Obsessive-compulsive disorder (OCD) is a mental health condition that affects millions of people around the world, and Perinatal OCD describes a specific manifestation of OCD that is experienced during pregnancy or in the first year after giving birth.
This might not be what you had in mind when you pictured bringing a child into the world, but it happens, and it’s more common than you think. According to many people’s expectations, when your baby is born, it’s supposed to be the most joyous occasion of your life. And in many ways, it is. But being a new parent also comes with stress, lack of sleep, and adjusting to life with a newborn—not to mention your own hormones, which are on a perpetual rollercoaster. It’s completely normal to not be able to handle these stressors in the way that you had envisioned.
It’s also normal to experience thoughts that you don’t recognize or that are really upsetting to you. There might be intrusive thoughts about hurting your baby, disturbing thoughts of sexually abusing your little one, or fear of making a wrong decision that severely impacts your child’s life.
It is very disturbing to experience these thoughts, but it’s extremely common in people experiencing Perinatal OCD. What’s more, although these thoughts can be terrifying, they almost never mean you actually want to harm your baby. In fact, they are likely indicative of your strong commitment to keeping your child safe.
Let’s examine the condition further, and explore ways to find relief.
What is perinatal OCD?
First, let’s define what OCD is in general. OCD has two key characteristics: obsessions and compulsions. Obsessions are unwanted thoughts, images, urges, or sensations that occur repeatedly and bring about a significant amount of anxiety or distress. Compulsions are repetitive actions or mental acts that are performed in an attempt to reduce the distress and anxiety caused by obsessions, or to keep an unwanted outcome from happening.
When we talk about Perinatal OCD, we are referring to OCD that takes place during pregnancy and/or after the baby is born. With Perinatal OCD, the obsessions frequently present as unwanted thoughts about something terrible happening to the child. Such obsessions often take the form of very vivid images of physical or sexual harm or even the infant’s death, by accident or from intentionally harming your baby. The thoughts or images can appear suddenly and without warning and are extremely upsetting to the person experiencing them. Obsessions also sometimes present as concerns about a safety-oriented task, like having left the door unlocked; intense, gripping fears about germs and contamination; a pressing, driving need to get everything perfect, or a need for symmetry or order.
Compulsions how people with Perinatal OCD try reduce their anxiety around all of these obsessive thoughts. These behaviors might include checking on your baby constantly; singing the same song over and over in the belief that it can protect your child; checking doors and windows over and over to ensure they’re locked, out of fear that your baby may be harmed by an intruder; crying over putting the baby in the right onesie because you might choose the “wrong” one; seeking repeated reassurance from friends and loved ones that you are doing a good job as a new parent; engaging in rituals like hand-washing or sterilizing the baby’s bottles over and over; or counting or praying as a way to banish the thoughts.
Who is affected by perinatal OCD?
Those who experience Perinatal OCD may have had OCD prior to becoming pregnant, with pregnancy exacerbating their symptoms. Some people who had never previously experienced any form of OCD can get it, too, and pregnancy is thought to possibly trigger the disorder in some people. Those who have experienced Perinatal OCD in the past are more likely to have it again during pregnancy or after pregnancy (“postpartum”).
How is perinatal OCD different from postpartum depression?
Postpartum depression is another mental health condition that can occur in the year after giving birth. The major difference between perinatal OCD and postpartum depression is the nature of these conditions’ symptoms.
Although there can be some overlap, postpartum depression often is characterized by sadness, hopelessness and overwhelm that stems from a mix of biological factors and the tremendous responsibility of caring for a new human. It’s frequently characterized by feeling sad, experiencing fatigue, losing interest in activities, changing appetite, crying, feeling guilty, and having difficulty concentrating. It’s also incredibly common, affecting one in eight new moms.
While Perinatal OCD and postpartum depression can go hand-in-hand—one study found that about 40% of those with postpartum major depression also experienced intrusive thoughts—having one condition doesn’t necessarily mean you will experience the other.
How to tell if you have perinatal OCD?
Intrusive thoughts about harming your baby can exist even if you don’t have Perinatal OCD. Many new parents have concerns about their baby being harmed—it’s perfectly natural to feel extremely protective of your infant, after all. The best way to get a proper diagnosis for any of the symptoms you’re experiencing is to consult with a professional.
It’s important to reiterate that people who have Perinatal OCD and experience thoughts of harming their child are horrified by these thoughts, but they are highly unlikely to actually harm their child, unlike those who are experiencing psychotic delusions. These thoughts and feelings are very upsetting, but are not indicative that the person experiencing them will not actually cause their child any harm.
Finding effective treatment
Having Perinatal OCD feels absolutely overwhelming, but there’s truly good news: you’re not alone, there are many other expecting parents who have gone through the same trials and gotten through it, and there are treatments available for you to access.
If you think you may be experiencing OCD as part of the prenatal process you should speak with a mental health professional who specializes in OCD treatment. Pediatricians, OBGYN’s, and primary care physicians may be able to recognize symptoms of Perinatal OCD, but for treatment it’s best to talk to a mental health clinician who specializes in diagnosis and treatment of OCD.
The most effective therapy for any type of OCD is ERP, or Exposure and Response Prevention therapy. ERP is a form of therapy in which you are exposed to your triggers—with a therapist present, at first—and make active choices not to engage in the compulsive behaviors you usually use to make them feel better. While this type of therapy may be anxiety-inducing at first, when you start to have control over your compulsions, there is typically a major drop in anxiety.
How we can help
NOCD works with highly trained therapists who specialize in ERP, the gold-standard treatment for the disorder. As an OCD specialist, I’ve used ERP to help many people regain their lives from OCD. I encourage you to learn about NOCD’s accessible, evidence-based approach to treatment.
One thing that tends to hold folks back from therapy is the idea that it’s a never-ending process, which we get—but unlike with traditional talk therapy, OCD therapy doesn’t actually have to be a years-long commitment. Most people are significantly better after completing just 11 hours of therapy. There’s also a great community of peers who are experiencing situations similar to your own who you can connect with, lots of therapeutic tools and resources, and the ability to message your therapist anytime. It’s a lot to go through, but you don’t have to do it alone—and real help is available to you if you reach out for it.
Feel you are in crisis and need emergency help? Reach out to the National Suicide Prevention Hotline at 1-800-273-TALK (8255).
