Pregnancy and Obsessive Compulsive Disorder

pregnancy obsessive compulsive disorder

Obsessive Compulsive Disorder (OCD) is a mental disorder that affects 2.2 million American adults. While both men and women can have OCD, women may find that the symptoms are affected or triggered by pregnancy. Women who have been diagnosed with OCD may experience a worsening or a recurrence of symptoms during pregnancy or after birth. The hormonal changes associated with pregnancy and/or birth can also trigger  OCD symptoms in women with no previous symptoms or diagnosis.

OCD is an anxiety disorder characterized by repetitive unwanted thoughts or feelings and the compulsive behaviors undertaken to minimize the anxiety. Such thoughts might focus on an excessive fear of germs or contamination or an irrational fear of hurting someone. The compulsive behaviors—rituals such as counting and excessive hand washing— may bring temporary relief, but not being able to perform these rituals can increase anxiety. Untreated, OCD thoughts and behaviors can so consume a person’s life that they interfere with the ability to function at work, school or home. OCD can interfere with parenting priorities.

What’s the difference between normal worrying and OCD?

Worrying during your pregnancy and about your baby’s welfare are perfectly normal. There’s a lot to think about when you suddenly become responsible for another person. It’s the degree to which you worry and how you attempt to solve such problems that determines OCD.

For example, most pregnant women become more concerned about their health when they learn they are pregnant. It’s normal to wonder if you are taking the right vitamins, eating enough vegetables or whether it’s safe to take certain allergy medications when pregnant, These are valid concerns and situations that you have some control over.

OCD takes normal fears to an extreme, harmful, and sometimes paralyzing degree. A person with OCD may spend hours worrying about germs. A person may wash their hands until they are bloody. The person may stay up all night cleaning to be sure the house is germ free. In an extreme case the person may feel as if her home is contaminated by some mysterious microbe, so she can’t live there or have the baby there.

A pregnant woman or a new mom with OCD may spend hours worrying about how her children might be harmed by imagined intruders and be so upset that she is unable to do the laundry or make them a healthy lunch. The basic impulse is sound. That mother wants to protect her child from danger. But the anxiety about an unrealistic problem can be time consuming, even disabling. Such thoughts and behavior can interfere with a mother’s ability to take care of herself and her baby.

What are the symptoms?

It can be helpful to learn more about OCD behavior and symptoms. It is also important to distinguish perinatal OCD from other postpartum mental disorders such as postnatal depression, which affects 10 to 15 out of every 100 women after childbirth,  or postpartum psychosis, which is more severe, and affects 1 in 1,000 women.

While doctors screen for gestational OCD during prenatal visits and postpartum OCD during postnatal visits, it’s wise to learn the symptoms in case they develop later on. Here are some of the symptoms usually associated with OCD:

  • Repeated thoughts, images and urges, which include fear of germs, dirt, contamination, intruders or imagining hurting loved ones.
  • Repetitive behaviors such as excessively washing hands, locking and unlocking doors, counting, hoarding. No pleasure is derived from engaging in these rituals but they do provide temporary relief from anxiety.
  • The person spends at least an hour a day on such thoughts and rituals.

Treating OCD

Fortunately, OCD can be treated with behavioral therapy and medication.

During OCD therapy, patients learn to recognize and confront disturbing thoughts without acting on their compulsions. Every time patients have such an irrational thought, they are encouraged to say, this is an OCD thought and not realistic. They learn not to try to solve the problem of the intrusive thoughts, but rather to let them be and ignore them. If it’s impossible to control the thoughts, it may be possible to control the reaction.

For many people with OCD medication such as selective serotonin reuptake inhibitors (SSRIs) can be helpful. SSRIs are a class of antidepressants used to treat depression and anxiety disorders.  The risk of birth defects in babies whose mothers take SSRIs during pregnancy is low, so most of these antidepressants are considered safe during pregnancy. You can discuss the risks and the benefits of taking medication with your doctor.

Already taking an SSRI?

If you are already being treated for OCD with a prescription drug and worry about the risk, do not stop taking it suddenly. Talk to your doctor about whether to continue taking it. If you decide to stop, it’s ideal to taper off slowly.

If you do decide to take medication, your doctor can help you find the lowest effective dose possible.

A woman who has been diagnosed with OCD and wants to start a family may want to first talk to her doctor about how her condition might affect her pregnancy.

Joan MacDonald
Joan Vos MacDonald has written about health and fitness for newspapers, magazines and websites. She is a member of the National Association of Science Writers and the author of two books on health-related topics, "Tobacco and Nicotine Dangers," for young adults, and "High Fit Home," a design book about fitness and architecture. She lives in upstate New York near her children and grandchildren.

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