Postpartum Depression (PPD) is the most commonly talked about and treated form of Perinatal Mood/Anxiety Disorder (PMAD). It affects as many as one in five new mothers (up to 20%), and can have a significant impact on the father, the infant, and the entire family.
Yet there is much to learn about Perinatal Mood/Anxiety Disorders beyond PPD. In fact, there’s a spectrum of disorders– ranging from the mild to the severe and including depression, various anxiety disorders, and yes, even psychosis.
The most misunderstood of these disorders is Pregnancy/Postpartum Obsessive-Compulsive Disorder (OCD).
What is Pregnancy/Postpartum Obsessive-Compulsive Disorder?
According to research, OCD affects 3-5% of all new mothers, and some studies estimate those rates might be even higher.  Symptoms may start in pregnancy and continue through postpartum, or they may begin after the baby is born—sometimes several months later.
Symptoms of Pregnancy/Postpartum Obsessive-Compulsive Disorder include:
- Recurrent, persistent thoughts, impulses or images that are intrusive and inappropriate.
- These are typically related to the baby, and cause mothers intense anxiety or distress.
- These thoughts/images are not simply excessive worry about real problems.
- The mother attempts to ignore or suppress the thoughts/ images.
- The mother recognizes these thoughts/images are a product of her own mind
- Repetitive behaviors or mental acts she feels driven to perform in response to the obsessive thoughts/images
- These behaviors/mental acts are aimed at reducing/preventing some dreaded event or situation, but they are not connected in a realistic way or are clearly excessive.
- A sense of horror about the obsessive thoughts/images.
Other important facts about PPOCD symptoms:
- The “obsessive” thoughts most pregnant/postpartum women experience are usually vivid images or thoughts in their head. These images are often like a movie playing in the mind and are typically centered around the baby. These women actually see terrible things happening to their body (in pregnancy) or the baby (postpartum), and it causes them deep distress.
- The “compulsive,” ritualistic behaviors often include: checking the baby, avoiding situations that cause distress (like cooking, sleeping with the baby, or taking the baby up the stairs), and/or searching for information about her symptoms on the internet or in books, etc.
- Unlike general OCD, in Pregnancy/Postpartum, the symptoms of OCD are directly related to baby.
- There are often co-occurring symptoms of Depression related to the OCD thoughts/images.
- Mothers feel intense anxiety/worry about the thoughts/images.
- The mother recognizes the obsessions/compulsions are excessive.
- They cause her severe distress or significantly interfere with normal life.
Understanding Pregnancy/Postpartum Obsessive-Compulsive Disorders
I’ve been working with pregnant and postpartum women for fifteen years, and I have helped many mothers deal with OCD in pregnancy and postpartum. In fact, a significant portion of my clients have presented with PPOCD. Here are a few things I have learned as I have treated PPOCD; I hope they will help you better understand PPOCD, too.
1) Mothers experiencing symptoms of Pregnancy or Postpartum OCD present with extreme anxiety, or even fear, about their symptoms. They are often afraid they are “going crazy” or that they are going to become psychotic. I’ve even had a mother show up at my office with her bag packed—certain I would commit her to “the mental hospital” because of her symptoms, and ready to go if I did. (I didn’t.)
2) These mothers are highly concerned about the welfare of their babies and go to extreme lengths to take care of and protect their children and families. They are devoted, wonderful mothers, but they will say things like, “What kind of mother would think such things about her baby?” They tend to take a severe hit to their sense of self-worth because of their symptoms, and that’s one reason therapy is so helpful, especially Cognitive-Behavioral Therapy–because it works to identify and correct these distorted thoughts and self-beliefs.
3) These mothers are afraid of telling anyone about their OCD thoughts/images, because they fear others will take their baby away or say they are unfit as mothers (which, unfortunately, happens sometimes—see below).
4) The fact that these mothers are so genuinely worried, nervous, and concerned about the thoughts/images they’re having is proof they are not psychotic. Psychotic people don’t understand what is real and what is not, and they do not experience anxiety about their disturbing thoughts. In fact, they find them ego-syntonic. (We’ll discuss this more in Part 2.)
5) Unlike psychosis, which can be life-threatenting, PPOCD women are much more likely to harm themselves before ever letting anything happen to their babies. In fact, there are no incidents on record of a PPOCD mom ever harming her child.
6) Part of my job as a psychologist specializing in Perinatal Mental Health is to help PPOCD moms understand the thoughts are not their fault. They’re a misfiring of the brain, and they mean nothing about the kind of mother a PPOCD mom really is. I help them get the right doctor who will understand their symptoms and work with them to find the right medication. I also work to help them understand their symptoms, overcome them, and feel like the wonderful mothers they are. (Read 3 Things Every Mom Needs to Hear, and How to Feel Self-Worth.)
7) Unfortunately, many mental health and healthcare professionals do not understand Pregnancy/Postpartum OCD, and so many women have been unnecessarily diagnosed with Postpartum Psychosis and hospitalized. (Part 2 of this article will discuss diagnosis and treatment in greater detail.)
8) This is why greater education on Perinatal Mood/Anxiety Disorders is needed—for all medical and mental health providers—and why mothers and families need education, too, so they can find the treatment and providers who will understand and help them with their concerns.
9) The good news is this: Pregnancy/Postpartum Obsessive-Compulsive Disorder is treatable–the gold standard of treatment being a combination of medication (to correct the brain chemistry and help the thoughts stop) and psychotherapy (preferably with someone who specializes in Perinatal Mental Health). Postpartum Support International (PSI) is an excellent resource to help you find a provider that is right for you.
To all mothers and families experiencing Postpartum or Pregnancy OCD…
Please remember this: “You are not alone. You are not to blame. With time, you will be well.” (PSI’s universal motto)
Join me in Part 2 as we discuss The Diagnosis & Treatment of PPOCD, including a look at PPOCD vs. Psychosis.
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Pregnancy/Postpartum Resources & Help:
Postpartum Support International Website (Worldwide help and support for new mothers and families, including state and country coordinators to help you find the right treatment provider or support in your area!)
Postpartum Progress Blog (Excellent source of education and support for mothers and families)
Arizona Postpartum Wellness Coalition (AZ Support Groups, Events, Education)
Postpartum Stress Center (Education for Providers and Families)