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In the years I’ve been specializing in treating OCD and other anxiety disorders, too often someone with OCD ends up in my office (or, these days, on my computer screen) unsure what to make of their persistent distress or having been chronically misdiagnosed through the years.
It can be hard to spot the often subtle signs of Obsessive Compulsive Disorder (OCD), especially in mothers of new babies. The excessive worry, irritability, disturbing thoughts, and helplessness that can be part of OCD are most often misinterpreted as generalized anxiety, but also depression, mania, even psychosis. The symptoms of OCD can also be written off as stress or “normal” worry in the postpartum period, by the person experiencing them and medical professionals alike.
In postpartum mothers, the signs of OCD might also be missed or hard to see for what they are because so many tasks of caring for a newborn are quite repetitive or require extra care and attention. It may not raise a red flag right away if a great deal of time is spent sanitizing bottles, excessive focus is put on monitoring food intake while breastfeeding, or hours are spent reading up on newborn care.
But the obsessive focus and attempts to control feared outcomes may be quite upsetting, time-consuming, disruptive to relationships, and interfere with a mother’s ability to care for her baby. A new mom might seem frazzled, disconnected, or high-strung, but it could be that she is stuck in a compulsive fear-driven loop.
Additionally, those struggling might not always be forthcoming with providers. If you are struggling with alarming intrusive thoughts (especially of a violent or sexual nature related to your baby) or engaging in odd or repetitive behaviors of which you might be ashamed, of course that’s going to be hard to share. This hesitation tends to be amplified in new mothers who often fear that their baby will be taken away from them if anyone knew what they were actually thinking. (The truth is that if you’re alarmed by thoughts of harming your baby, that’s a pretty reliable indicator that you won’t do it.)
It is important to accurately diagnose postpartum OCD. Getting an accurate diagnosis, while sometimes upsetting initially, can be a relief. Giving a name to your experience and symptoms is like a huge exhale. It opens the door to demystifying the symptoms, learning more, connecting with others, reducing shame, and getting the most appropriate treatment possible so you can feel better.
Main characteristics of postpartum OCD
So how do you know if what you are experiencing is postpartum OCD? There are many subsets of OCD—it is not always the stereotypical hand-washing and extreme organization—but they share these attributes listed below. When OCD is experienced postpartum, the themes naturally tend to be focused on the safety of the baby.
- Intrusive, scary, persistent, and unwanted thoughts or images.
- Fear of the thoughts themselves, i.e., the thoughts are upsetting and not in line with intentions.
- Behaviors or cognitive compulsions aimed at neutralizing the anxiety (e.g., repeated checking, cleaning/sterilizing, needing to do things a certain number of times, seeking constant reassurance, engaging in a behavior until you feel you’ve gotten it “just right”).
- Awareness that the thoughts and behaviors are irrational or excessive.
- Intolerance of uncertainty, i.e., persistent doubt and “what if-ing” that is not lessened or relieved by reassurance, facts, or actions.
Common examples of postpartum OCD thoughts and behaviors
- Sexual intrusive thoughts: “What if I molest my baby?” “What if I am turned on when changing my baby’s diaper?”
- Violent/harm intrusive thoughts: “I keep imagining my baby falling and cracking his head open.” “I might smother my baby by accident." "What if I stab the baby?”
- Contamination fears leading to excessive cleaning, sterilizing, and avoidance measures (including avoidance of leaving the house or interacting with others).
- Rigid obsessive schedule adherence, and extreme distress when not able to adhere to a schedule.
- Overprotectiveness: Fears that others will harm the baby leading to complete and excessive control of care.
- Difficulty caring for the baby: Fear of harming the baby leading to avoidance of being alone with the baby or participating in caretaking tasks.
- Health anxiety: Unshakable fears that something is wrong with the baby leading to frequent checking for symptoms, excessive online researching, calls to the pediatrician, or unwarranted doctor/ER visits.
Distinguishing Generalized Anxiety and OCD
Generalized anxiety disorder (GAD), which is characterized by excessive worry, and OCD can sometimes be tricky to differentiate; thus, many OCD cases are missed or inaccurately labeled as GAD.
The anxiety in generalized anxiety and OCD function similarly. An anxious thought arises, distress occurs in reaction to the thought, something is often done to attempt to obtain a feeling of certainty about an uncertain outcome or to avoid feeling anxious. Both involve an intolerance of uncertainty. Both can be accompanied by physical anxiety symptoms (e.g., increased heart rate, shortness of breath, numbness in limbs, etc.) ranging from mild sensations to full-on panic attacks. However, there are some key distinctions.
Scope of anxiety
The worries in generalized anxiety tend to be, well, general. Worries pop up frequently and in response to a range of situations (often the worst-case scenarios are imagined). With GAD, there is a sense that the feared outcomes are possible or reasonable to worry about, even if extreme. There is also often an implicit belief that the worry is somehow productive or helpful, i.e., “If i think about this terrible thing happening, it will help me find ways to avoid it or somehow prepare me to handle it emotionally and practically if it occurs”—both typically false.
With OCD, the mind becomes focused and fixated on specific thoughts or outcomes. Rather than a record frantically jumping from track to track (GAD), in OCD, the record is stuck on one track which plays over and over.
Content of anxious thoughts
Another distinction between GAD and OCD is the degree to which the thoughts are in line with a person’s beliefs, values, and intentions. With generalized worries, the themes are egosyntonic, meaning they are consistent with a person’s desires and concept of self, even if they take on a life of their own and feel inescapable.
In OCD, the thoughts are egodystonic. There is an awareness that the thoughts and behaviors are somewhat irrational and out of line with a person’s intentions and values. There is often magical thinking or thought-action fusion. A person with OCD often believes that having a thought increases the likelihood of acting on the thought or creating a consequence in the material world just by thinking it, but acting on the thought or having it come true is the last thing the person wants to happen.
Because of this thought-action fusion, the thoughts feel alarming and efforts are taken to check or ensure that you won’t do anything you might be imagining, like harming the baby. The fear of acting on the thoughts, while the source of distress, is also a strong indicator that you will not act on them.
What Help Looks Like
The good news is that there are well-researched and effective therapeutic treatment approaches for OCD, the most effective being a type of Cognitive Behavior Therapy (CBT) called Exposure and Response Prevention (ERP). ERP works by disrupting the cycle of avoidance that fuels OCD. There are also many medications that, especially when combined with therapy, can be helpful in reducing the intensity and susceptibility to symptoms.
If you think you might be experiencing postpartum OCD, know that you are not a bad mother, thoughts can just be thoughts, and that you can get help.
Some Helpful Reading
- “Dropping the Baby and Other Scary Thoughts” by Karen Kleiman
- “Good Moms Have Scary Thoughts” by Karen Kleiman, illustrated by Molly McIntyre
- “Overcoming Unwanted Intrusive Thoughts” by Sally Winston and Martin Seif
- This post on intrusive thoughts by Sally Winston and Martin Seif
