Perinatal OCD is a type of OCD that occurs during pregnancy or the first year after childbirth. It’s characterized by distressing thoughts about harm or failing as a parent, accompanied by compulsions to reduce anxiety.
If you’re experiencing perinatal OCD, you may have thoughts like: What if I accidentally harm my baby? What if I don’t know how to be a good parent? What if I pass down a health condition to my baby? These thoughts can feel overwhelming, intrusive, and out of your control—causing you to repeatedly check on your baby, avoid certain situations, or perform rituals to ensure their safety.
It’s important to remember that these thoughts, although scary, do not reflect your true intentions or abilities as a parent or caregiver, and they are part of a condition that can be treated. Read more to learn about perinatal OCD, how it differs from postpartum depression, as well as the steps you can take to manage it.
What is perinatal OCD?
The perinatal period refers to the time frame surrounding childbirth, from the onset of pregnancy up to the first year after birth. This period is critical for both the physical and emotional well-being of the parent and the baby. This can also be a time of significant changes and stress. People may experience a range of mental health challenges, including perinatal depression, anxiety, and obsessive-compulsive disorder (OCD).
Some people who experience perinatal OCD may never have been diagnosed with OCD before, but pregnancy triggers the onset of the condition. Other people may have been diagnosed with OCD or experienced symptoms in the past, but notice an intense increase in their OCD symptoms during the perinatal period.
People who are pregnant or have recently given birth are at an increased risk of OCD symptoms due to fluctuation of hormones during this time—having a child is also a major stressor that could contribute to an onset of OCD symptoms. It’s common for new parents to have intrusive thoughts about their baby. However, they’re typically brief, don’t cause significant distress, and don’t lead to compulsive behaviors. They can range from random and irrational fears to just odd or fleeting thoughts that cross your mind.
Intrusive thoughts cross over into perinatal OCD when they become obsessions. These can be recurrent thoughts, sensations, images, feelings, or urges that are upsetting and distressing. They might include fears of harming or contaminating your baby, or being an inadequate parent.
Because obsessions cause significant anxiety, you may feel compelled to perform compulsions, which are repetitive behaviors or mental acts, in an attempt to neutralize these fears or prevent them from coming true. These compulsions might include constantly checking the baby’s safety, avoiding certain situations or activities that feel risky, or seeking constant reassurance from others.
It’s important to highlight that people with perinatal OCD do not want to harm their baby, despite experiencing distressing intrusive thoughts about doing so. In fact, the fear of harming their baby is often one of the core features of perinatal OCD, but it stems from the intense anxiety and obsessive worry that the parent may unintentionally cause harm—not from any actual desire or intention to hurt the child.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
Signs of perinatal OCD
Common perinatal obsessions
- Fear of harming the baby: What if I drop my baby? What if I accidentally hurt them? What if I shake my baby?
- Intense worry about being a bad parent: What if I’m not fit to be a parent? What if I make a mistake?
- Worry about the baby’s emotional well-being: What if I’m not bonding with my baby? What if they feel neglected?
- Fear of contamination: What if I don’t clean properly and my baby gets sick? What if I accidentally give my baby an illness?
- Worry about hereditary conditions: What if I pass on a mental health condition or a physical condition to my baby?
These obsessions can feel distressing and uncontrollable, often leading to compulsions.
Common perinatal compulsions
- Repetitively checking your baby’s health or safety such as their breathing, temperature, and movements while they’re awake or sleeping.
- Constantly seeking reassurance from your loved ones that you’re a good parent or that your baby is okay.
- Avoiding activities or situations that might put your baby at risk for getting sick or hurt, such as allowing others to hold your baby, or leaving the house (unless otherwise directed by your baby’s healthcare provider).
- Excessively cleaning or sanitizing to ensure your baby doesn’t get sick.
- Checking your baby’s items to make sure they are not contaminated.
- Researching constantly about baby care and safety.
- Performing mental rituals such as praying or repeating phrases to prevent harm from occurring.
Community discussions
The differences between perinatal OCD and postpartum depression and psychosis
Postpartum depression can also affect people soon after childbirth, or up to a year afterwards. Symptoms include depressed mood, loss of interest, changes in sleep patterns, change in appetite, feelings of worthlessness, inability to concentrate, anxiety, and suicidal ideation. People with postpartum depression can also experience psychotic symptoms, also called postpartum psychosis, a rare condition that includes hallucinations and delusions.
The International OCD Foundation makes an important distinction between perinatal OCD and postpartum psychosis, “Perinatal/postpartum OCD is not nearly as rare as postpartum psychosis, and perinatal OCD is not associated with actually committing violence. Whereas a person with postpartum psychosis believes his or her hallucinations and delusions are true, [people with perinatal OCD] are afraid of their obsessions and recognize that these thoughts and ideas are inconsistent with their world view and general sense of morality. Finally, there is no evidence that perinatal OCD symptoms can change into postpartum psychosis. These two conditions are very different problems.”
Depression can also co-occur with OCD, leading to a more complex set of symptoms. However, postpartum depression primarily involves feelings of deep sadness and hopelessness, whereas, perinatal OCD is marked by repetitive, intrusive thoughts and compulsions performed to try to alleviate the anxiety associated with those thoughts.
“Women with perinatal OCD might also experience symptoms of depression, especially since the constant anxiety and intrusive thoughts can contribute to emotional exhaustion, feelings of guilt, or helplessness—hallmarks of depression,” says NOCD therapist MaryBeth Overstreet MA, LPC. The reverse is also true: women with postpartum depression may develop intrusive thoughts or become fixated on particular fears or risks. That overlap is why they can be so challenging to differentiate in some cases.”
Treatment for postpartum depression may look different from treatment for perinatal OCD. For depression, therapies such as cognitive behavioral therapy (CBT) and medications may be used to reduce depressive symptoms. You can also reach out to support groups to help you navigate the emotional challenges of postpartum depression. Connecting with others who are going through similar experiences can provide emotional support, reduce isolation, and help normalize feelings during a difficult time.
While joining a supportive community or connecting with friends and loved ones is also a good idea when you have perinatal OCD, breaking the OCD cycle requires a specialized form of therapy known as ERP.
Treatment for perinatal OCD
Exposure and response prevention (ERP) therapy is a specialized form of cognitive behavioral therapy (CBT) that is designed to target the symptoms of OCD. ERP helps you confront your obsessions, while resisting the urge to do compulsions.
The core principle of ERP is gradual exposure to situations or thoughts that trigger anxiety, followed by response prevention—learning to resist the urge to engage in compulsive behaviors that would normally offer short-term relief.
You’ll begin by making an exposure hierarchy with your therapist, which consists of exposures that vary in difficulty and intensity.
For example, if a common fear is of accidental harm coming to your baby, the hierarchy might look something like this: Imagine a scenario where the baby is in a potentially risky situation, such as someone holding them. Then, you’ll work your way up to more challenging exposures that are manageable, such as leaving your baby with a loved one.
Higher level exposures can look like sitting with the possibility that you may potentially harm your baby. This can be difficult, and you might not even want to imagine these thoughts, but it’s an essential part of ERP. You’re learning that having an intrusive thought doesn’t mean it will come true, and that you can handle the distress without engaging in compulsions.
It’s important to remember that you’re not alone in this process. Your therapist will be there to guide you, and support from loved ones can also help as you work through these challenging exposures.
“Dealing with perinatal OCD can make you feel like a ‘bad mom’ at times, but it’s important to remember that these thoughts do not define you,” says Overstreet. “They are symptoms of a treatable mental health condition. It’s okay to have a hard time—what matters is that you’re working toward healing and moving towards not doubting the type of parent that you want to be.”
Bottom line
It’s important for people who are pregnant or have recently given birth to give themselves compassion—the perinatal period is physically and emotionally demanding. Many new parents may feel pressure to be constantly “on” or to live up to unrealistic expectations. If you’re struggling with perinatal OCD, you should reach out to a therapist who specializes in ERP who can offer you support for your unique needs.
Key Takeaways
- Perinatal obsessive-compulsive disorder (OCD) is a subtype of OCD characterized by intrusive thoughts about your baby, often centered around fears of harm, contamination, or being an inadequate parent.
- Postpartum depression includes feelings of deep sadness and hopelessness, whereas perinatal OCD is marked by repetitive, intrusive thoughts and compulsions.
- Exposure and response prevention (ERP) is an effective treatment for perinatal OCD.