What is Perinatal OCD?
Becoming a parent can bring a lot of joy, but it can also bring stress and worry. For some parents, these feelings can turn into a type of mental health condition called Perinatal Obsessive-Compulsive Disorder (OCD). When this happens during pregnancy or after the baby is born, it’s called “perinatal OCD.” It can make parents feel scared or ashamed of their thoughts, but this condition is more common than you might think, affecting 2-3% of new/expecting parents and possibly, higher. It is important to know that this is a treatable condition and help is available.
Understanding Perinatal OCD
Perinatal OCD can occur in birthing and non-birthing parents and include recurrent, intrusive thoughts that result in intense and uncomfortable feelings of fear, doubt, or disgust. These worries during the perinatal period (pregnancy through about a year after birth) usually focus on keeping the baby safe, sometimes making the mom feel she needs to perform certain behaviors, or compulsions, in order to keep the baby safe.
Research shows that approximately 90% of all new moms experience intrusive thoughts that can be disturbing within the first few months postpartum. The difference is that many moms are able to move on from them, unlike moms with perinatal OCD who start to experience these thoughts very intensely and frequently. As the cycle of OCD strengthens, moms with perinatal OCD will notice impairments in functioning such as difficulty sleeping, completing daily tasks, avoiding being alone with their baby, etc.
Symptoms of Perinatal OCD
Obsessive-Compulsive Disorder involves the presence of both obsessions and compulsions.
Obsessional Intrusions: Unwanted thoughts, images, sensations, or impulses that occur repeatedly, feel outside of the person’s control, and cause them intense and uncomfortable feelings such as fear, disgust, and/or doubt.
Compulsions: Urges to engage in certain behaviors repeatedly. These can be observable like like checking on the baby many times, cleaning often, or unobservable such as frequent rumination, reviewing memories, or avoiding certain activities like bathing the baby.
Common Themes of Obsessions in Perinatal OCD:
Intentional/Unintentional harm of the baby or self (What if I dropped the baby on purpose?)
Contamination (If the bottle has germs, the baby could die.)
Just Right/Perfectionistic (If items aren’t arranged perfectly, my baby could die.)
Unwanted sexual thoughts (What if I’m a pedophile and I don’t know it?)
Religious/Moral obsessions (What if I’m a bad mom and my baby goes to Hell?)
Losing Control (I could “break” during a moment of overwhelm and become psychotic.)
Common Compulsions in Perinatal OCD:
Checking (frequently checking to see if baby is breathing/baby monitor, logging all of baby’s bodily functions, checking baby’s temperature or heart rate)
Mental rituals (rumination, mental review of past actions, providing self reassurance)
Excessive cleaning/washing/sanitizing (excessively/ritualistically sanitizing bottles/pump parts, wiping down what’s considered contaminated)
Seeking reassurance from others (calling the pediatrician repeatedly, frequently looking for answers on the internet, asking care providers the same questions)
Avoidance (not engaging with potential dangerous items such as knives, not holding the baby or giving the baby a bath, not driving with the baby)
Checking the baby monitor so frequent that it makes it difficult to get things done throughout the day can be a compulsion in perinatal OCD.
What Causes Perinatal OCD?
We really aren’t sure exactly what causes perinatal OCD, but a few things might contribute to its development during pregnancy or postpartum.
Hormone Changes: The body changes a lot during pregnancy and after giving birth, which can affect emotions and make anxiety stronger.
Lack of Sleep: New parents are often very tired, which can make it difficult to handle stress and control worries.
Big Responsibilities: Becoming a parent is a huge change, and the responsibility can make anyone feel anxious. Sometimes significant changes in roles and responsibilities can trigger OCD.
It’s also important to note that women who had symptoms or a prior diagnosis of OCD, anxiety, or depression prior to becoming pregnant have a higher risk of experiencing perinatal OCD during pregnancy or postpartum. For parents with perinatal OCD, I often encourage them to connect with a therapist, whether it’s myself or another therapist with training in both perinatal mental health and treatment of OCD symptoms, for monitoring of symptoms and to create a postpartum plan to increase support.
Can Perinatal OCD be treated?
Absolutely! Parents with perinatal OCD can notice significant symptom improvement with the correct research-based treatment such as:
Therapy: A type of Cognitive behavioral therapy called Exposure and Response Prevention (ERP) is very helpful for OCD and is considered the gold standard treatment. It helps individuals expose themselves to things that trigger their anxiety in small steps without giving in to the urge to engage in compulsions. Over time, this can make the fear, doubt, or disgust less powerful.
Medication: Sometimes medicine may be recommended by medical providers to help with OCD symptoms. Some psychiatric medications used to treat OCD are able to be used during pregnancy and breastfeeding, however your medical provider will review any risks and benefits so you can make an informed decision.
You are not alone.
Many of the new or expecting mothers that I work with who are experiencing perinatal OCD report feeling incredibly alone and scared. They often say things like “I feel like I’m going crazy, I can’t trust my mind any more”. One reason I truly love working with moms with perinatal OCD is that I often see a huge sigh of relief, increased hopefulness, and decreased sense of isolation after they learn more about perinatal OCD, its prevalence, and start to identify their OCD cycle.
