What is Postpartum OCD?

Anxious mother with baby
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Have you noticed a change in yourself since becoming pregnant? Do you find yourself more anxious and distressed since giving birth? It is normal for women to experience emotional adjustments during perinatal (from the time you become pregnant up to a year after giving birth) or postpartum (after birth) times. 

If you have a new child, you may find yourself with distressing thoughts about possible harm to your baby, and you may also be more obsessive about rituals and behaviors around keeping your child safe. This could be Postpartum Obsessive Compulsive Disorder (OCD). 

If this feels like you, read on to answer questions like, How do I know if I have postpartum OCD? How long does postpartum OCD last? Does postpartum OCD go away? And what are treatments for postpartum OCD?

Postpartum emotional changes are normal

It is natural for mothers to become more protective after childbirth and some anxiety is normal. During this time of motherhood, there is a lot happening: significant hormone changes, increased physical demands, and identity adjustments, to name a few. Because of this, it is also common that more significant emotional changes may occur during this timeframe. 

The Seleni Institute estimates: 

  • 7-15% of women experience perinatal major depressive disorder (MDD) 
  • 7-10% experience generalized anxiety disorder (GAD) 
  • 6-10% experience Posttraumatic Stress Disorder (PTSD)
  • 1-5% experience panic disorder 
  • 3-5% experience perinatal or postpartum obsessive compulsive disorder (OCD). 

Could your fears and intrusive thoughts be more? Let us explore what is postpartum OCD.

Defining Postpartum OCD

Postpartum OCD is an anxiety disorder that occurs after giving birth. It is the only anxiety-related disorder with increased risk of rapid onset in the perinatal time frame – especially with women who are pregnant and giving birth for the first time. 

A hallmark of Postpartum OCD is distressing and intrusive thoughts, often around harm coming to the baby. 

Symptoms of postpartum OCD can include: 

  • behaviors that reduce distress triggered by obsessions 
  • irritability and anger, 
  • difficulties bonding with the baby, and 
  • unwanted, intrusive thoughts. 

When these thoughts occur, new moms – in attempts to rid themselves of anxiety – may begin performing mental or physical rituals, checking things repeatedly, or seeking reassurance excessively. 

Mothers are not the only ones who can experience postpartum disorders. There is growing research showing that approximately 10% of new fathers have postpartum anxiety (PPA) or postpartum depression (PPD).

What are the Differences between Postpartum OCD and OCD?

If you have OCD prior to pregnancy, you are at an increased risk of developing greater symptoms during the perinatal period. Over half of women with an OCD diagnosis prior to pregnancy experience an increase in OCD symptoms during the pregnancy and postpartum time frame. However, postpartum OCD can occur without ever having experienced OCD before. 

The main difference between postpartum OCD and OCD is that perinatal OCD centers around caretaking of the new baby. OCD that is not related to pregnancy can have obsessions and compulsions around anything. Additionally, non-perinatal OCD generally begins to develop more slowly, whereas postpartum OCD tends to be a more rapid onset either during pregnancy or after giving birth. 

Postpartum OCD is often associated with distressing thoughts such as: 

  • What if I harm the baby? 
  • What if I drop the baby? 
  • Am I a good mother? 
  • Am I doing it right? 
  • What if I touch the baby inappropriately by accident when I change their diaper? 

It’s important to note that these thoughts are symptoms, and there is a low risk the baby is in danger of being harmed. Parents with postpartum OCD go out of their way to prevent these bad or “immoral” thoughts from occurring, which perpetuates the fear. 

Another important distinction is that postpartum OCD is not the same as postpartum psychosis. Someone experiencing postpartum psychosis lacks insight and is experiencing delusions. Instead, one of the main symptoms of postpartum OCD is that mothers have insight into the distressing thoughts they experience. These symptoms are not a sign of you’ve done something wrong or that you are a bad person or parent. 

How do I know if I have postpartum OCD?

Postpartum OCD begins after childbirth. It can also occur during pregnancy. You may ask yourself, how do I know if I have postpartum OCD? Postpartum OCD is made up of both obsessions and compulsions. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) defines obsessive–compulsive disorder (OCD) as “the presence of obsessions, compulsions or both.” 

Obsessions characteristic of Postpartum OCD

Obsessions involve persistent thoughts, ideas, images, impulses or doubts. The obsessions are unwelcome, disturbing, and often appear irrational. 

DSM-5-TR states that with OCD, the person tries to ignore or suppress such thoughts, urges or images, or neutralize them with another thought or action (the compulsion). 

Common themes in perinatal OCD obsessions are contamination, responsibility for harming, violence, sex, morality and religion. For example, a new mother may not be comfortable, unable to sleep, or in distress. When they return home from hospital, they may feel significant anxiety and be unable to sleep when their newborn sleeps. She might feel dissociated (or not connected with herself) and dreamy throughout the day. A new mother may be unable to hold her baby out of fear of her bad thoughts harming the baby. There could be constant reassurance seeking to her partner or others around her that I am a good mother or excessive thoughts of, “Am I doing it right?” There could be anxious thoughts or worries about if she is feeding her baby bad breast milk. 

Compulsions characteristic of Postpartum OCD

Compulsions are urges to do certain things or say certain things to rid yourself of obsessive thoughts or to avoid the things you are afraid of. Common compulsions include: seeking reassurance, ordering and arranging, repeating routine activities, counting, praying or balancing (e.g. if I touched this with my left hand, I now have to touch it with my right hand). 

In new mothers, checking in on a newborn is normal in terms of alertness to their new baby’s well-being. In perinatal OCD, however, the checking is intensified to a degree that affects the mother’s ability to care for the newborn. The compulsion may not be a ritual, but may be the avoidance of the feared situation, behavior, or objects associated with obsession – such as not changing your baby’s diaper because you fear you will touch them inappropriately.

The DSM-5-TR defines compulsions as repetitive behaviors or mental actions that people feel compelled to perform in response to an obsession or according to strict rules.  These behaviors or mental actions are aimed at preventing or reducing anxiety or distress, or preventing a dreaded event or situation, but these behaviors or mental actions are clearly excessive.

In Postpartum OCD, these thoughts and actions impact your everyday functioning, your relationship with your baby, and potentially others in your life who may be frustrated or not understand why you are doing and acting the way you are. 

How long does Postpartum OCD last? And does Postpartum OCD go away?

Just like anything, the length of postpartum OCD symptoms will vary depending on the individual, any prior OCD, and the type of treatment received. Postpartum OCD symptoms can be managed and go away with the appropriate treatment. 

What are treatments for Postpartum OCD?

Postpartum OCD can be treated. If left untreated, it may impact your ability to bond with your child due to the time spent with the compulsions. It may also lead to an avoidance of your baby due to fear of harm. 

OCD is not different from a medical illness, and there are several treatments for postpartum OCD. You want to find a mental health provider trained in maternal mental health. Treatments for postpartum OCD include exposure and response prevention and medication management.  

Exposure and Response Prevention

The gold standard for treating postpartum OCD is a type of cognitive behavioral therapy (CBT) specifically for OCD, known as Exposure and Response Prevention (ERP).  This treatment can be done in outpatient settings, and also in inpatient facilities if severity warrants it. In ERP, you work with an ERP-trained therapist to confront the feared situations and learn that the compulsive behavior doesn’t get rid of the obsession. This could include exposing you to what is making you anxious or the triggers to your obsessions and then learning skills to not choose or give in to the anxiety-reducing behavior or compulsion.

Medication Management 

Medication in conjunction with ERP has shown to be the most beneficial, especially if your symptoms are severe (eg., not responding to behavioral treatments alone or significantly impacting your everyday functioning). It is a good idea to get a psychiatric consultation to find medicine that may provide you some symptom relief, as significant distress and compulsive acts can take a toll on your physical and mental health. 

A psychiatrist may prescribe certain anxiety-reducing medications, which can help reduce unwanted thoughts in conjunction with behavioral health treatment. There are actually specific psychiatrists called Reproductive Psychiatrists who specialize in medications related to women’s health issues, including maternal mental health. These psychiatrists are well-versed in the impact of various medications and the impact on the fetus in-utero or while breastfeeding. 

Being a new parent does not come with a manual. There is already a lot of pressure with being a new parent, and there can be feelings of shame associated with having bad thoughts about your baby. You are not a bad parent. Postpartum OCD is common, and the symptoms are treatable. 

If you or someone you know is experiencing perinatal mental health issues, help is available. 

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