What is Perinatal OCD?
Perinatal OCD, sometimes also referred to as Postpartum OCD, refers to obsessive-compulsive disorder that occurs during sometime from the onset of pregnancy up to one year after pregnancy. Some people who experience Perinatal OCD may never have been diagnosed with OCD before and pregnancy acts as a trigger for symptoms, while others may have been diagnosed or experienced symptoms in the past, but notice an intense increase in symptoms during the perinatal period.
Pregnant and post-pregnancy mothers are at an increased risk of OCD symptoms due to fluctuation of hormones during this time, as well as the fact that having a child itself can be a major stressor, contributing to an onset of OCD symptoms. These include intrusive thoughts, urges, or images (obsessions) and physical or mental acts (compulsions) done in an attempt to neutralize fears or prevent a feared outcome. In Perinatal OCD, the content of obsessions and compulsive behaviors will most often center around fear of harm or contamination coming to their infant.
To better understand Perinatal OCD, let’s consider an example:
Six months into Justine’s pregnancy, she noticed that she was petrified about something happening to her unborn child. She noticed that if she drank tap water, she would have intrusive thoughts about her baby being slowly poisoned from something in the water supply. She stopped drinking her tap water and started only drinking bottled water. Her husband even surprised her with a home water system cooler that would have water delivered weekly.
Then, she noticed fears about losing her pregnancy before going into labor. At first, Justine would simply drink something sugary and lie down on her side to see if the baby started moving. As time went on and she got closer to the end of pregnancy, Justine started calling the OB-GYN office daily to ask questions and would often be told to come into the office to have an ultrasound to be sure everything was “okay” with the baby. The nurses and doctor’s reassured Justine that she was just having “new parent jitters” and that she would feel much better after delivering her baby.
After her daughter was born, things only seemed to get worse. Justine started having intrusive thoughts when she would change the baby’s diaper. She worried she would touch the baby in a sexually inappropriate way. She started to avoid diaper changes, and would have her husband do them instead. She also had intrusive thoughts about her baby not breathing, so she stayed up all hours of the night to check that the baby was still breathing.
Justine got less and less sleep, and her symptoms seemed to increase in intensity. She worried she would poison the baby’s formula, would lose control and smother the baby with a pillow, and the worst fear was that she would somehow use a kitchen knife to harm her baby. Not only did she have intrusive thoughts about harming her baby, but gruesome images popped into her head as well, causing immediate distress and panic. She shared her fears with her husband, who decided to take a leave from work fearing that Justine would harm their baby. Neither parent had any understanding of Perinatal OCD and worried that harm would come to their child because of the fears Justine was experiencing, when in reality they had nothing to fear.
Does Perinatal OCD mean I will be a bad parent?
Often, parents who experience Perinatal OCD fear that they will be a bad parent because of their fears and obsessions. They think to themselves, “How could I possibly be thinking these things about my child?” It’s important to recognize that OCD very often attacks the things we care about most. It goes after the people we would never want to harm, and the responsibilities that are central in our lives. These obsessions are ego dystonic, meaning that their experience is distressing, unacceptable, and inconsistent with one’s actual values and identity. Fears in OCD are opposed to parents’ actual desires or intentions.
Perinatal OCD is no indicator that someone will be a bad parent. In fact, the intense distress and extreme behaviors often displayed in parents with Perinatal OCD demonstrates the great level of concern and care they have for their child. The OCD brain twists that desire into some very distressing contexts, but anyone can have hope with treatment. There is absolutely no evidence that a parent with Perinatal OCD poses any risk to their child, and no cases ever reported of a parent with this diagnosis actually harming their child.
How long does Perinatal OCD usually last?
“Perinatal” refers to the period from the onset of pregnancy to up to one year after pregnancy. Symptoms may be present throughout that entire period, or may resolve sooner if symptoms are recognized and treatment is pursued. It is also possible that without treatment, OCD will persist past the perinatal window, in which case the perinatal distinction would no longer apply.
Will my child have OCD?
According to the International OCD Foundation (IOCDF), “Research shows that OCD does run in families, and that genes likely play a role in the development of the disorder. Genes appear to be only partly responsible for causing the disorder, though.” This is a topic that continues to be researched. In treating OCD, links are often observed among families, but there are several other factors that are important to the development of OCD. In short, while there are some genetic components to OCD, this does not mean that your child will inherit the condition.
I want to have another child but I’m scared about OCD coming back. What can I do?
Many parents will fear having another child due to their first experience with Perinatal OCD. Just like a mother who had a traumatic first experience and needed a C-section, or dealt with gestational diabetes and needing insulin, so might a mother with Perinatal OCD often fear having to deal with the onset of symptoms again.
The good news is with awareness comes some freedom and reason for confidence, because Perinatal OCD is highly treatable, and symptoms can be addressed proactively. A mother who wants to have a second baby could have support in place prior to the beginning of pregnancy. Maybe that mother decides to start seeing her OCD therapist more frequently to prepare for therapy exercises related to her pregnancy and childbirth. A mother can also talk with her doctor about a medication plan should symptoms present again. There is nothing that can completely prevent the onset of symptoms in a second pregnancy; however, knowing the ways to manage OCD symptoms, like identifying and resisting compulsions early, can help greatly in minimizing the impact of one’s symptoms.
How Perinatal OCD is treated
Treatment for Perinatal OCD involves exposure and response prevention (ERP) therapy. Medications may also play a role in treatment as well. Just like medication is used to treat Postpartum depression in new moms, it may be helpful in cases of Perinatal OCD due to the fluctuation of hormones during this time.
ERP is the gold standard of treatment for OCD and is backed by decades of clinical research. Most individuals who do ERP with a trained OCD therapist experience a decrease in OCD symptoms, reduced anxiety and distress, and increased confidence in their ability to face their fears. People who struggle with Perinatal OCD will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually an ERP therapist will start with exposures that bring a low level of anxiety, then work up to harder exposures as confidence is built. When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions. Over time, this allows you to tolerate anxiety about your pregnancy or child, without relying on compulsions to feel better.
Because of the sensitive nature of the fears associated with this presentation of OCD it is necessary to work closely with all care providers. Be sure to work closely with professionals who can provide you with evidence-based care. Sleep deprivation, which also comes with being a new parent, can also affect the ability to fully engage in practicing exposure work. It is important to know that ERP may move more slowly when treating Perinatal OCD, and that there are also intensive and even inpatient options available for new parents who need a higher level of care. Several programs have “mother and baby” options so an infant can be with the mother while she receives care. Any mother experiencing Perinatal OCD can seek further resources from NOCD or the IOCDF to learn more about treatment options in their area.
Finally, it is important to note that these symptoms may also affect adoptive parents, foster parents, and even the non-birthing parent. Why? Because having a child can be a major stressor, and OCD symptoms are often worst in times of high stress, and OCD is not just genetic—environmental stressors can play a major role, as well.