Fear of Pregnancy: Is it OCD, Tokophobia, or Anxiety?

As rewarding as pregnancy can be for many, it’s normal to feel some fear or anxiety about becoming or being pregnant. For some, however, these fears reach abnormal levels and interfere in daily life—in these cases, fear and anxiety about pregnancy can be signs of mental health conditions like tokophobia (fear of pregnancy) or obsessive-compulsive disorder (OCD). 

So how can you tell whether your concerns and attitudes towards pregnancy are healthy, paranoid, or indicative of a mental health condition? We cover these topics and more below, including how these conditions can be treated if fears about pregnancy are causing you to suffer.

What is OCD focused on a fear of pregnancy?

OCD is a mental health condition characterized by two primary symptoms: obsessions and compulsions. Obsessions are persistent and recurring thoughts, images, and urges that are unwanted and unpleasant. Compulsions are mental or physical actions performed in response to obsessions in order to alleviate anxiety or prevent an unwanted outcome from occurring.

OCD can focus on a variety of themes, such as contamination, health concern, false memories, or existential fears. One of the more common but less talked about topics involves obsessions and compulsions related to becoming, being, or completing one’s pregnancy. 

Common obsessions about pregnancy involved in OCD include:

• What if the protection we used didn’t work?
• What if I somehow got sperm on my clothes accidentally?
• What if I have an ectopic pregnancy and don’t know it?
• What if I can’t afford contraception?
• What if I have a partial miscarriage?
• I don’t remember that sexual encounter perfectly. What if I got pregnant?
• This period is slightly late or irregular. Does that mean I’m pregnant?

Common triggers of obsessions

Sometimes intrusive thoughts and worries about unwanted pregnancy come seemingly out of nowhere—striking at random. But more often, they come in response to specific triggers that are related to obsessive fears. Here are a few common examples:

• Seeing a pregnant person
• Late period
• Menstrual irregularities
• Possible symptoms of early pregnancy, like nausea
• Sexual intimacy
• Knowing someone who had a challenging pregnancy or birthing experience

Common compulsions in OCD with a fear of pregnancy

When someone’s obsessions about unwanted pregnancy are triggered, they cause a wave of distress, anxiety, or fear. This is what leads to the “C” in OCD: compulsions. Contrary to common beliefs and misunderstandings about OCD, compulsions can be physical or mental—in fact, many of the most common and most debilitating compulsions are completely invisible to others.

Here are some examples of specific compulsions that may be done in response to obsessions about pregnancy:

How can I tell if it’s OCD, and not a phobia?

Fear of pregnancy in OCD and a phobia of pregnancy can present very similarly. However, there are a few key differences. Here’s how they compare. 

Similarities

One of the most notable similarities between OCD with a fear of pregnancy and tokophobia is that they can both involve a variety of safety behaviors done to alleviate stress and anxiety. “Fundamentally, there is hardly any difference between safety behaviors in a phobia and compulsions in OCD,” states Dr. Nicholas Farrell, psychologist and clinical director here at NOCD.  “They functionally ‘accomplish’ the same purpose for the sufferer. In other words, they reduce anxiety and, at least ostensibly, prevent feared outcomes from occurring. However, they also both directly maintain pathological anxiety or fear.”

Moreover, people with a phobia of pregnancy and individuals with a fear of OCD engage in some of the same safety behaviors. For example, they both might frequently take pregnancy tests, avoid sexual acts or interactions, repeatedly seek reassurance from friends or doctors that one is not pregnant, or repetitively search for possible symptoms of pregnancy.

Differences

Despite their similarities, tokophobia and OCD with a fear of pregnancy have a number of key differences.

OCD involves obsessions

In some sense, it might seem like individuals with any type of phobia experience obsessions, characterized by all of the thoughts and worries they have related to their phobic stimulus. But while these might count as obsessions in some sense of the word, they are different from the type of obsessions that characterize OCD. 

In particular, in phobias, intrusive thoughts are triggered by direct encounters with phobic stimuli, whereas with OCD, they may also occur persistently and sporadically throughout the day without any obvious trigger. Moreover, the obsessions themselves may tend to be more irrational or unusual in the case of OCD. For example, someone with OCD who fears pregnancy may worry about being pregnant despite not having had sex for years. 

OCD can involve many themes or topics

While someone with a specific phobia may have one phobia and no others, individuals with OCD often focus on multiple themes or topics they are concerned about. If your excessive fear or avoidance behaviors are only related to one narrowly defined topic, that’s an indication that you have a phobia and not OCD.

Symptoms fluctuate in OCD

Another difference between the two disorders is that OCD symptoms often wax and wane from the time of onset. A person may spend only several months consumed by obsessions and compulsions related to pregnancy, after which their intrusive thoughts and compulsive behaviors may focus on another theme. In a specific phobia, one’s fears and behaviors usually remain consistent without treatment and don’t shift to other topics or fluctuate widely in severity. 

Is it normal to have fears about getting pregnant or getting others pregnant?

Being afraid of getting pregnant doesn’t automatically mean that your concerns are a cause for concern, that you are paranoid, or that you have tokophobia or OCD. In fact, some degree of worry is widespread. Estimates suggest that up to 80 percent of women feel some degree of anxiety over pregnancy and childbirth.  

If your thoughts and fears around pregnancy are not interfering with your life, undermining your goals, causing severe fear, or resulting in avoidance behaviors, obsessions, or compulsions, then your feelings about pregnancy are likely not related to a mental health condition. 

How to overcome a fear of pregnancy

Whether someone is diagnosed with a fear of pregnancy in OCD or tokophobia, effective treatment will be similar. Studies have demonstrated that exposure and response prevention (ERP) therapy is highly effective in treating both OCD and Specific Phobias, and is backed by decades of clinical research proving its effectiveness. 

People who struggle with a fear of pregnancy will work with their therapist to build an exposure hierarchy and begin working on one trigger at a time. Usually, an ERP therapist will start with an exposure that is predicted to bring about a low level of fear and anxiety and work up to the harder exposures as confidence is built. When doing exposures, the goal is always response prevention: your therapist will guide you in resisting the urge to respond to fear and anxiety by doing compulsions and safety behaviors. Over time, this allows you to tolerate anxiety about pregnancy, without relying on compulsions to feel better.