Obsessive compulsive disorder - OCD treatment and therapy from NOCD
OCD subtypes
Postpartum OCD

Postpartum OCD: Thoughts, Symptoms, and Treatment

6 min read
Patrick McGrath, PhD
All types of OCD include obsessions and compulsions. Obsessions are unwanted and intrusive thoughts, feelings, urges and doubts, while compulsions are repetitive physical or mental actions performed in an attempt to relieve distress and anxiety.

No story about new parents worrying a lot is going to turn heads. Infants are vulnerable in countless ways, and the blend of intense emotions in the months after a child is born can only heighten every anxious impulse. Worrying about a newborn is adaptive—but is it always? And what happens when a new parent’s mind seems to feed them the worst of all thoughts? It’s difficult to imagine a lonelier place than a home that’s supposed to be happy but is suddenly flooding with unwanted thoughts and terrifying urges.

We hear a good amount about postpartum depression—a prolonged period of sadness, fatigue, anxiety, and other symptoms that follows childbirth. It robs up to 15% of mothers of their vitality in an already difficult period, and is probably caused by a variety of factors including hormonal changes. An estimated 10% of new fathers are affected too, with partners of depressed mothers more likely to develop the condition.

By acknowledging postpartum depression, we poke holes in common assumptions about new parents: they’re supposed to be experiencing pure joy, they can only think “positive” things about infants and parenting, they have to be on top of their game to take care of their child. And now we know this condition isn’t rare at all; many new parents, especially mothers, experience depression far beyond the “baby blues.”

Much less common, though, is any awareness of postpartum OCD. Like postpartum depression, it emerges rapidly after childbirth (or occasionally right before) and can become debilitating to new parents. And, although it primarily affects new mothers (reportedly 1-3%), fathers can also demonstrate symptoms.

According to Dr. Jonathan Abramowitz, Professor of Clinical Psychology at the University of North Carolina at Chapel Hill, common obsessions for people with postpartum OCD include:

• The idea that the baby could die in their sleep (S.I.D.S.)
• An image of the baby dead
• Thoughts of the baby choking and not being able to save them
• Unwanted impulses to shake the baby to see what would happen
• Thought of stabbing the baby
• Thoughts of drowning the baby during a bath

And although there’s an understandable fear of talking about thoughts like these, Abramowitz says up to 80% of new mothers report “nasty, senseless, unacceptable, unwanted thoughts” about their own children. But unlike other parents experiencing these thoughts, people with postpartum OCD interpret theirs as urgently meaningful—as signs that something bad is bound to happen.

Unwanted thoughts become obsessions as new parents find themselves unable to let them go. They turn to compulsive attempts in an attempt to mitigate the perceived danger, or the distress caused by the thoughts themselves. Going far beyond normal efforts to keep a young child safe, a new parent with postpartum OCD will perform compulsions like these:

• Checking on their child over and over, even throughout the night
• Avoiding being around the child alone
• Mentally repeating prayers or assertions about how much they care for the child
• Looking up unwanted thoughts on the internet
• Asking others if their child will be okay, or if they’re a good parent

These repetitive behaviors, though performed in response to the new parent’s anxiety about disturbing thoughts, aren’t serving to keep their child safe. In fact, besides exhausting new parents, the behaviors associated with postpartum OCD can reduce the quality of care a young child is getting. The good news, though, is that there’s help available to any parent having “nasty, senseless, unacceptable” thoughts about their child.

In a recent HuffPost piece, Catherine Pearson speaks with two mothers about their experiences with postpartum OCD. Both describe a distinct moment when their first disturbing thought appeared–one an image of smothering her baby, the other a recognition that she could throw her newborn down the stairs. Then the spiraling of their minds into more varied violent thoughts, and the development of compulsions. As Pearson writes:

“I was triggered by all kinds of things, especially the spiral staircase or knives,” Loretta Notareschi said. “Bathtubs. Being in the car. I would think, ‘What if I hurt her with that?’ Or, ‘What if I hurt myself with that?’”

Over time, she began to develop what she thought of as coping mechanisms, though later she learned they were simply the hallmark compulsions of her illness…

“I decided in the first couple of days after my daughter was born that every time I had a scary thought I would have to repeat to myself a certain phrase, which was ‘Baby face, hairbrush, duckie.’ In my mind, it was going to neutralize the thought or magically make it OK.”

Notareschi describes the typical components of OCD: trigger, obsession, compulsion. Her catastrophic assessment of disturbing thoughts triggered by potentially dangerous situations, and the compulsive behaviors that follow, separate postpartum OCD from typical parental worry. Unaware of what was happening, convinced these thoughts urgently needed attention, she developed very specific compulsions—repeating a seemingly nonsensical phrase among them. But to her this wasn’t nonsense; it was a way to protect her child from the inevitability that she’d harm her.

It may be impossible to make parenting easy, but there are effective interventions for postpartum OCD. It’s treated in much the same way as any other type of OCD, except that more caution may be required with SRI medications for breastfeeding mothers. Cognitive-behavioral therapy (CBT), with a focus on exposure and response prevention (ERP), is effective at helping new parents learn different responses to obsessions. Treatment doesn’t require any kind of removal from the child—in fact, learning not to withdraw is often part of ERP therapy.

We don’t know what causes postpartum OCD, but we do know it exists. Extreme feelings of fear and shame around the idea of letting a helpless child get hurt or hurting them oneself are compounded by a general lack of good information about OCD, making it unlikely that a suffering parent will get help. But there’s no need for any parent to spend the first part of their child’s life stuck in an obsessive-compulsive cycle.

Connect with the NOCD community to learn more, or share your experience with postpartum OCD.

Did you know that ERP (Exposure and Response Prevention therapy) is most effective when the therapist conducting the treatment has experience with OCD and training in ERP? At NOCD, all therapists specialize in OCD and receive ERP-specific training. Schedule a free call today with a member of the NOCD clinical team to learn more about how a licensed OCD therapist can help you get better. This consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make. You can also join our Postpartum OCD community and get 24/7 access to personalized self-management tools built by people who have been through OCD and successfully recovered.

Patrick McGrath, PhD

Dr. McGrath is a Licensed Clinical Psychologist and the Chief Clinical Officer at NOCD. He is a member of the Scientific and Clinical Advisory Boards of the International OCD Foundation, a Fellow of the Association for Cognitive and Behavioral Therapies, and the author of "The OCD Answer Book" and "Don't Try Harder, Try Different."

NOCD Therapists specialize in treating Postpartum OCD

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Taylor Newendorp

Taylor Newendorp

Network Clinical Training Director

I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.

Madina Alam

Madina Alam

Director of Therapist Engagement

When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.

Andrew Moeller

Andrew Moeller

Licensed Therapy, LMHC

I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.

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