About Obsessive-Compulsive Disorder (OCD)

"I kept having these horrible images of hurting my baby. Every time I would have these thoughts, I felt sick to stomach. They wouldn't stop."
Ocd 2

Key Takeaways

  • Intrusive thoughts are common during the postpartum period, but for some mothers they can be a sign of a mental health condition. 

  • Postpartum OCD is a mental health condition that involves a vicious cycle of obsessions and compulsions that are very distressing for a new mother.

  • Treatment for postpartum OCD includes evidence-based therapies like exposure therapy.

What Is Postpartum OCD?

Postpartum obsessive-compulsive disorder (OCD), also known as perinatal OCD, is a perinatal mood and anxiety disorder (PMAD) . PMADs are mental health conditions that develop during the perinatal period, which encompasses pregnancy, childbirth, and the first year after giving birth. Postpartum OCD is marked by obsessions and compulsions that significantly impact a mother’s quality of life.

Obsessions are unwanted thoughts, urges, or images that cause significant anxiety and distress. These thoughts often involve harm coming to the baby. Some women respond to these thoughts by engaging in compulsions, which are repetitive behaviors that help alleviate the anxiety caused by the obsessions. 

OCD can present at any point in a person's life. The main difference between postpartum OCD and other forms of OCD is that postpartum OCD either develops or worsens in the first year following birth. Postpartum OCD also usually involves obsessions and compulsions surrounding harm coming to the baby. 

Postpartum OCD may not improve on its own. Treatment, including therapy and medication, can help a mother recover.

What are Intrusive Thoughts?

Up to 90% of mothers experience intrusive thoughts during the postpartum period. Intrusive thoughts are upsetting and unwanted thoughts that seem to come out of nowhere. There are many different types of intrusive thoughts that new mothers can have. 

While nearly all mothers have some intrusive thoughts, only a portion meet the criteria for OCD. It is estimated that between 3 and 5% of new mothers have OCD. What distinguishes ‘normal new mom worry’ from OCD is that with OCD, the symptoms are distressing and interfere with a woman’s ability to function. Intrusive thoughts can also cause mild distress, but they are more manageable than OCD symptoms.

Symptoms of Postpartum OCD

Symptoms of postpartum OCD usually begin within the first few weeks of giving birth but can present at any point within a year of giving birth. The symptoms of postpartum OCD include obsessions and compulsions that feel like they take over a new mother’s life. 

Obsessions are thoughts, images, or urges of something unwanted. Examples of obsessions in postpartum OCD include:

  • Dropping the baby
  • Something terrible happening to the baby
  • Accidentally touching the baby’s genitals
  • Being a bad parent

Compulsions are mental or behavioral acts that are performed in response to obsessions. They may temporarily reduce anxiety caused by the obsessions, but the anxiety later returns. Examples of compulsions in postpartum OCD include:

  • Excessively washing one’s hands or the baby
  • Needing to do things a certain number of times
  • Checking the baby repeatedly 
  • Repeating a word or prayer over and over again
  • Seeking constant reassurance from doctors, the internet, or members of one’s support system
  • Redoing tasks repeatedly if they are not done “correctly”

Another feature of postpartum OCD is that mothers feel disgusted and ashamed of their obsessions, especially if their obsessions involve sex or violence. They may think that they are a terrible mother or fear that they are “going crazy.” If you are experiencing this, the very fact that you are distressed by your obsessions makes it very unlikely for you to act on them. Treatment can help you manage these symptoms and find joy in motherhood.

Is perinatal OCD the same as postpartum depression?

Postpartum depression and perinatal OCD are both types of perinatal mood and anxiety disorders (PMADs), but they are different conditions. The term postpartum depression is often used to refer to any mental health concerns that develop after giving birth, but this is not accurate. 

Postpartum depression is a mood disorder where a mother feels sad often for several weeks. It also includes other symptoms like changes in appetite and sleeping patterns, low energy, and feelings of guilt and worthlessness.

Women who experience postpartum OCD are likely to also have postpartum depression. While these two conditions often occur together, you can have one without the other.

 

Causes of Postpartum OCD

Like other PMADs, the exact causes of postpartum OCD are unknown. Professionals believe that a combination of factors can lead to the development of OCD during this period.The following factors are linked to postpartum OCD:

  • Genetics: Research has found that genetics play a role in OCD. Studies of twins and families show that having a family member with OCD increases a person’s risk of also having it. 
  • Hormones: Low levels of serotonin, a neurotransmitter involved in mood regulation, is linked to OCD. Experts also believe that the dramatic drops in estrogen and progesterone following childbirth are responsible for the higher likelihood of developing OCD during this time. 
  • Stress: Caring for a newborn, adjusting to parenthood, and coping with sleep deprivation are all very stressful experiences that can leave new mothers vulnerable to OCD.
  • Brain structure: Brain scans have revealed that people with OCD show abnormalities in areas of the brain responsible for controlling emotions and behavior. 

 

Treatment

Untreated OCD can significantly affect your life and make it challenging to enjoy motherhood. Perinatal OCD is treatable with therapy, self-care, and/or medication. Seeking help at any point can make a difference.

Therapy

Therapy is the first line of treatment for postpartum OCD. A type of therapy called exposure and response prevention (ERP) has been well-studied and is effective in reducing symptoms of this condition. During ERP, a trained therapist helps you face fearful thoughts, images, and situations without engaging in compulsive behaviors. An ERP therapist will equip you with skills to tolerate your anxiety before having you face your obsessions. The goal is to learn how to cope with your obsessions without resorting to compulsions. ERP can sound scary to a new mother with OCD. She may wonder if and how she could face her obsessions. ERP therapists are skilled at going at the right pace. They will help you face your fears without pushing you too hard. 

Medication

Women with moderate to severe postpartum OCD may benefit from medication. A type of antidepressant called selective serotonin-reuptake inhibitors (SSRIs) are prescribed for OCD symptoms. SSRIs work by increasing the amount of serotonin in the brain. It can take six weeks or more to feel the full benefits of these medication.If you are breastfeeding or trying to conceive, you may be wondering if it is safe to take medication. Some medications are considered safe for pregnant and breastfeeding women. It is best to speak with a psychiatrist or psychiatric nurse practitioner who has experience treating pregnant and postpartum women. They can talk to you about the pros and cons of taking medication and help you decide whether it’s right for you. 

Help is only a click away

Postpartum obsessive-compulsive disorder (OCD) is a mental health condition that can develop after a woman gives birth. 

At Phoenix Health, we treat a range of maternal mental health concerns, including OCD. If you’re experiencing symptoms, we can help. Schedule an appointment with a maternal mental health specialist and start feeling better today.

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