoiding being alone with baby all together, and the impression or fear that you are a bad person who might act on obsessions or cause them to come true. People with postpartum OCD are not likely to act on their intrusive thoughts, but these thoughts can still be troubling and isolating. [2] What makes postpartum OCD even more challenging is that the obsessions and compulsions can be self-reinforcing. That is, the person experiencing postpartum OCD believes that her repetitive rituals or prayers prevent the terrible things she is imagining from happening. Or she believes that if she mentions her intrusive thoughts to anyone, that person will think she is crazy, when really it is normal to have worries about baby and sharing obsessive thoughts with a trusted person can lead to getting help. [1]

Causes, Treatment, and Prevention

Clinicians and researchers have proposed two potential causes of postpartum OCD. The first focuses on the idea that hormone changes during pregnancy and in the postpartum period affect chemicals in the brain and can lead to obsessive thoughts and compulsive behaviors. The second potential cause centers on the sometimes-distressing thoughts that most new parents experience, and suggests that in some people, these thoughts take on increased importance or are viewed as dangerous, which causes anxiety. [1]

Like perinatal depression, it is possible to treat postpartum OCD with medication, including some prescriptions that are safe for pregnancy and breastfeeding. Cognitive Behavioral Therapy or CBT is another option that has been shown to be safe and effective in both treatment and prevention of postpartum OCD. [4] CBT is a four-pronged approach. The first element is an assessment of the situation: how extensive intrusive thoughts are, what triggers obsessions, and the nature of the person’s responses to the thoughts. The second component focuses on education about the normalcy of negative thoughts, and the third focuses on addressing intrusive thoughts with therapy. In the final piece of CBT, a person is exposed to stressful situations, while being supported to avoid coping with compulsive behaviors [1].

If you recognize your own behavior in the signs and symptoms described here, know that you are not alone. Effective treatments exist to help you overcome these challenges, bond with your baby, and move forward with your life, and plenty of new parents have done exactly that. The first step is to talk to a trusted person, preferably your doctor or midwife, who will help you get the support you need.

Resources:

  1. International OCD Foundation, Beyond the Blues: Postpartum OCD
  2. Postpartum Support International, Pregnancy or Postpartum Obsessive Symptoms
  3. WebMD, Dads Obsess Over Fate of Newborns, Too
  4. K.R. Timpano et al., “Efficacy of a prevention program for postpartum obsessive compulsive symptoms,” Journal of Psychiatric Research, 2011.
Abby Olena
Dr. Abby Olena has a PhD in Biological Sciences from Vanderbilt University. She lives with her husband and daughter in North Carolina, where she writes about science and parenting, produces a conversational podcast, and teaches prenatal yoga.

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