We’re familiar with the image of a frazzled mother. One arm bounces a baby who has finally gone to sleep, the other juggles an endless cycle of diapers and formulas and carefully determined schedules: when will the baby sleep, eat, play, have appointments, need changing? The new mother’s mind is a minefield of anxieties and precautions. She is flooded with oxytocin and prolactin, her estrogen and progesterone levels have plummeted, and her system is effectively a bundle of hormones and emotions waging war on themselves and only ever focused consistently on one thing, that being the baby.

In this maelstrom of mental mayhem, the symptoms of much more serious conditions may go unnoticed.

The rapid changes in hormones that come with pregnancy and childbirth often lead to chemical imbalances in the brain, which present as forms of anxiety and depression. Our focus today is on a postpartum condition that does not receive as much attention as postpartum depression, but is nevertheless just as distressing and potentially detrimental to the people who experience it: postpartum OCD.

What is Postpartum OCD?

Symptoms and Common Experiences

To understand what postpartum OCD is, we must first understand what OCD is. Obsessive Compulsive Disorder is a mental health disorder characterized by obsessions - things like repetitive and disturbing intrusive thoughts - and compulsions - things like repetitive actions that can be detrimental to a person’s daily routine. People with OCD are plagued by intrusive thoughts that tend to focus on violent or sexual subject matter, and generally have a set of actions that their brain dictates they must perform in certain situations (i.e. obsessive hand washing, avoiding sidewalk cracks, tapping objects multiple times, etc.). This can also include intense cleanliness, a focus on symmetry, and an intolerance of uncertainty. Common symptoms include:

• Intrusive and persistent unwanted thoughts and images that lead to anxiety
• Fear of the thoughts themselves, which are not in line with the person’s intentions
• Behaviors or compulsions meant to neutralize the perceived threats and anxieties, e.g. repeated checking, cleaning, need for constant reassurance, perfectionism, etc.
• Awareness of the irrationality and excess of the thoughts and actions, but inability to stop them.
• Constant “what if” thoughts and fear of uncertainty.
  

What makes postpartum OCD different from regular OCD is firstly that it arises following childbirth, and secondly that the symptoms tend to focus on the baby. People with postpartum OCD may experience the following symptoms:

• Sexual intrusive thoughts such as “What if I molest my baby?”
• Violent intrusive thoughts, such as constantly imagining harm befalling the baby, often harm perpetrated by the person experiencing the thoughts
• Fear of said thoughts to the extent that it impedes on one’s ability to care for their baby and leads to them avoiding being alone with their baby.
• Overprotectiveness leading to excessive control. For example, covering corners with soft materials is perfectly reasonable. Insisting that the baby constantly be strapped into a pillow harness is indicative of an unhealthy amount of anxiety.
• Unshakable anxiety concerning the baby’s health leading to frequent and unnecessary doctor’s appointments and research.

How Is That Different Than Anxiety?

GAD vs. OCD

OCD is a condition closely related to anxiety, and a person with OCD is likely to also have anxiety, but they are nevertheless separate conditions. Obsessive Compulsive Disorder (OCD) and Generalized Anxiety Disorder (GAD) both include troubling thoughts, for example, but the nature of the thoughts differs. They both involve a fear of the unknown, but the source of this fear and the means of dealing with it tend to be different.

The fears associated with GAD tend to be more generalized, as the name would imply. The anxieties vary and the person does not find themself hyperfocusing on a single topic for long periods of time as often. On the other hand, the anxieties experienced with OCD tend to be more specific, and focus on recurring themes. The nature of the thoughts themselves are also wildly different, with GAD focusing on ego syntonic thoughts, and OCD focusing on egodystonic thoughts. Egosyntonic thoughts are relatively consistent with the thoughts and desires already experienced by the person experiencing the thoughts, although the thoughts may become blown out of proportion. So a mother habitually worrying about being unable to interpret based on crying alone what their baby wants would constitute as a thought more in line with GAD. Egodystonic thoughts, on the other hand, are out of line with the person’s regular intentions and values. The mother does not want to throw her baby against a wall, and so the constant fear that she will do so anyway is a violent intrusive thought. Additionally, OCD often involves a fear of the thoughts themselves, precisely because they are so alien to the person’s sensibilities.

Why Isn’t It Diagnosed?

Fear and Misconceptions

We touched earlier on the issue of postpartum OCD symptoms appearing similar to the behavior expected of a new mother. The imbalance of hormones already inherently leads to some amount of stress and anxiety, and the lack of sleep brought on by the addition of an infant into the household certainly doesn’t help. It is not surprising to see a new mother frazzled, disconnected, and high-strung, and so people may not realize that this is partially the fault of a compulsive, fear-driven loop.

The other main reason that postpartum OCD is not diagnosed more often is that the people who experience it may be afraid to come forward with their symptoms. This is not only because they have convinced themselves that the anxiety they are experiencing is perfectly normal of new mothers. Remember that the intrusive thoughts linked with postpartum OCD usually involve committing violent or sexual acts against the baby, and the mother fears that telling anyone about these thoughts will involve their baby being taken away. This is precisely why it is important to understand and address intrusive thoughts.

Having intrusive thoughts does not make you a bad or violent person. It is only if the thoughts cease to concern you in any way that it becomes an issue. If the thought of committing atrocities against your baby upsets you, then that means you don’t actually want to commit those atrocities. Intrusive thoughts are effectively your brain being unable to filter out garbage effectively, and instead attempting to present that garbage as vivid imaginings. No one is going to take away your baby because you have thoughts that you would never in a million years act on. People experience millions upon billions of random thoughts every day; the existence of a thought does not reflect upon you as a person.

What Do You Do?

You Are Not Alone

As with most things, the first thing you need to do if you think you may have postpartum OCD is be willing to ask for help. Once you have talked to a doctor about the issue, the doctor can further advise you on a course of action. A common treatment is Cognitive Behavior Therapy (CBT), specifically Exposure and Response Prevention (ERP), which can help you better learn to live with and manage the symptoms of OCD. Anxiety medications and therapy are also helpful in many cases. And, as always, remember that you are not alone. For more information on the experiences of those with postpartum OCD, considering checking out these resources:

• “Dropping the Baby and Other Scary Thoughts” by Karen Kleiman
• “Good Moms Have Scary Thoughts” by Karen Kleiman, illustrated by Molly McIntyre
• “Overcoming Unwanted Intrusive Thoughts” by Sally Winston and Martin Seif‍
• This post on intrusive thoughts by Sally Winston and Martin Seif