Understanding Perinatal OCD
In the realm of parenting, the road is often peppered with unexpected twists and turns, even when it comes to our mental health. As we honor Maternal Mental Health Awareness Month this May, let’s shine a light on the challenges faced by parents dealing with perinatal and postpartum obsessive-compulsive disorder.
One of the most profound and often unspoken challenges faced by parents dealing with perinatal OCD (pOCD) is the overwhelming sense of shame that accompanies their intrusive thoughts and compulsions. This blog post aims to reduce that shame, provide education, understanding, support, and hope to those navigating the complexities of pOCD.
What is Perinatal OCD?
Perinatal Obsessive-Compulsive Disorder (pOCD) is a subtype of obsessive-compulsive disorder that involves intrusive thoughts and repetitive behaviors or mental rituals surrounding one’s newborn or unborn infant. These intrusive thoughts and obsessions are entirely unwanted and cause immense distress to the new parent. This distress leads the parent to engage in compulsive behaviors to either alleviate distress or prevent a feared outcome. Again, compulsions can be observable behaviors, or they can also be unseen mental acts carried out in one’s mind.
Technically, OCD that happens during pregnancy is called perinatal OCD, and OCD that happens after birth is called postpartum OCD. Since these conditions have so much overlap (and because OCD is OCD regardless of subtype), I will refer to them collectively as pOCD in this blog post.
Common pOCD Obsessions
Fear of Harm: This obsession involves intrusive thoughts or mental images of accidentally harming the infant or unborn baby. Examples include:
Fear of dropping the baby while carrying them.
Worries about getting injured while pregnant and harming the baby.
Intrusive thoughts about suffocating the baby or being unable to protect them from harm.
Contamination: This obsession revolves around the fear of the baby being contaminated or getting sick. It leads to compulsive cleaning or avoidance behaviors. Examples include:
Excessive cleaning of baby items, surfaces, or oneself to prevent contamination.
Avoiding certain objects or places believed to be contaminated.
Fear of passing on germs or illnesses to the baby, leading to strict hygiene practices.
Perfectionism: This obsession manifests as constant worry about being a perfect parent and fear of making mistakes. Examples include:
Obsessively checking on the baby's well-being to ensure nothing goes wrong.
Feeling inadequate or anxious about not meeting perceived standards of parenthood.
Fear of making parenting errors or not living up to societal expectations.
Intrusive Thoughts: These are disturbing or unwanted thoughts that contradict the person's values or beliefs. Examples include:
Thoughts or mental images of violence towards the baby, such as harming them physically.
Unwanted thoughts about sexual aggression or harm towards the baby, which are distressing and contrary to the person's true feelings.
Images or scenarios that evoke guilt, shame, or anxiety due to their graphic or disturbing nature.
These are just some common examples, but pOCD obsessions can vary in nature. Regardless of content, they often center around fears related to the safety, well-being, and perfectionism in caring for the baby.
Common pOCD Compulsions
Checking Behaviors: This compulsion involves constantly checking on the baby to ensure their safety, even when there's no real threat present. Examples include:
Checking the baby's breathing multiple times throughout the night.
Repeatedly verifying that the baby is securely strapped in a car seat or crib.
Continuously monitoring the baby's temperature or health indicators.
Cleaning Rituals: This compulsion entails excessive cleaning or sanitizing of baby items, surroundings, or oneself to alleviate contamination fears. Examples include:
Cleaning and disinfecting baby toys, bottles, and pacifiers multiple times a day.
Avoiding touching certain objects or surfaces believed to be contaminated.
Showering or washing hands excessively to prevent passing on germs to the baby.
Reassurance Seeking: This compulsion involves seeking reassurance from others or constantly researching online for information to ease worries about the baby's well-being. Examples include:
Calling or texting family members or friends repeatedly for reassurance about the baby's health.
Spending excessive time researching baby-related topics online to alleviate fears or doubts.
Seeking confirmation from healthcare providers about normal baby behaviors or symptoms.
Avoidance: This compulsion includes avoiding situations or activities that trigger obsessive thoughts or anxiety related to parenting. Examples include:
Avoiding leaving the baby's side, even for short periods, due to fear of something bad happening.
Refusing to delegate caregiving responsibilities to others out of fear of mistakes or harm.
Avoiding certain responsibilities like changing diapers or feeding, leading to increased stress and guilt.
pOCD doesn’t Discriminate
Recent albeit limited research suggests that pOCD may stem from a combination of factors including hormonal shifts, genetic predisposition, environmental influences, and the unique stressors that come with the responsibilities of parenthood. This insight sheds light on the understanding that pOCD can impact all caregivers involved – whether they are fathers, non-gestational parents, or adoptive parents – irrespective of their sex, gender, or biological ties to the child.
Thoughts Do Not Equal Danger
Many new parents with pOCD experience intense shame and guilt regarding the content of their intrusive thoughts. They may question their worthiness as parents and as people. This internal struggle can lead to a profound sense of isolation and a reluctance to seek help. They may worry about being thought of as unfit parents or fear that their intrusive thoughts will be misunderstood as genuine desires or intentions. This fear can create barriers to seeking support and opening up about their struggles, further deepening the sense of shame and isolation.
What many people do not know is that some research found that parents with pOCD are no more likely to act on their intrusive thoughts compared to individuals without OCD. This is because pOCD sufferers are aware that the obsessions and intrusive thoughts are inconsistent with their beliefs, values, and desires. They recognize these thoughts as symptoms of a mental health condition and NOT their true intentions or desires.
Again, while folks with pOCD may experience distressing and unwanted thoughts about harm or violence towards their baby, they are not at a higher risk of actually acting on these thoughts. In fact, the fear and distress caused by these intrusive thoughts often lead pOCD sufferers to take extra precautions and seek help to ensure the safety of their baby. This proactive approach highlights their devotion and love for their infant, even amidst the challenges of pOCD.
Generally speaking, it's crucial to note that the relationship between thoughts and harm/aggression is complex and can vary based on individual factors, specific symptoms, and other contextual elements.
It Get’s Better
Treatment for pOCD can include specialized, evidenced-based therapy for OCD like Exposure and Response Prevention and Acceptance and Commitment therapy. Treatment also may include medications. A combination of therapy and medication has shown to be most effective in the treatment of OCD of any subtype. Medications vary based on risks/benefits and safety for pregnant and breastfeeding people; always consult your doctor for guidance regarding medications.
Anxiety, protectiveness, intrusive thoughts about your born or unborn infant – everyone experiences this at some point. However, if your experiences are so much so that you feel you are unable to function day-to-day or if it gets in the way of bonding and caregiving, you may be experiencing pOCD. Please do not suffer alone. There are people who understand that pOCD means nothing about your character or your love for your baby, and they want to help. Remember, with the right support, you can find the joy in parenthood that you've always dreamed of.
If you’re a Michigan resident and want to inquire about online OCD therapy with me, Chelsea, please don’t hesitate to reach out for a free 20 minute phone consultation. Even if we find we aren’t a good fit, I will help you find someone that is. If you do not live in Michigan, please visit www.IOCDF.org to find competent OCD therapists near you. Hang tight.
I’ll end this post with a favorite quote about parenting:
“There's no way to be a perfect parent and a million ways to be a good one.”
- Jill Churchill
Disclaimer: It's important to remember that while my blog post can provide insights and tips for managing OCD, it is not a substitute for professional therapy. Therapy offers personalized guidance, support, and evidence-based interventions tailored to your specific needs and challenges. A trained therapist can help you develop coping strategies, navigate difficult emotions, and work towards long-term recovery from OCD. So, while I hope you find this article helpful, I want you to know that it’s okay to reach out for professional help if you're struggling with OCD or any mental health concerns.
