While postpartum depression and anxiety have become more widely-understood, there is still limited research about postpartum obsessive-compulsive disorder. This mental health struggles occurs in approximately 1-10% of parents. Since postpartum OCD presents as excessive worrying and helplessness, it is commonly misdiagnosed as anxiety, or worse, it is dismissed as “normal worrying”.

When you think of OCD, your mind may jump to stereotypical examples like excessive hand washing due to a fear of germs. With postpartum-OCD, parents are often struggling with scary thoughts regarding the safety and well-being of their baby. As a forewarning, some of the examples shared below can be triggering. Please read with caution, and reach out if needing support.

The first element of OCD: Obsessions

There are two key components that make up OCD. The first is obsessions. Obsessions involves intrusive and distressing thoughts, images, or beliefs that continue to repeat incessantly. Individuals struggling with obsessions do not feel in control of these thoughts, and are quickly overwhelmed. Common OCD obsessions include:

• needing order or symmetry
• fear of harming yourself or other people
• unwanted sexual thoughts
• religious obsessions (e.g. fear of offending God)
• fear of limited or lack of control (e.g. acting on impulsive urges to shoplift)

Common obsessions with Postpartum OCD:

• Contamination fears (e.g. bottles not being cleaned thoroughly)
• Fear that baby will get sick or die (e.g. sudden infant death syndrome, car accidents)
• Sexually intrusive thoughts (e.g. what if I am turned on when changing my baby’s diaper?)
• Concerns about hurting the baby. For example:
  • What if I drop the baby and her head cracks open?
  • Intrusive thoughts about stabbing/shaking the baby
  • Image of drowning baby in bathtub
  • Urge to scream at baby
• Concerns that others may harm the baby
• Stress about making the wrong decisions (e.g. feeding the wrong food)
• Rigidity to schedules/routine (e.g. nap times, feed times)

The second element of OCD: Compulsions

An individual with OCD is aware that these obsessions are not valid or logical. However, because the images or thoughts are so distressing, it feels important to get rid of them quickly. This is how compulsive behaviours start. When an obsession becomes too much to handle, compulsive behaviours are used to manage them. If you’re scared of germs, you start to wash your hands. If you’re scared of your baby dying during sleep, you may need to check repeatedly during the night to ensure safety. These compulsions are not effective in actually eliminating or addressing the fear; however, they provide a quick fix in that moment. Because the intrusive thought comes back quickly, the compulsive behaviour is repeated in order to help the individual calm down.

Common Compulsions with Postpartum OCD

When it comes to postpartum OCD, these parents are overwhelmed by the idea of harming their baby or being unable to protect their baby. Compulsive behaviours involve any means in which to offer their baby protection. Examples include:

• Avoidance of the baby
• Checking repeatedly to see if bottles/supplies are clean
• Excessive-reassurance seeking from health care professionals to confirm that baby is safe and healthy
• Removing all sharp objects from the home
• Avoiding any news or media related to child abuse (due to fear of being turned on)
• Refusing to give baby a bath
• Refusing to change diapers (due to fear of sexually abusing baby)
• Avoiding breast feeding or eating certain foods to prevent contamination
• Excessive praying
• Isolating baby from loved ones
• Not driving in the car with baby

Some compulsive behaviours seem normal. After all, double checking that the bottles are clean, or peeping in to the nursery to ensure your infant is asleep are perfectly normal tasks that all parents practice. The concern with compulsions is when these behaviours are done repeatedly. When intrusive thoughts are too distressing and compulsions take up a large chunk of time, our quality of life starts to suffer.

The commonality of intrusive thoughts

Most of us, irrespective of having a mental health diagnoses, will have disturbing thoughts from time to time. In fact, intrusive thoughts happen to approximately 80% of new parents. We’ll have a fleeting thought about falling off a balcony, driving into oncoming traffic, or yelling at our family members. When we are not fraught with distress and fatigue, we can usually shake our heads and call it for what it is: a strange thought. We may scoff and think it’s odd, but we don’t put too much thought into it, and can move on. For those with postpartum OCD, intrusive thoughts are so distressing that these parents assume there is some truth or meaning to these obsessions. Rather than shaking their head and saying “what a weird thing to think”, they become overwhelmed with guilt and shame at ever considering these thoughts.

Fears in reaching out

In a previous post, I had talked about some of the barriers that prevent parents from seeking help. One of the biggest blocks in reaching out for help is the fear that expressing these intrusive thoughts will lead to a call to the Children’s Aid Society. For those who struggle with this fear, I would like to reassure you that having a scary thought does not mean you are going to act on them! Parents with postpartum OCD have the best intentions for their children. They are overwhelmed by the fear of causing any harm that they are willing to practice whatever forms of compulsive behaviours to avoid this potential issue. Seeking help does not mean a call to the authorities.

Postpartum OCD is not a “mom’s issue”; it can also be experienced by dads, adopted parents, and other caregivers. If you or a loved one is experiencing intrusive thoughts during the postpartum months, please do not stay silent. Postpartum mental health is treatable. If you are concerned about your own symptoms, but are not ready to talk, you can fill out the Yale-Brown Obsessive-Compulsive Scale to complete a self-assessment.

Take care,

Kasi