Perinatal OCD: Understanding and Managing OCD During and After Pregnancy

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Jennifer B. Wilcox-Berman, PsyD

 

 

 

 

Anyone who has ever had a baby knows that it comes with many emotions, from pure joy to fatigue and feeling overwhelmed. Anxiety is a common feeling experienced by parents as they learn how to navigate new parenthood.

At times, new mothers (and new fathers) experience significant and unmanageable anxiety, which may be attributed to Perinatal OCD. In this article, I will explain what Perinatal OCD is, what it’s not, and how it can be managed.

What is Perinatal OCD?

Perinatal OCD (sometimes referred to as Post-Partum OCD) is a term used to describe someone who has OCD symptoms that occur before and/or after a baby is born. OCD is a mental health disorder that causes one to experience obsessions and compulsions. These compulsions cause significant distress, interfere with one’s daily functioning, and are time consuming (more than one hour per day).

Obsessions are unwanted and uninvited intrusive thoughts, images, feelings, and sensations that trigger strong fears, discomfort, or distress. Obsessions are considered to be ego-dystonic, meaning that are inconsistent with one’s values and beliefs, therefore leading to significant distress and fear. It should be noted that new parents with Perinatal OCD do not want to harm their babies/children and their thoughts are very distressing to them. Although the content of obsessions can be anything fear-inducing, new parents commonly experience obsessions related the care and safety of their baby. Compulsions are behavioral or mental attempts to neutralize the distress associated with these thoughts, images, and sensations.

Perinatal OCD is not uncommon with studies showing that an estimated 2-3% of new mothers may experience some form of Perinatal OCD. It is difficult to determine how many new parents are affected due to under-reporting, which means it could be much higher.

Common Obsessions in Perinatal OCD

  • Fear of germs, getting the baby sick, or inadvertently interfering with healthy development
  • Unwanted sexual thoughts about the baby
  • Fear of self or others harming the baby (intentionally or unintentionally)
  • Need for perfection in caring for self (during pregnancy) or the baby
  • Fear of going crazy or losing control
  • Fears of not wanting or loving the baby

Common Compulsions in Perinatal OCD

  • Washing, cleaning, or sanitizing oneself, the baby, or household items excessively
  • Avoiding being near, holding, carrying, diapering, bathing, breastfeeding, or playing with/tickling baby
  • Reassurance seeking from others, repeatedly reassuring oneself, or engaging in online “research”
  • Checking that the baby is breathing, safe, or unharmed
  • Distracting oneself from thoughts

How does Perinatal OCD Differ from Other Perinatal Mental Health Disorders?

  • Postpartum Depression refers to persistent sadness that happens most of the day, nearly every day, on most days. It also involves lack of interest in previously enjoyed activities, fatigue, apathy, and feelings of worthlessness.
  • Postpartum Psychosis is rare and can involve delusions, hallucinations, and disorganized thinking during the perinatal period. It is not recognized as irrational and can therefore pose a risk to oneself or the baby.
  • By contrast, Perinatal OCD involves unwanted intrusive thoughts that are recognized as irrational and are avoided. It involves compulsive behaviors, shame, and guilt about the unwanted thoughts.

What Causes Perinatal OCD?

A number of factors play a role in someone developing Perinatal OCD. If somebody is genetically predisposed to it, such as having a personal or family history of OCD or anxiety, this increases their chances of developing Perinatal OCD. Hormonal shifts in estrogen, progesterone, and cortisol that occur during pregnancy and in the postpartum period are also a contributing factor. Increased stress due to sleep deprivation, breastfeeding, changes in schedule and routine, and balancing new roles can also be triggers for developing Perinatal OCD.

What Types of Evidenced-Based Treatments Are Available for Perinatal OCD?

  • Cognitive-Behavioral Therapy (CBT), specifically Exposure and Response Prevention, a type of CBT is considered to be the gold standard treatment for all types of OCD, including Perinatal OCD. It involves helping individuals to conquer their fears and reduce compulsive behavior.
  • Medication management is often used in combination with therapy to treat Perinatal OCD. SSRI medication is the first line medication for all types of OCD. Some specific SSRIs are considered safe during pregnancy and in the postpartum period. The risks and benefits of all medications should be discussed with your psychiatric provider and OB/GYN to ensure that it’s appropriate for use.
  • Psychoeducation refers to learning more about OCD and how to manage it. Peer and family support can also be beneficial to help the person with Perinatal OCD to feel supported, reduce shame, and promote self-compassion.

When to seek Professional Help

If you or someone you know is struggling with persistent, unwanted, and distressing thoughts during pregnancy or after a baby was born, is avoiding their baby, or performs rituals to protect the baby, they may need professional help to manage the situation. Help is available and Perinatal OCD is considered highly treatable if the right approaches are used. Seeking help is the first step in recovery.

References and Additional Resources:

  • International OCD Foundation
  • Postpartum Support International
  • Maternal Mental Health Alliance