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  • Writer's pictureMelissa Shepard, MD

Postpartum OCD: the anxiety disorder that can plague parents after their baby's birth.

TW: Describes thoughts of infant harm/abuse


We've talked about OCD plenty of times but it's worth talking more about OCD in the special population of new parents: Postpartum Obsessive-Compulsive Disorder (Postpartum OCD). Postpartum refers to the period after childbirth. This is an incredibly stressful period for new parents, and dealing with symptoms of OCD can make things feel unmanageable.

As we've discussed before, OCD is characterized by obsessions and compulsions. Obsessions are recurrent, unwanted, and intrusive thoughts, images, and urges that cause distress. Obsessions are often accompanied by compulsions, which are thoughts or behaviors that someone feels they must do to get rid of or cancel out/neutralize the obsessions.



The timing of postpartum OCD is not the only distinguishing feature of this type of OCD. People with postpartum OCD may have the same types of intrusive thoughts, obsessions, and compulsions as other people with OCD, but they also tend to have obsessions and compulsions that center around their newborn.


Some common obsessions in Postpartum OCD are:

  • Graphic images of intentionally hurting their infant (often images of stabbing, drowning, dropping, or hitting their child)

  • Feeling unwanted urges to harm their infant

  • Fears that they may have sexual thoughts or may sexually abuse their child (similar to Pedophilia OCD)

  • Fears of losing, misplacing, or forgetting their infant

  • Fears that others will see them as an incompetent or unfit parent

  • Excessive fear of SIDS or suffocation

  • Fears that they may contaminate their child or cause them to get sick

Some common compulsions in Postpartum OCD are:

  • Avoiding or restricting access to things they could use to hurt their infant (like knives or other sharp objects)

  • Avoiding being alone with the infant

  • Avoiding doing certain things with the infant, such as changing diapers, giving baths or touching the infant

  • Seeking reassurance from others that they would not "snap" or lose control and harm their child

  • Excessively monitoring and checking on their infant at night and during naps (sometimes even awakening the infant to check on them)

  • Excessively washing their hands before touching the infant

  • Excessively washing feeding supplies (bottles, breast pump parts, etc)

Having intrusive thoughts does not necessarily mean that you have OCD. Intrusive thoughts can be a part of OCD when the thoughts are persistent and upsetting enough that they start to interfere with your ability to function or are associated with compulsions. In fact, intrusive thoughts are common and normal in pregnant and postpartum women, with some studies suggesting that up to 100% of women have intrusive thoughts after giving birth (Brok & Lok, et al., 2017, J Clin Psychiatry).


It is important to note that people with postpartum OCD are not at increased risk of acting on their obsessions or harming their children. Intrusive thoughts and obsessions are scary and upsetting, but they are not dangerous. A very important part of all OCD treatment is helping people understand that thoughts are just thoughts, not signs of danger or mandates to act.


Therapy, in particular Exposure and Response Prevention, Cognitive Behavioral Therapy, and Acceptance and Commitment Therapy, can help significantly with postpartum OCD. We can also use medications and other interventions to treat the disorder.


Please note that the studies done on this disorder have been done on people self-identifying as mothers. Most of what we know refers to cisgender, heterosexual women. More research needs to be done on people with different sexual orientations and gender identities.


 

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