When A Beautiful Time In Your Life Turns Terrifying: Postpartum OCD

She waited her whole life for this. When she was 4-years old, she laid all her baby dolls out on the kitchen floor and covered them, lovingly, with dish towels, shushing them to sleep. When she was 17-years old, she delighted in babysitting for the neighborhood kids. Now, at 33-years old, she leans over her newborn baby’s bassinet and….something is terribly, terrifyingly wrong.

An image flashes across the screen of her mind: she sees herself pick the baby up, walk toward the window, open it, and throw the baby from the second story.

The mother shakes her head, blinks hard. “Why would I think such a horrible thing? Who envisions disgusting things like that? Maybe I’m not going to be a good mother after all.” She feels her heart pounding, hears her pulse in her ears. It’s like a steam engine roaring furiously toward her. She blinks hard, looks down again at her sleeping newborn. “What if I smothered him with a pillow? Oh my God! Why would I think that?!”

She looks over at the nearby master bed and counts the pillows….1, 2, 3, 4. “Ok. They’re all there,” she thinks to herself. “I didn’t smother him. But, what if I did and I don’t remember it? What if I’m in denial about some unconscious urge to hurt my baby?”

Tears well in her eyes. She leans over the baby again, watches his breathing closely. The rise of his chest. Up, and down. She brings her pointer finger just under his nose, gently. “Is he still breathing?,” she wonders. “Am I sure I didn’t smother him?”  The door behind her opens; she startles and straightens up, wiping her eyes on the sleeve of her nightshirt. “Is everything okay, honey?'” her partner asks. “You’ve been up here a while.” “Oh! Yes. Yes it is. I’m just enjoying some time with the baby,” she responds, and looks away.

Reading this, you might think: “Wow. She’s crazy. She’s totally losing it.” In fact, this mother is probably thinking the same thing about herself. But, this is not “crazy.” This is Postpartum OCD.

Postpartum OCD occurs in approximately 3-5% of new mothers, however this estimate may be lower than the actual incidence due to low self-reporting and/or misdiagnosis. While Postpartum OCD is defined as occurring during the 2-3 months after birth, I have seen many women in my office who either had an onset of symptoms later than 2-3 months or have suffered with the symptoms for quite a while and finally arrive for help when the baby is 1- or 2-years old. Some women only present after their second or third child is born and the symptoms have persisted for years. Rigid medical definitions and diagnoses should not prevent any mother from seeking help for intrusive, unwanted, terrifying thoughts.

Postpartum OCD targets what a new mother holds most dear. It picks on her vulnerabilities and inherent insecurities. It weakens her grip on reality, destabilizes her sense of self, and warps what is real and what is imagined. Typically, the focal point of Postpartum OCD is intrusive images or thoughts about either intentionally or unintentionally harming one’s baby.

Common symptoms of Postpartum OCD include:

• Intrusive thoughts or images about killing the baby (stabbing, smothering, drowning, throwing the baby from a roof or window)
• Persistent fears that you might accidentally kill the baby (roll over on it, drop the baby, get in a car accident)
• Anxiety-inducing thoughts or images that you might purposefully neglect the baby (withhold food, deliberately not change soiled diapers)
• Chronic fears that you might unintentionally neglect the baby (questioning if you remembered to nurse, repeated fears that you forgot the baby in the back seat of the car)
• Unwanted and intrusive images or thoughts about sexually molesting your baby
• Removing dangerous objects from your reach such as scissors, pillows, knives, etc out of fear that you may act on the images or thoughts in your head
• Compulsively seeking reassurance from others that you are a good parent and  that the baby is ok
• Persistent doubts that you are not a good enough mother or fear that others are harshly judging your parenting or perceive you as unfit to parent (in the absence of actual evidence)
• Difficulty seeking help or letting others know how much you are struggling due to excessive shame, guilt, confusion, or fear that you will be labeled “crazy” or have the baby taken away
• Frequently checking for signs that the baby is alive and healthy (monitoring breathing, scheduling excessive pediatrician appointments)
• Avoidance of diaper changes or giving the baby a bath for fear you might molest the baby
• Replaying events in your head to ‘account’ for your behavior or intention or to ‘check’ and make sure you did not harm the baby
• Difficulty making day-to-day decisions, especially about caring for your baby, out of fear you will make the ‘wrong’ decision
• Persistent fears that your baby will be taken away (by DCF, CPS, etc) if you told anyone about the thoughts or images in your head; hesitancy to reach out for help due to fear of being judged or stigmatized
• Extreme difficulty leaving the baby alone, even for short periods of time (e.g. while you throw in a load of laundry or use the bathroom) or experiencing extreme anxiety and distress when leaving the baby in the care of someone else, including your partner or trusted family members/friends
• Insomnia, frequent night-wakings, or other sleep difficulties due to compulsive need to check on your baby’s well-being; notable difficulty relaxing or enjoying ‘down-time’ when the baby is napping or otherwise content
• Perinatal OCD symptoms (during pregnancy) include fears that you ingested a chemical or poisonous substance that will harm your fetus, avoidance of perceived environmental toxins and disease, taking excessive precautions to prevent harm from coming to the baby, or experiencing persistent fears that something is ‘wrong’ with the baby or you are somehow ‘harming’ the baby

Postpartum OCD is frequently misdiagnosed. A recent study showed that more than half (57%) of mothers diagnosed with Postpartum Depression (PPD) also had symptoms of Postpartum OCD. Given that as many as 60-80% of new mothers experience “the baby blues” and 10-20% receive a diagnosis of PPD, the number of women suffering from Perinatal and Postpartum OCD symptoms may be much higher than we currently appreciate.

Help is available. The same treatments that effectively treat OCD can also alleviate the distress caused by Postpartum OCD. These include exposure and response prevention (ERP), cognitive behavior therapy (CBT), acceptance and commitment therapy (ACT), and, in some cases, medication (typically an SSRI that has been well-studied in pregnancy and breastfeeding such as sertraline/Zoloft or paroxetine/Paxil).

There are OCD specialists available who do home visits, allow your baby to come to therapy sessions with you, conduct remote telehealth video counseling, and will otherwise work with you around the unique needs in your life to make effective treatment for OCD available to you. Don’t hesitate. Reach out for help now. To find a therapist near you, visit: https://iocdf.org/find-help/.