Postpartum OCD

Dr. Erica Goldblatt Hyatt, Erica Goldblatt Hyatt, DSW, MSW, MBE

Posted by: Dr. Erica Goldblatt Hyatt
Erica Goldblatt Hyatt, DSW, MSW, MBE

Life after baby should be blissful, shouldn’t it? After 10 months of scans, stretched ligaments, restless legs, insomnia, and overheating, once that baby is on the outside, shouldn’t you get a break? In particular, if you have recently given birth to your rainbow baby after babyloss, you may especially be looking forward to kicking back, relaxing, and snuggling with your newborn. 

Unfortunately, for some women, the postpartum period is also when postpartum depression (PPD) and OCD (PPOCD) can hit. You may be more familiar with PPD, a disorder in which mamas of any number of children can feel tearful, moody, withdrawn, hopeless, restless, fatigued, and even suicidal. In recent years, awareness and advocacy around PPD have resulted in more women coming forward to admit that they are struggling with this terrifying disorder, which is treatable with therapy and sometimes medication. In the past, women were afraid to come forward about their PPD because of the fear of being judged, singled out, or even having their children taken away from them. Thankfully, recent campaigns to bring attention to PPD and destigmatize it have resulted in more mothers being treated for the all-too-common disorder. Unfortunately, PPOCD still remains in the shadows of postpartum mental health, because its symptoms can be even more troubling and stigmatizing. 

PPOCD mainly consists of intrusive thoughts and images (also known as "obsessions")  that are disturbing to the individual, causing them to engage in certain rituals (or "compulsions") to avoid, neutralize, or suppress the thought. Though the person having the obsession often knows that it is irrational, unrealistic, or out of character, it is difficult to stop fixating on or over-analyzing. It becomes increasingly upsetting to the person experiencing it, and they may desperately seek for ways to stop having the thoughts through rituals, worrying that they are seriously mentally ill. For example, a mother may develop repeatedly intrusive thoughts about smothering her newborn with a pillow. The image is so vivid and painful, especially because she feels deep love for her child. This mother may begin to experience increased anxiety, worrying that she will lose control and harm her baby, as though her thoughts may be predictions of the future. As a result, she may feel compelled to do certain things: remove all pillows from the house, or even anything that might smother her baby. She may even feel afraid to nurse or soothe her baby out of a fear of harming her. This disrupts not only the mother's postpartum period, but her adjustment to motherhood.

It's natural and healthy to want to protect our babies from harm, from everything to child locks and removing any sort of extra bedding or materials that could leave an infant at risk of SIDS. However, in the case above, the mother has taken safeguarding measures to the extreme. Other mothers may experience other distressing obsessions that prey on their love for their children and their fear of harming them in some way. As a result, they may spend more time thinking about the obsessions, trying to understand if they present a real risk, and some may engage in repetitive, compulsive rituals to help calm the frightening thoughts in their heads. Not all of the rituals need to be physical in nature: some take the form of prayer, immediately asking a loved one for reassuring, or developing a counter-argument to the obsession that is then repeated. PPOCD is in the same family as postpartum anxiety (PPA), which involves near-constant worry over a baby’s, mother’s, or other family members’ safety. PPA can cause mamas to feel sick to their stomachs, avoid leaving the house, and more. 

If you think you may be suffering from PPOCD, know that you are not a bad mother, and you are not alone. People who experience OCD are normal, loving, wonderful humans (and parents!) who are distressed and upset by the intrusive thoughts and images that come suddenly and feel uncontrollable. Having these thoughts by no means will result in your harming your baby. Being upset over them means that you love your child and care about their safety. What's important is to remember the mantra, Don't believe everything you think. Starting there, you can reaffirm that your thoughts are just thoughts, and though upsetting, they do not present any real danger or risk to your baby. Your next step is to reach out for help. 

It's normal to be afraid to tell a loved one or doctor about your symptoms, but people who care about you and your mental health will not judge you or call child protective services. Most healthcare providers these days are aware of PPOCD and its symptoms, and they can confirm for you that this is a real, treatable disorder. You'll likely be referred for therapy, which involves facing the distressing images in a safe space, exploring their meaning with your therapist, and challenging the assumptions or worries about what the OCD brings out in you. Having PPOCD does not mean that bad things will happen, but trying to control the thoughts with physical rituals, or even mental ones, like repeatedly asking others for reassurance, will likely cause the obsessions to return and feel more uncontrollable. Facing them, though it sounds frightening, is your ticket to improved mental health. It can also be helpful to talk to your primary care doctor, OB, or psychiatrist about a prescription for medicine that can make a big difference in how “loud” the intrusive thoughts can get. There are a number of medications that have shown effectiveness in treating the symptoms of OCD.

PPOCD and PPA are real disorders and they can be terrifying, but you don’t need to suffer silently. Seeking treatment is brave, and once you begin, you’ll soon be able to enjoy the precious period after the birth of your child, and the adventures thereafter. Don’t hesitate to ask for help-you deserve it.