Postpartum and Perinatal OCD

What are Postpartum and Perinatal OCD?

In the United States, 6% of pregnant women and 10% of post-partum women develop anxiety, according to Postpartum Support International. Research shows that women who are pregnant, or who have recently given birth, are at an increased risk of developing Perinatal or Postnatal OCD symptoms. If they already have OCD, the obsessions and compulsions may worsen during this time. Because these two forms of OCD are very similar, we refer to them collectively as “pOCD.”

• OCD that occurs immediately after childbirth is called postpartum OCD

• OCD that occurs during pregnancy is called perinatal OCD.

pOCD symptoms can include:

Obsessions also called intrusive thoughts, which are persistent, repetitive thoughts or mental images related to the baby. These thoughts are often very upsetting and not something that has been previously experienced.
Compulsions, where the mother may do certain things over and over again in an attempt to reduce fears and obsessions.
- needing to clean constantly
- check things many times
- count or reorder things.
A sense of horror about the obsessions
Fear of being left alone with the infant
Hypervigilance in protecting the infant
Research has shown that moms with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

How is pOCD different from OCD which occurs at other times?

• In pOCD, the obsessions (thoughts) and compulsions (behaviors) usually focus on the newborn (or unborn) infant.

For example, there may be obsessions about the baby getting hurt, contaminated, or lost; and compulsive rituals involving checking, mental rituals, and seeking reassurance. There may also be unwanted sexual obsessions. The person may also use excessive avoidance, such as avoiding bathing or holding the baby.

• While OCD typically begins gradually, pOCD tends to begin somewhat rapidly, coinciding with feelings of being responsible for the newborn.

What are the signs of pOCD?

• OCD symptoms that start or worsen around the time of pregnancy or delivery.

• Obsessions involving fear of harm to the unborn or newborn infant.

• Not wanting to tell others about obsessions for fear of being diagnosed with psychosis or being hospitalized.

• Fear that you might harm the baby even when you don’t really want to.

• Compulsions meant to control or stop the obsessional thoughts, or to prevent fears from coming true (e.g., checking on the baby, excessive washing, repeating prayers or requests for assurances).

• Avoiding certain activities with the baby (e.g., bathing, using stairs, holding, diaper changing).

• Feeling overwhelmed by the obsessions and compulsions.

• Feeling depressed (postpartum depression and pOCD often occur hand in hand).

• Needing to have a partner or helper nearby because of obsessional fear.

• Trouble sleeping because of obsessions and compulsive urges.

• Interference with taking care of the child.

Why do obsessions and compulsions focus on the unborn/newborn baby?

• Increased anxiety about having a baby is normal, but it is a major source of stress, so some people develop anxiety during this time.

• Feelings of responsibility for the unborn or newborn baby.

• Research shows that it is normal to have strange unwanted thoughts about stressful events.

• Thinking upsetting thoughts about the baby seems like the worst possible thing to think about—and OCD feeds off of these kinds of thoughts because these are the exact kinds of thoughts that are try very hard to control, dismiss, or fight. But this is how OCD plays a nasty trick—the more strategies used for fighting thoughts, the more they backfire, and the more one can get caught into OCD’s web of obsessing over and over. (Do an experiment: try not to think of a pink elephant!).

• Compulsions are performed because they reduce anxiety over obsessive thoughts about the newborn, but these don’t work well in the long run—they just lead to more obsessing.

Will obsessions about violence or sex lead me to harm my baby?

The chance of someone acting on unwanted, disgusting, distressing obsessional thoughts is extremely low. But although this risk is low enough that treatment actually involves provoking these thoughts (i.e., exposure therapy), it probably doesn’t seem low enough! That’s what leads to obsessional anxiety and fear.

Who struggles with pOCD?

The estimates vary, but pOCD seems to affect about 1-2% of pregnant or postpartum women. Some new fathers can even develop pOCD symptoms because they are also responsible for caring for the new infant. People with OCD who become pregnant may have a worsening of their symptoms, but this is not necessarily the case for everyone.

Is pOCD related to postpartum depression?

Yes, but how these problems are related is not clear. When people become depressed they tend to have more negative thoughts, which can develop into obsessions. Alternatively, obsessions and compulsions can lead to depression because these are very distressing symptoms. Many people expect pregnancy and childbirth to be a very happy time. When negative obsessional thoughts occur, the person might feel extremely sad and anxious because they don’t expect to have these types of thoughts.

Is pOCD related to postpartum psychosis?

No, but sometimes pOCD is confused with postpartum psychosis because both might involve thoughts about harming the newborn infant. Recently, a few serious cases of postpartum psychosis have received media attention, leading many people with pOCD to worry that they have psychosis. In postpartum psychosis, the sufferer develops hallucinations (seeing or hearing things that aren’t really there; e.g., “I saw smoke coming from the baby’s ears”) and delusions (strongly held beliefs that are not based in reality; e.g., “The baby is possessed by the devil and I must kill him to save his soul”). Postpartum psychosis is also an extremely rare condition, affecting 0.1% of new mothers. In some severe instances (but not in all cases), mothers with postpartum psychosis have actually harmed their infant, acting on their hallucinations and delusions. On the other hand, pOCD is not nearly as rare as postpartum psychosis, and pOCD is not associated with actually committing violence. Whereas a person with postpartum psychosis believes his or her hallucinations and delusions are true, pOCD sufferers are afraid of their obsessions and recognize that these thoughts and ideas are inconsistent with their worldview and general sense of morality. People with pOCD try to fight their obsessions. Finally, there is no evidence that pOCD symptoms can change into postpartum psychosis. These two conditions are very different problems.

What are the effects of pOCD?

• Depression (sadness, loss of interest in people and activities, sleep loss or excessive sleepiness, loss of appetite, suicidal thinking, hopelessness, helplessness, lack of self-care)

• Problems with caring for the newborn because of fear and avoidance

• Problems bonding with the newborn because of avoidance, which can impact the ability to form a secure attachment with the primary caregiver.

• Problems with one’s relationship (marriage or partnership) because of extreme anxiety.

Can pOCD be treated?

Yes, pOCD can be treated using the same methods used to treat other types of OCD. Strategies to treat pOCD include:

Psychotherapy:

- - Learning that unwanted thoughts are normal and not dangerous
  - Challenging how the person interprets their obsessional thoughts
  - Gradually confronting situations and thoughts that have been avoided
  - Reducing the use of compulsive rituals to deal with obsessional anxiety
  - Processing trauma that may resurface during pregnancy or/birth-related trauma

Medication:

- - Serotonin reuptake inhibitor (SSRI) medicine
  - Most medicines used to treat OCD are probably safe to use for pregnant and breastfeeding women, although it is important to check with your doctor about whether he or she thinks these medicines will be safe for you.

TMS:

- - When treating pOCD with TMS , we target the Supplementary Motor Cortex (SMA). This area of the brain is shown to trigger intrusive thoughts and movements when over-active. By treating this area of the brain, it will slowly be able to relieve those thought patterns and movements. TMS protocols can look different for everyone, but what makes TMS so great is that it is able to be personalized to each person’s brain anatomy.