Mothers with obsessive-compulsive symptoms in pregnancy, or in postpartum face unique and deeply distressing challenges. They may be plagued by persistent, intrusive thoughts about harming their baby, fear of contamination, or overwhelming doubts about their ability to care for their newborn. These frightening thoughts often lead to compulsive behaviors such as excessive cleaning, constant checking on the baby’s safety, or seeking frequent reassurance from others.
The anxiety and guilt associated with these thoughts and behaviors can be incredibly isolating, as mothers may fear judgment or feel ashamed to share their struggles. It's important to approach mothers struggling with these symptoms, with empathy and understanding, recognizing that their fears are symptoms of a condition called perinatal obsessive-compulsive disorder (OCD). Perinatal OCD is more common than you might think, is very treatable, and is in no way a reflection on a mother’s ability, or love.
What is Perinatal Obsessive-Compulsive Disorder (OCD)?
Perinatal OCD is a form of obsessive-compulsive disorder that develops during the perinatal period, which includes pregnancy and the period after childbirth. More recent research suggests that Perinatal OCD is a relatively common condition, affecting a significant proportion of women during pregnancy (2.9%) and the postpartum period (7.0%).
For those experiencing it, OCD is not just about orderliness. OCD is a mental health condition characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that cause a great deal of distress and interfere with many aspects of life.
In many cases, people with OCD see that their obsessions and compulsions are too much or go too far and that can also be very scary. Because they are overwhelmed by frightening thoughts, they feel driven to combat perceived threats by doing compulsive behaviors. Unfortunately, any reassurance (including from loved ones) is either very short-lived or never really comes. It just isn’t possible to be 100% certain that any threat is totally eliminated.
During the perinatal period, some common obsessions might include:
Fear of harming the baby accidentally or deliberately
Worry about the baby getting sick or dying suddenly
Worry that harm will come to the baby from the environment or other people
Related compulsions might include:
Repeatedly checking on the baby to make sure they are breathing
Excessively cleaning of the baby’s bottles and toys to ensure they are germ-free
Excessively researching potential threats to the baby online, or seeking reassurance from others
These are not the only obsessions or compulsions people experience in the perinatal period, just the most common ones. Relatively uncommon obsessions and compulsions are still OCD and not a reflection of any inherent flaws or desires in the person experiencing them.
How is Perinatal OCD Different from Being an Anxious New Parent?
Perinatal OCD and the anxiety experienced by new parents can seem similar. In fact, new parents without OCD have the same type of scary thoughts about the baby’s safety, for example. However, new parent anxiety and perinatal OCD are fundamentally different in their intensity and impact.
For moms with perinatal OCD, these worries escalate into persistent, intrusive thoughts and fears that are overwhelming and distressing. Unlike typical parental anxiety, these obsessions lead to compulsive behaviors, such as repeatedly checking if the baby is breathing or excessively cleaning to avoid contamination, which can consume hours of the day, feel out of control, and significantly impair daily functioning.
Understanding this difference is crucial for offering the right support—new parents mostly need reassurance and guidance, while those with perinatal OCD often require specialized treatment that does not rely on reassurance to treat their condition effectively.
How is Perinatal OCD Different from Regular OCD?
While perinatal OCD is a subtype of clinical OCD, it also has specific distinct characteristics compared to regular OCD. These include:
Onset during the perinatal period: Perinatal OCD refers to the development of obsessive-compulsive symptoms during the perinatal period, which includes the time before and after childbirth
Exacerbation during the postpartum period: Studies have shown that a significant number of individuals with OCD experience an exacerbation of symptoms during the postpartum period. Hormonal changes and the stress of the transition to parenthood likely contribute to this exacerbation
Specific triggers: Perinatal OCD often manifests around concerns related to the baby's safety, including intrusive thoughts about accidentally harming the baby or fear of contamination. These obsessions can trigger compulsive behaviors aimed at preventing harm or reducing anxiety.
Parental guilt and shame: Individuals with perinatal OCD may experience intense guilt and shame related to their obsessions and compulsions, particularly if they involve thoughts of harm to their baby. Understanding that these thoughts are a result of the OCD and not a reflection of their true intentions is essential.
High comorbidity with anxiety and depression: Individuals with perinatal OCD often experience symptoms of anxiety and depression concurrently. This highlights the interconnected nature of these perinatal mood and anxiety disorders.
For individuals who are experiencing OCD for the first time in the perinatal period, the experience can be particularly difficult. They are less likely to recognize their symptoms as OCD, and less likely to have any tools to address the symptoms.
Why do Some Mothers Get Perinatal OCD?
OCD is an anxiety disorder, and anxiety is pretty common, especially among high-achieving individuals. Anxiety - worry, rumination, hypervigilance, asking “what if” - creates well-established neural patterns and pathways in the brain which create a vulnerability to developing OCD.
Pregnancy, birth and early parenting are quite stressful and present new challenges as well as new, often more meaningful threats. Few things are more frightening to think about than harm to one’s child, and new parents are dealing with these thoughts and feelings for the first time. In addition, fluctuations in hormones and sleep patterns increase vulnerability during this already stressful and challenging time.
How is Perinatal OCD Treated?
Perinatal OCD needs to be diagnosed by a mental health professional with a background in perinatal mental health and in treating OCD. It is important to distinguish OCD from other perinatal mood and anxiety disorders in order to treat it properly.
The gold standard treatment for perinatal OCD is a cognitive-behavioral approach called Exposure and Response Prevention. This research-supported treatment needs to be tailored to the individual and her circumstances. For individuals in the postpartum period, it should be coupled with support with infant care, working on improving and increasing sleep, and support of the family unit.
If you or someone you know might be experiencing symptoms of perinatal OCD, we can help. Schedule a diagnostic assessment or start with a telephone consultation. OCD is serious condition that doesn't go away on it's own, we will do everything we can to get you connected with care and support.
References:
Fairbrother N, Collardeau F, Albert AYK, et al. High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. J Clin Psychiatry. 2021;82(2):20m13398
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