Postpartum OCD: What You Should Know
Obsessive-compulsive disorder (OCD) is a mental health condition that can affect anyone. When it occurs in parents who have recently given birth, their partners, or adoptive parents who have recently welcomed a child home, it’s referred to as postpartum or postnatal obsessive-compulsive disorder (OCD).
Perinatal mood and anxiety disorders—or those occurring during pregnancy or up to a year after giving birth—are often underdiagnosed or misdiagnosed. This is particularly true for postpartum OCD. While more attention has been placed on recognizing and treating postpartum depression in recent years, postpartum OCD remains one of the less recognized, less talked about, and, therefore, less treated perinatal mental health conditions. Knowing how to identify and manage postpartum OCD may help make sure that people who experience it get the help they need.
What is postpartum OCD?
OCD is a mental health condition in which people have recurring and unwanted ideas or worrying thoughts, called obsessions. To get rid of them, they are driven to perform repetitive actions, or compulsions. These compulsive rituals may make them feel better temporarily but often make the obsessions worse and significantly interfere with their ability to function in daily life.
Postpartum OCD is when signs of OCD appear in a parent in the weeks after having or welcoming their baby home. Symptoms can appear immediately after birth or up to six weeks later. Research also suggests that the postpartum period is a time of increased risk for exacerbation of symptoms of existing OCD.
The estimated prevalence of postnatal OCD varies from study to study, with estimated rates for new-onset OCD ranging from 2–22% in this population. This wide range may have to do with how well people are screened for postpartum OCD. For instance, some research found that when birthing parents were encouraged to report their symptoms and current diagnostic criteria were applied, more were diagnosed, leading researchers to conclude that “estimates for perinatal OCD may be higher than previously believed.”
Identifying postpartum OCD
The symptoms of postpartum OCD have certain similarities to and key differences from OCD in the general population.
Like OCD, postpartum OCD is characterized by obsessions like intrusive thoughts, impulses, or ideas, repetitive or ritualistic compulsions, or both. However, in postpartum OCD, the focus of the obsessions is often the infant—specifically, infant harm. A parent’s obsessive thoughts and fears can be graphic, violent, and extremely stressful and frightening. They can cause acute distress in the parent, who may be reluctant to share these thoughts with anyone—including healthcare providers.
Compulsions in the postpartum period are most likely to involve contamination prevention, like cleaning, or checking rituals, like repeatedly checking the baby monitor while the infant is asleep. If the obsessions are extreme, compulsions may center on avoidance. For example, if someone experiences intrusive images of harming the baby by dropping them out of a window, they may avoid being next to a window. While most compulsions do not cause harm to the child, they can in extreme cases, like if the parent cleans the infant too vigorously or neglects the infant as a way of avoidance.
Recognizing postpartum OCD symptoms can be crucial for the long-term well-being of both the parent and the child. In general, postpartum OCD symptoms may include:
- Having OCD symptoms that start or worsen with pregnancy or delivery
- Having intrusive thoughts about harm coming to the infant
- Being afraid to tell others about obsessive thoughts for fear of being judged, hospitalized, or diagnosed with psychosis
- Fearing harming the baby
- Exhibiting compulsions to stop the obsessive thoughts
- Avoiding certain activities with the baby
- Feeling overwhelmed by the obsessions and compulsions
- Experiencing signs of postpartum depression
- Having difficulty sleeping due to obsessive thoughts and compulsive urges
- Having symptoms that interfere with caring for the child
Postpartum OCD vs. postpartum psychosis
To ensure proper treatment, it’s crucial to distinguish postpartum OCD from postpartum psychosis. Postpartum psychosis is the most severe type of postnatal mental health condition. It’s characterized by a loss of touch with reality, extreme confusion, delusions, paranoia, and hallucinations. Postpartum psychosis is considered a mental health emergency.
While both postpartum OCD and postpartum psychosis have features that may center on harm coming to the baby, people with postpartum OCD are typically aware enough to be extremely troubled by their thoughts and will protect or avoid their infants if necessary to prevent harm. People with postpartum psychosis do not typically have this awareness and are at elevated risk of harming their babies.
People with postpartum psychosis usually require inpatient care, and social services may get involved to ensure the safety of the child. In contrast, people with postpartum OCD may be treated in outpatient settings and generally do not have to be separated from their infants.
Diagnosing and treating postpartum OCD
Because people with postnatal OCD may be afraid to talk about their intrusive thoughts, it is “critically important for clinicians to ask specifically and non-judgmentally about intrusive thoughts” and to understand how to distinguish these thoughts from the symptoms of postpartum psychosis.
Further research is needed on effective interventions for this postnatal condition, as treatment for postpartum OCD has not yet been studied extensively. At this time, it’s generally treated the same way as OCD in the general population but focuses on the postpartum context of the symptoms. Cognitive behavioral therapy in conjunction with antidepressants like selective serotonin reuptake inhibitors (SSRIs) and clomipramine is usually recommended.
How to support someone with postpartum OCD
If you have a loved one who is experiencing postpartum OCD, your first instinct may be to tell them everything is going to be okay, offer advice, or do whatever you can think of to help relieve their anxiety symptoms. These efforts may help in the short term but could actually make things worse over time.
Someone with postpartum OCD needs professional treatment to address their symptoms. That’s why the best things you can do to support a loved one with this condition are typically to listen without judgment, offer empathy, be supportive, and—most of all—encourage them to seek support from a licensed mental health care provider.
Many new parents are reluctant to get professional help because they’re too tired from caring for the baby or don’t want to be away from them. Online therapy can be a flexible, convenient option for parents of newborns who need mental health support. While it’s not appropriate in every case—such as for those showing signs of postpartum psychosis, who require immediate in-person care—many individuals can attend sessions from the comfort of their home at a time that works for their schedule. Plus, talking to someone from the other side of a screen or via phone or in-app messaging instead of face to face can make it easier to talk about distressing symptoms.
When you sign up with an online therapy platform like BetterHelp, you can get matched with a qualified, licensed mental health professional in as little as 48 hours. Plus, if needed, you can change providers at any time for no fee until you find the right fit.
Research also indicates that online therapy can be effective in many cases. For example, one review of 14 studies suggests that online cognitive behavioral therapy led to a 50% improvement in symptoms of a number of mental health conditions—including obsessive-compulsive disorder—and decreased the impact of stress and chronic fatigue.
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