Intrusive Thoughts and Postpartum OCD
Don’t feel bad if you’re a mom, medical professional, or mental health therapist and you’ve never heard of Postpartum OCD (Obsessive-Compulisive Disorder). Most people haven’t. The thing is, it’s more common than you may think and it’s important for most everyone to be aware of it. If more people know about it, then chances are, women and their families will have a better chance at getting correctly diagnosed and treated. Hopefully, they’ll also avoid the uninformed judgements of others. I consider it my mission to spread the word because the women who have it typically suffer in silence and do so needlessly. I assure you, with help, relief is within reach.
Index of topics:
What it is
What it isn’t
Risks for developing it and prevalence rates
Why mothers stay silent
When to get help
A message to moms
What friends and family can do
Bibliography
There are some women who, after they give birth, experience a typical variety of OCD. They likely had OCD prior to becoming pregnant and, if they had been symptom-free previously, they may find that their symptoms re-emerge with the stresses that commonly accompany the transition to parenthood. Although their obsessions and compulsions can take many forms, one of the most well-known are obsessions centered around germs and cleanliness; they wash their hands until they bleed and fret over the idea that they and/or their children may get sick with something horrible. It is distressing, time consuming, and tiring.
What I’ve described above is what I learned in graduate school and it is the kind of OCD that I had treated prior to my work as a volunteer with Baby Blues Connection (BBC), my local perinatal support organization. While facilitating support groups with BBC, I learned about a variation of OCD of which I had previously been unaware. Many of the moms I saw reported having scary, intrusive, and sometime violent, thoughts about harm coming to their babies. As Karen Kleiman and Amy Wenzel wrote in their 2011 book, Dropping the Baby and Other Scary Thoughts, these thoughts of harm fall into the following categories that frequently overlap with one another:
- Threats to the baby’s physical well-being
- Thoughts of an accident
- Thoughts of intentional harm inflicted by the mother
- Thoughts of intentional harm inflicted by another person
- Disturbing sexual thoughts
Many times these thoughts are highly visual in nature and some say that it’s as if they see a movie play out in their heads. Women are horrified to have these thoughts or impulses, especially when they see themselves causing the harm. They do not want to do these acts and often go to great lengths to ensure their babies’ safety. They may avoid certain places or activities and install safety devices. They may hire someone else to care for their baby. They may believe that they should not be a parent. Then they worry. And worry. Then worry some more. When they’re finally so exhausted that they fall asleep, they have nightmares about what they’ve spent their day trying not to think about. In pushing the thoughts away, they inevitably make it worse.
Most all of us, at some point, have had intrusive, horrible thoughts. We imagine something gruesome or perverted, because…well…we’re human and that’s what the human brain will do. Typically, we dismiss that thought and if it does pop up again, we are able to continue with our daily lives without disruption. This is not OCD. It does not cause us undue distress and we can function normally.
This is also not psychosis. We have all heard the tragic stories on the news of mothers taking the lives of their children. The women in these stories almost certainly suffer from psychosis or other serious mental health disorder and typically have a long history of problems. When they think of harming their children, they are typically under the delusion that doing so would be a good thing. Hearing these stories, unfortunately, fuels the fears of postpartum women. In contrast, those with OCD are horrified by the intrusive thoughts and may go to great lengths to protect their children; the thoughts are extremely anxiety provoking. I have never heard of a woman with postpartum OCD killing her child.
Risks for developing it and prevalence rates
For some women, their symptoms of OCD seem to come out of nowhere. Researchers have found that all women are at higher risk for OCD following the birth of a child. Typically, however, women have had a history of OCD or other psychiatric disorder (such as depression or anxiety) or had complications during pregnancy or birth (Zambaldia, Cantillinoa, Montenegroa, et al., 2009). One’s thinking style, such as perfectionism, can also predispose a person to develop it (Timpano, KR, Abramowitz, JS, Mahaffey, BL, Mitchell, M, & Schmidt, N, 2011). Zambaldia et al. found that 9% of the 400 women they test met the criteria for OCD, but others (including me) believe that number is much higher; one small study found that 29% of the women in their study, who were in their third trimester of pregnancy, met the criteria for OCD, and that number went up in the one month after giving birth (Chaudron & Nirodi, 2011).
Mothers who have intrusive thoughts often avoid telling anyone of their scary thoughts because they are afraid others may think they are crazy. Sadly, they may themselves question their sanity. Those who have thoughts of themselves harming their babies are even less likely to disclose this information because they fear that their babies will be taken from them and that they may be locked up. They often feel intense shame. They may desperately want to tell someone to relieve the burden of their secret, but unless they are adequately informed about postpartum OCD and unless they can find someone in whom they can trust about the nature of their problem, they will likely stay silent. This is why I am so adamant about educating people about the nature of intrusive thoughts and OCD; if the reality of intrusive thoughts was common knowledge, women would be able to reach out and learn how to find relief.
Most new parents will have intrusive, scary thoughts at some point following the birth of a child. It’s when those thoughts increase a person’s anxiety, stop them from enjoying time with their baby, impact the choices they make, and make it difficult to enjoy life, that she would benefit from professional help. Depression often accompanies Postpartum OCD, so having a depressed mood nearly every day for most of the day is another symptom to play close attention to.
It goes without saying that anyone who wants to harm his or her baby, doesn’t think it’s a really bad idea to act on these thoughts, and/or has a plan or intention to hurt her baby, needs to seek help immediately.
If you are a mother who is experiencing intrusive, scary thoughts, you are not alone. You are not crazy. Just because you have horrible thoughts, it does not mean that you’re going to act on them; no matter how awful they are, your thoughts do not make you a bad person. Also, Postpartum OCD and psychosis are two different things; one does not turn into the other. I also want to repeat what I said earlier — I’ve never heard of a mom with postpartum OCD killing her child. The best news is, help is readily available.
You can seek out the help of a therapist who specializes in postpartum issues (see my previous post about how to find a therapist). If you’re lucky enough to live in the Portland, Oregon area, you can contact Baby Blues Connection (BBC) and talk with someone over the phone at no charge who has suffered through — and come out the other side — of postpartum OCD. They can also tell you if there are free support groups in your area. If you do not have an organization such as BBC near you, call Postpartum Support International (PSI). They get it. If you’re still unsure whether or not you can trust such an organization, you can always call and ask what they know about intrusive thoughts. Doing so may allay your fears.
If group or individual therapy is not an option for you, call PSI for support, learn diaphragmatic breathing and practice it daily, eat healthy food, exercise, DO NOT isolate, and get Karen Kleiman’s book (listed in bibliography). You don’t have to feel this way forever. Be good to yourself; both you and your baby deserve it.
What friends and family can do
If you are lucky enough that a mom confides in your about having intrusive thoughts, listen without judgement. Know that she is not exaggerating the depths of her distress and anxiety, or how real and vivid the thoughts can be. Don’t minimize her feelings or tell her that she’ll be fine. Let her know that she can get help. If she wants information, point her to Postpartum Support International or this blog post. Discourage her from searching the internet about her symptoms. Unfortunately, there is a lot of inaccurate information that could exacerbate her fears. If she says things such as, it would be better if I weren’t around, or otherwise indicates that she would be better off dead, seek professional help immediately.
Keep in mind that no one decides they want to get Postpartum OCD. They’ve done nothing to deserve it and they have not brought in on themselves. It is important to avoid blame, because adding that onto the guilt and shame they already feel will only make things worse.
And please…spread the word…okay? You may just save a life by doing so.
Chaudron, LH, Nirodi, N. (2010). The obsessive-compulsive spectrum in the perinatal period: A prospective pilot study. Archives of Women’s Mental Health, 13, 403-10.
Kleiman, K, Wenzel, A. (2011). Dropping the Baby and Other Scary Thoughts. New York, NY: Taylor and Francis Group.
Timpano, KR, Abramowitz, JS, Mahaffey, BL, Mitchell, M, Schmidt, N. (2011). Efficacy of a prevention program for postpartum obsessive-compulsive symptoms. Journal of Psychitaric Research, 45, 1511-7.
Zambaldia, CF, Cantilinoa, A, Montenegroa, AC, Paesb, JA, de Albuquerqueb, TLC, Sougeya, EB. (2009). Postpartum obsessive-compulsive disorder. Prevalence and clinical characteristics. Comprehensive Psychiatry, 5, 503-9.
The Friendly Psychologist 