Could I have postpartum OCD?

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Motherhood is an amazing experience, but it can also be difficult. In fact, becoming a new mom is one of the most significant life changes you will experience. The combination of hormones, psychological changes and physical demands can cause a myriad of emotions that may make you feel overwhelmed, inadequate and anxious. Along with these emotions, moms often worry about accidentally harming their baby. This is a very normal part of adjusting to your new role as a parent. However, if harmful scenarios start to ruminate in your mind and consume your thoughts, it is important to discuss them with your doctor immediately.

“What if I …”

Unwanted, distressing thoughts about harming your baby that intrude your mind, get stuck there and build anxiety could be a sign of Postpartum Obsessive Compulsive Disorder. Women who experience this condition will often try to dispel their thoughts by performing mental rituals, checking themselves, doing extensive research or asking other people for reassurance. Some of these thoughts include:

What if I drop my baby?

What if my baby stops breathing?

What if they choke?

What if I accidentally hit my baby’s head on something?

What if they slip during a bath?

What if I accidently touch them inappropriately during a diaper change?

These “what if” thoughts can be very upsetting to a new mom, causing her to feel guilty or ashamed. Because of her shame, she may not share what she’s feeling with another person, making the condition difficult to recognize. As she continues to dwell on these thoughts, it further contributes to her distress, leading back into a cycle of unhealthy and upsetting thoughts.

Distressing but not dangerous

Most women with postpartum OCD become extremely upset by their thought process, causing them to be overly anxious about caring for their child. They are typically very attached to their babies and have no desire to act on their bizarre thoughts. Rather, the thoughts become their worst fear. This is a key difference between postpartum OCD and postpartum psychosis.

In psychosis, bizarre thoughts aren’t as alarming because they are part of some other kind of paranoid thought process or delusion. In extreme cases, moms with postpartum OCD can withdraw from caring for their baby, for fear of harming them.

Talk with your doctor

If you are experiencing obsessive thoughts about accidentally harming your child, please talk with your obstetrician. This is not an uncommon problem, but you need help to redirect your thoughts. Many women worry about extreme consequences of sharing their thoughts, like being hospitalized or losing their child. These are not realistic options. Your doctor will help you find proper treatment.

Where does it come from?

If you’ve had OCD before, then you are probably at an increased risk for postpartum OCD. However, it can also develop for the first time after delivery. In some cases postpartum OCD is  commonly associated with postpartum depression.

We are still trying to understand the exact cause of these disorders, but they are likely related to the hormonal and psychological changes associated with pregnancy and giving birth. For example, we know progesterone and estrogen are linked to serotonin in the brain. When hormone levels shift rapidly, as they do during pregnancy and delivery, around 20% of women are more likely to have mood and anxiety symptoms. Add that to the big psychological change of being a first-time parent and feeling overwhelmed with responsibility, and you have a recipe for mood and anxiety disorders.

How is it diagnosed?

To determine if a woman has postpartum OCD, a doctor should begin by taking a thorough history to assess her thoughts and feelings. Rating scales are also helpful in tracking symptoms and measuring obsessions and compulsions. These show how severe the behaviors are and how much they interfere with normal life. Sometimes it’s very illuminating for people to see how common their thoughts really are.

Is it treatable?

Not only is postpartum OCD common, but it is very treatable. At the Pavilion for Women, we usually approach it with medication or therapy, but using both is most effective. The medications used are SSRIs, which are also used to treat postpartum depression and anxiety. They are very safe drugs—even for breastfeeding moms. Sometimes, OCD symptoms require slightly higher doses. Less frequently, we use a class of medicines called tricyclic antidepressants, which are also effective in treating OCD.

The most successful therapy we’ve used is a form of cognitive behavioral therapy called exposure and response prevention. With the guidance of a therapist, mom identifies some of her disturbing thoughts and, over time, gradually exposes herself to them. As she confronts these thoughts, the therapist helps her prevent her normal response of a compulsion or mental ritual. Over time, this process makes the thoughts less intense and builds mom’s confidence to face them. Most women respond fairly quickly to this therapy, only requiring 10-12 sessions once a week or so.

Indicator of hormonal sensitivity

Women who experience postpartum OCD may be sensitive to other hormonal changes later in life, such as perimenopause or menopause. This doesn’t necessarily mean they will demonstrate OCD tendencies with those hormonal changes, but it does appear their bodies are more sensitive to hormonal changes as they age.

We can help: At Texas Children’s Pavilion for Women, we offer specialized care for women with postpartum disorders. Our goal is to help moms become the best mom they can be.