When your baby is born, it’s supposed to be the most joyous occasion of your life. And in so many ways, it truly is—those tiny fingers! that perfect little nose!—but being a new parent also comes with mountains of stress, zero sleep, constant wailing, and your own hormones, which are on a perpetual rollercoaster. Being responsible for a brand-new infant is basically the definition of overwhelming, and it’s really, really normal to not handle all the stressors that suddenly descend on your shoulders in the way that you had envisioned. We’re raised in a culture that promotes a weirdly picture-perfect idea of parenthood, but the reality is a whole lot more confused and, frankly, upsetting.
In fact, it’s really normal to end up spiraling out into some really dark places when you’re that stressed-out and sleep-deprived all the time. If you end up with some strange thoughts flitting through your brain, you’re hardly the only one. In fact, if you’ve found yourself having thoughts that are really upsetting to you, like images of your baby getting cut or being smothered, you’re not alone. It is very disturbing to experience these thoughts, but it’s extremely common in people experiencing obsessive-compulsive disorder (OCD). That means these thoughts, while anxiety-producing and upsetting, aren’t indicative of any ill-intent—just because you’re having very scary thoughts doesn’t mean you’re in any danger of harming your kid.
These thoughts are characteristic of a form of OCD , which is a common mental health condition, that can occur during or after pregnancy, often characterized by the following symptoms: intrusive, uninvited thoughts or images about your child experiencing harm; anxiety about experiencing these thoughts; and thoughts or actions you engage in to try to curb that anxiety.
What is perinatal OCD?
When someone exhibits obsessive-compulsive thoughts or behaviors during pregnancy or during the period of about a year after giving birth, they may be experiencing perinatal OCD. Over the past decade, researchers have even recognized that this issue happens more often than was previously understood and that it deserves more attention. OCD broadly refers to unwanted thoughts, images, or urges. In order to reduce the stress caused by these intrusive thoughts, they will create mental or physical rituals to block those thoughts. These rituals may include repeating a word or phrase over and over or repeating a physical action (such as touching a surface a certain number of times).
Whom does perinatal OCD affect?
Those who experience perinatal OCD may have had OCD prior to becoming pregnant, with pregnancy exacerbated their symptoms. Some people who had never previously experienced any form of OCD can get it, too, and pregnancy is thought to possibly trigger the disorder. Those who have experienced perinatal OCD in the past are more likely to have it again during pregnancy or after pregnancy (“postpartum”).
How is perinatal OCD different from postpartum depression?
Postpartum depression is another mental health condition that can occur postpartum. The major difference between perinatal OCD and postpartum depression is the nature of the symptoms., being primarily OCD symptoms vs. primarily depressive symptoms While perinatal OCD and postpartum depression can go hand-in-hand— one study found that about 40% of those with postpartum major depression also experienced intrusive thoughts—one doesn’t necessarily mean you will experience the other. However, postpartum depression is common: in fact, it’s a condition that affects an estimated one in seven people who have just given birth. Like perinatal OCD can disrupt the pregnancy process, postpartum depression can make the months after giving birth more distressing and stressful. It’s frequently characterized by feeling sad, experiencing fatigue, losing interest in activities, changing appetite, crying, feeling guilty, and having difficulty concentrating.
How to tell if you have perinatal OCD?
Many new parents have concerns about their baby being harmed—it’s perfectly natural to feel extremely protective of your infant, after all. However, when they become invasive and intrusive, that’s a sign that you may be experiencing something greater. Here are some of the most common symptoms of perinatal OCD:
These obsessions frequently present as unwanted thoughts about something terrible happening to the child. Such obsessions often take the form of very vivid images of physical or sexual harm or even the infant’s death, by accident or from intentionally harming your baby. The thoughts or images can appear suddenly and without warning and are extremely upsetting to the person experiencing them. Obsessions also sometimes present as concerns about a safety-oriented task, like having left the door unlocked; intense, gripping fears about germs and contamination; a pressing, driving need to get everything perfect, or a need for symmetry or order. It’s important to note that people who have perinatal OCD and experience thoughts of harming their child are horrified by these thoughts, and are not at risk for actually following through and harming their child, unlike those who are experiencing psychotic delusions. These thoughts and feelings are very upsetting, but are not indicative that the person experiencing them will not actually cause their child any harm.
Anxiety and other distressing emotions
It is very common to feel anxiety, guilt, sadness, and other negative emotions as a result of these thoughts, and to try to “fix” or ward them off with compulsive behaviors. While all parents worry about their children and think about, for example, harm coming to them, new parents who are incapable of turning off these thoughts may be experiencing serious anxiety, a common symptom of perinatal OCD. If you have heightened anxiety, your thoughts may leap from one to another and spiral out into catastrophic thinking. For instance, “If the baby doesn’t latch right, she’ll be underweight, and if she’s underweight, her brain won’t develop right, and if her brain doesn’t develop right…” If you have a thought about accidentally shaking your baby, that can lead to thoughts about intentionally doing so, and feeling wracked with guilt for it, despite having not actually done anything at all other than take good care of your child. As mentioned, other OCD symptoms might not involve intrusive thoughts of harm happening to your child but can be equally distressing, such as concerns about contamination or the need for order or symmetry (ref).
Compulsions are a common way people with perinatal OCD try to prevent disturbing images from invading their thoughts, or to reduce their anxiety around these thoughts. These behaviors might include checking on your baby constantly; singing the same song over and over in the belief that it can protect your child; checking doors and windows over and over to ensure they’re locked, out of fear that your baby may be harmed by an intruder; crying over putting the baby in the right onesie because you might choose the “wrong” one; seeking repeated reassurance from friends and loved ones that you are doing a good job as a new parent; engaging in rituals like hand-washing or sterilizing the baby’s bottles over and over; counting or praying as a way to banish the thoughts; ordering and arranging items, and avoiding common activities and situations because they may trigger thoughts.
Having perinatal OCD feels absolutely overwhelming, but there’s truly good news: you’re not alone, there are many other expecting parents who have gone through the same trials and gotten through it, and there are treatments available for you to access.
If you think you may be experiencing OCD as part of the prenatal process you should speak with a mental health professional who specializes in OCD treatment. Pediatricians, OBGYN’s, and primary care physicians may be able to recognize symptoms of perinatal OCD, but for treatment it’s best to talk to a mental health clinician who specializes in diagnosis and treatment of OCD. An important time of effective therapy to ask your treatment providers about is ERP, or Exposure and Response Prevention, a type of Cognitive Behavior Therapy (CBT). ERP is a form of therapy in which you are exposed to your triggers—with a therapist present, at first—and make active choices not to engage in the compulsive behaviors you usually use to make them feel better. While this type of therapy may be anxiety-inducing at first, when you start to have control over your compulsions, there is typically a major drop in anxiety. This type of therapy is a first-line treatment for OCD, as are medications (ref), and has been shown to be very effective for treating OCD—both perinatal OCD and other forms, as well. It can feel scary to engage in, but it is a proven, safe way to retrain your brain and teach it to challenge your triggers.
Resources to consider
If you believe you’re experiencing perinatal OCD, Postpartum Support International and the National Perinatal Association are both great organizations that are very well-versed in perinatal OCD. Postpartum Support International also has a helpline, if you’re more comfortable speaking with a person about what you’re going through. However, it should be noted that they do not handle emergencies—people in crisis can reach out to the National Suicide Prevention Hotline at 1-800-273-TALK (8255).
How we can help
Face-to-face online OCD therapy is Covid-safe and tailored to your particular needs. You can start with a free 15-minute phone call so you can tell us about your journey, learn about a NOCD therapist in your state, and start getting the help you need to get on track. NOCD works with highly trained therapists who specialize in ERP, the gold-standard treatment for the disorder. One thing that tends to hold folks back from therapy is the idea that it’s a never-ending process, which we get—but unlike with traditional talk therapy, OCD therapy doesn’t actually have to be a years-long commitment—with these types of therapies, most people are significantly better after completing just 11 hours of therapy. There’s also a great community of peers who are experiencing situations similar to your own who you can connect with, lots of therapeutic tools and resources, and the ability to message your therapist anytime. It’s a lot to go through, but you don’t have to do it alone—and real help is available to you if you reach out for it.
Jamie Feusner, MD is the Chief Medical Officer at NOCD and is Professor of Psychiatry and Biobehavioral Sciences at UCLA where he is the Director of the UCLA Adult OCD Program. Dr. Feusner is a member of the Board of Directors of the International College of Obsessive Compulsive Spectrum Disorders and is a member of the International OCD Foundation Scientific and Clinical Advisory Board.