It was the worst, darkest time of my life. I wouldn’t have wished postpartum OCD on my worst enemy. There’s still so much unknown and misunderstood about this condition.
Let’s break it down to the basics.
The basics of postpartum OCD
Postpartum OCD (Obsessive-Compulsive Disorder) is a subtype of OCD that occurs in women after giving birth. Although it is generally thought to afflict women, we know now that anyone can experience postpartum OCD. That is, postpartum OCD can also affect fathers and adoptive parents. You might have also heard about perinatal OCD, which is similar but simply also includes the time during pregnancy (i.e., not exclusive to just after birth). It’s also not *IMMEDIATELY* after birth, either. In my opinion, OCD can strike at any time and last for however long you’re breathing into its fire. It is estimated that around 3-5% of women experience postpartum OCD. Postpartum OCD is characterized by intrusive and distressing thoughts, images, or impulses related to the baby’s well-being, safety, or care. However, there are so many issues with this percentage, and I think this is a significant underestimation.
Recently, researchers have found that up to 100% of new parents indicate struggling with intrusive thoughts and obsessions. We get that 3-5% estimation by 1) unfortunately asking the wrong questions [i.e., only identifying more conventional subtypes of OCD such as presentations that include hand washing and contamination fears or perfectionism] and 2) asking new parents these questions directly, which causes issues with transparency as many individuals do not want to share this information due to its taboo nature.
Examples of postpartum obsessions
These obsessive thoughts can take many forms. Examples includs fear of accidentally harming the baby, obsessive checking of the baby’s breathing, or excessive washing or cleaning to prevent the baby from getting sick. Those examples are just scratching the surface of what OCD could look like. After all, OCD is really only limited by one’s imagination. The compulsive behaviors that are associated with postpartum OCD are often focused on preventing harm to the baby. They can be very time-consuming and distressing for the mother and the rest of the family.
Postpartum OCD is often accompanied by feelings of shame, guilt, and embarrassment. This can make it difficult for women to seek help. This is another reason why the percentages reported above (3-5%) are not necessarily accurate. As a field, we don’t know what we don’t know. When individuals are having a hard time coming forward, we can’t possibly know the true occurrence of these difficulties. However, it is important to understand that postpartum OCD is a treatable condition. Seeking help from a qualified mental health professional is essential. In fact, some studies would show that treatment for OCD is more effective than any other treatment for any other disorder.
Treatment for postpartum OCD
Treatment for postpartum OCD often involves a combination of therapies. Primarily, these treatments include cognitive-behavioral therapy (CBT) and exposure and response prevention (ERP), as well as medication. Keep in mind that ERP is a type of CBT, but not all CBT is ERP (how’s that for confusing?). Exposure and Response Prevention can help individuals to identify their obsessive thoughts and beliefs. It can also help people recognize their dysfunctional rituals or safety behaviors, and gradually expose them to the feared situation or object without compulsions. Medications such as selective serotonin reuptake inhibitors (SSRIs) can also be helpful in reducing symptoms of postpartum OCD. It’s important to note that these medications are generally also safe to take while pregnant and while breastfeeding. As always, I encourage you to speak to your medical professionals about this for your unique situation.
There are also lots of other, non-conventional ways that postpartum OCD may present. A new parent may have intrusive and unwelcome sexual intrusive thoughts about their baby. They then may feel responsible for those thoughts (to clarify, they DO NOT want these thoughts). The difficulty with OCD is that the thoughts and experiences are ego-dystonic. This means that the individual does not want to have these experiences. These experiences are not consistent with their values, their sense of self, and what they believe or want to be true.
A new parent may also struggle with obsessions and compulsions related to the relationship with their child. This could result in rituals such as reassurance seeking, avoidance, and perfectionism. It’s important to remember that OCD can take many forms. While the subtype “postpartum OCD” is helpful insofar as it provides basic clinical information, OCD is OCD. Put differently, OCD is the doubt disorder – in fact, this is what it’s called in other countries. It’s a disorder of doubt, and it is only limited by one’s imagination.
Moving forward from postpartum OCD
In summary, postpartum OCD is a subtype of OCD that generally occurs in women. It can also happen to any caregiver after a baby is born (or brought into the family via adoption, for example). It is characterized by intrusive and distressing thoughts related to the baby’s well-being, safety, or care. This condition is often accompanied by feelings of shame and guilt. Treatment for postpartum OCD should include ERP as well as adjunctive, evidence based strategies such as I-CBT and ACT. I also encourage Behavioral Activation if any low mood or depression is present.
If you or someone you know is experiencing postpartum OCD, it is important to seek help. It’s critical to ensure you’re knowledgable about OCD versus, say, other conditions such as psychosis or general anxiety disorder. Unfortunately, many professionals still do not know or recognize the nuances of OCD and its treatment. Because of this, I encourage all of you to arm yourselves to be your own best advocates. You can do this using information from this blog, my other free resources (e.g., my podcast called “All The Hard Things), and my masterclasses (available by clicking here – all information on my website).
For more on this topic, be sure to check out my masterclasses on Scary Thoughts in Motherhood, How to Support Without Accommodating, and When It’s Scary Having Kids. We go deep on postpartum OCD and anxiety, including treatment options and practical strategies you can put into place immediately to start feeling better. I even talk about how to deal with day to day triggers such as hearing triggering news events like the Lindsay Clancy story. Click here to learn more about the masterclasses.
If you have any questions about postpartum OCD and anxiety or my upcoming workshop, be sure to leave a comment below or email me at firstname.lastname@example.org. I’m here for you guys every step of the way.