What Is Postpartum OCD?
Scary thoughts often pop into the heads of new moms and dads. “What if the baby’s not breathing?” “What if I drop him?” But sometimes, new parents are horrified by their own incessant thoughts of hurting or losing the baby. Psychologist Dr. Ellen Hendriksen explains Postpartum Obsessive Compulsive Disorder (OCD).
Ellen Hendriksen, PhD
Let’s take a look at the cases of two patients who have come to my office recently:
Patient #1: Shelly
Shelly is a first-time mom of 2-month-old Aiden. She loves him with all her heart. Shelly had a tough delivery and there were some frightening moments when Aiden’s breathing was touch-and-go. A few days after birth, Aiden’s doctors pronounced him totally healthy, but Shelly still can’t shake the feeling that his breathing is defective. She worries non-stop that he’ll die of SIDS. She’s convinced he’ll stop breathing and no one will catch it in time to save him.
As a result, Shelly watches him constantly during naps to make sure he’s still breathing. At night, she wakes up to check the bassinet a few times an hour, her heart pounding until she sees him stir or feels him exhale. In her worst moments, she wakes Aiden up just to reassure herself he’s alive. She’s exhausted but can’t rest. Shelly’s husband is concerned that she’s overdoing her monitoring. She knows she’s out of control but can’t stop.
Patient #2: James
James is a new dad of 3-month-old Caitlyn. James and his wife live in a fifth-floor apartment with a lovely balcony overlooking the city. A few days after coming home from the hospital, James took Caitlyn out on the balcony to get some fresh air. Out of nowhere, a horrible thought popped into his head. He pictured himself throwing Caitlyn off the balcony. Alarmed, he rushed inside and gave Caitlyn to his wife. He knew the idea didn’t make sense and that he would never do it, but he couldn’t get it out of his head.
The next day, while slicing tomatoes for a sandwich, he suddenly pictured himself stabbing Caitlyn with the knife. Over the last few weeks, he’s pictured himself doing these things over and over. Now, whenever the thoughts return, his heart pounds and he breaks into a sweat. He’s convinced he’s a monster. The harder he tries not to think about it, the more he pictures himself hurting her. In the past few weeks, he hasn’t touched Caitlyn. Afraid he’ll hurt her, he won’t feed her or change her diaper. His wife is angry and keeps asking what’s the matter with him. James swears to himself never to tell anyone of these thoughts because he fears he’ll be locked up or Caitlyn will be taken away from him.
What Is Postpartum OCD?
Postpartum OCD (Obsessive Compulsive Disorder) is a condition that can strike both moms and dads, like Shelly and James.
Almost all new parents have strange or upsetting thoughts that cross their minds from time to time, such as, “What if I drop her?” or “What would happen if I shook him?”
In postpartum OCD, however, the thoughts feel out of control, are extremely distressing, and persist even when parents try to brush them off. When unwanted thoughts are intrusive, inappropriate, and relentless, they are called obsessions – the “O” in OCD.
Common themes of postpartum OCD include, but are certainly not limited to:
- hurting the baby on purpose (like James’s intrusive thoughts)
- suffocation or SIDS (like Shelly’s intrusive thoughts)
- unacceptable sexual scenarios
- losing the baby
- accidents
- contamination or illness
Obsessions go hand-in-wringing-hand with compulsions – the “C” in OCD. Here’s how…
Compulsions are actions taken to counteract the thoughts or prevent the fear from happening, like Shelly waking Aiden to make sure he’s breathing. Compulsions might include action or avoiding action, such as:
- avoiding the baby altogether (like James)
- avoiding “dirty” places or things
- avoiding “dangerous” rooms or places, like stairs, cars, or heights
- avoiding “dangerous” objects, like knives or household cleaners
- avoiding certain activities, like baths, for fear of the baby drowning
- checking things over and over (like Shelly)
- washing or cleaning again and again to get rid of dirt or germs
- counting, ordering, or arranging until things “feel right”
- tapping, repeating words, or doing other actions over and over even though they don’t make sense
- praying for the thoughts to go away or to minimize the chance that the bad thing will happen
- attempting to suppress the thoughts
Finally, in postpartum OCD, the thoughts, avoidance, or compulsions take up a lot of time—generally more than an hour a day. Plus, they get in the way of life. People with OCD and their families often feel trapped by their thoughts and compulsions.
Why Am I Thinking These Horrible Things?
You’re suddenly in charge of this new, defenseless little person whom you love with the fire of a thousand suns. Your brain is equipped with a normal, natural burglar alarm, alerting you to dangers that could befall your baby. However, postpartum OCD shorts out the burglar alarm, taking it from reasonable to hair-trigger sensitive.
In OCD, your brain’s broken burglar alarm tells you your baby is in danger when she is not. The alarm not only goes off for actual danger, but also for imagined or nonexistent dangers. It’s as if your home’s security system went off not only for smoke or an intruder, but also for squirrels, rain, friendly neighbors, and shadows.
How Do I Know My Baby’s Not in Danger?
OCD has a knack for targeting what we care about most, which is why intrusive thoughts about new babies are so common. But even the most grotesque or repulsive unwanted thoughts do not lead to an increased risk of harming the baby.
OCD has a knack for targeting what we care about most, which is why intrusive thoughts about new babies are so common. Even the most grotesque or repulsive unwanted thoughts do not lead to an increased risk of harming the baby. If the thoughts that keep popping into your head are distressing and you know the thoughts are coming from your mind—not an outside force—the thoughts are OCD talking, not you. Individuals with OCD do not act out their thoughts; in fact, they work really hard to make sure the thought doesn’t come true by avoiding things or taking action to neutralize the thought.
There is a rare condition called postpartum psychosis that also involves thoughts of harming the baby. This illness requires immediate treatment, as it does raise the risk of babies being hurt. However, there are crucial differences between postpartum psychosis and postpartum OCD. First, individuals with OCD know the bizarre thoughts are coming from them. By contrast, individuals with postpartum psychosis may believe the thoughts are coming from an outside entity, such as spirits or voices. For example: “I hear the devil telling me to hurt the baby.”
Second, in postpartum psychosis, bizarre baby-centered thoughts are often part of a collection of other beliefs and behaviors that are disconnected from reality. Individuals may experience hallucinations such as, “I saw fire coming from the baby’s nose,” or odd beliefs called delusions, such as “Aliens are monitoring my baby.”
Again, if the thought popping into your head upsets you, you’re taking action to minimize the thought coming to fruition, and you know the thought is coming from your own mind, rest assured it’s OCD and you are not dangerous.
How Common Is Postpartum OCD?
Best estimates tell us that about 26 out of 1,000 women can be diagnosed with OCD at 8 weeks postpartum. The number of new dads is unclear, but OCD affects about 20 out of 1,000 men in general.
However, many more moms and dads report at least some intrusive and upsetting thoughts or worries about their new babies. According to a survey by Mayo Clinic researchers, 69% of moms and 58% of dads reported upsetting, unwanted thoughts popping into their heads from time to time, like “Maybe my baby rolled over and suffered SIDS,” or “What if the neighbor’s dog attacked the baby?” The difference was that the distress was mild, didn’t interfere with functioning, and the parents could control the intrusions fairly well.
I Think I Have Postpartum OCD. What Can I Do?
Seek treatment. Your family practitioner—or, for new moms, your Ob/Gyn or midwife—can refer you to a psychiatrist, psychologist, or other mental health provider who knows how to diagnose and treat OCD. If you have health insurance, call your insurance company for a list of providers. Or simply look online for providers in your area. Many universities have low-cost training clinics where you’ll work with a student supervised by a licensed professional. Both medications and cognitive-behavioral therapy, or CBT, are first-line treatments for OCD. CBT will include teaching you about the nature of thoughts, reducing avoidance, and safely approaching your fears. For a preview, read I’m Thinking Crazy Thoughts!, but know that this is not a substitute for one-on-one treatment with a qualified provider. - Put a nametag on your OCD thoughts. Label the thoughts as “OCD thoughts,” “my broken burglar alarm,” “monkey thoughts,” “brain zaps,” or whatever else works for you. Put some space between you and your thoughts by telling yourself, “I’m not going to hurt the baby. I’m having an OCD thought that I’m going to hurt the baby.” Or “My broken burglar alarm is telling me I’m going to hurt the baby.”
- Move the spotlight. Try focusing your attention on something else. When Shelly has the urge to wake Aiden to make sure he’s breathing, she might say to herself, “That’s my OCD thought bubbling up. The doctors say he’s strong. I don’t have to wake him.” Then she might do something that takes focus, like work on a baby album, check email, make a grocery list, or do anything else that draws her brain away from the OCD thoughts. It feels wrong at first, but once attention is refocused, anxiety subsides.
- Think of your OCD thoughts as annoying telemarketers. Infuriating salespeople always seem to call during dinner. You can’t make them go away, but it doesn’t mean you have to answer the phone. Likewise, you can’t make an OCD thought stop, but you don’t have to pay attention to it. Tell yourself, “That’s just my annoying OCD thought calling.” Then get back to what you were doing. The thoughts may, in protest, increase the frequency and urgency of their calls at first, but if you continue to ignore them, they’ll stop calling.
- Remember thinking is not the same as doing. Just because you think it, doesn’t make it real. You can think about eating sardines all day long and it doesn’t mean you like sardines. You can think your OCD thought all day long and it doesn’t mean you’ll do it.
- Know you are not alone. Know that your symptoms are so common that they have a name: OCD. You are not crazy, dangerous, or a bad person. You are fit to be a parent. You deserve to have your child. Your burglar alarm is simply broken. Countless moms and dads have suffered this illness and made it through. With help, you can too.
Seek treatment. Your family practitioner—or, for new moms, your Ob/Gyn or midwife—can refer you to a psychiatrist, psychologist, or other mental health provider who knows how to diagnose and treat OCD. If you have health insurance, call your insurance company for a list of providers. Or simply look online for providers in your area. Many universities have low-cost training clinics where you’ll work with a student supervised by a licensed professional. Both medications and cognitive-behavioral therapy, or CBT, are first-line treatments for OCD. CBT will include teaching you about the nature of thoughts, reducing avoidance, and safely approaching your fears. For a preview, read References
https://www.ocfoundation.org/eo_postpartum.aspx
https://www.ocfoundation.org/uploadedFiles/WhatYouNeed_09.pdf
Abramowitz, J.S., Schwartz, S.A. & Moore, K.M. (2003). Obsessional thoughts in postpartum females and their partners: Content, severity, and relationship with depression. Journal of Clinical Psychology in Medical Settings, 10, 157-164.
Dr. Ellen Hendriksen is a clinical psychologist at the Stanford University School of Medicine. Ellen graduated from Brown University, earned her Ph.D. at UCLA, and completed her training at Harvard Medical School. In her clinic, she treats everything from depression to trauma to panic, but she has a special place in her heart for anxiety disorders. Ellen is also an active research scientist and develops therapy programs for individuals and families living with chronic illness. She lives in the San Francisco Bay Area with her husband and two sons, ages 5 and 2.
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About the Author
Dr. Ellen Hendriksen was the host of the Savvy Psychologist podcast from 2014 to 2019. She is a clinical psychologist at Boston University’s Center for Anxiety and Related Disorders (CARD). She earned her Ph.D. at UCLA and completed her training at Harvard Medical School. Her scientifically-based, zero-judgment approach is regularly featured in Psychology Today, Scientific American, The Huffington Post, and many other media outlets. Her debut book, HOW TO BE YOURSELF: Quiet Your Inner Critic and Rise Above Social Anxiety, was published in March 2018.