Postpartum OCD: Symptoms, Treatment & Causes
You just gave birth to the bundle of joy you have always dreamt about, however; the delivery was complicated and now that your little girl has arrived…you feel no connection to her. Although you were originally excited about having a little girl, that excitement has been replaced with anxiety, depression, and an overwhelming fear that you will hurt your newborn. You can’t shake the feeling, so you avoid your daughter at all costs. This is postpartum OCD.
The truth is many women experience postpartum OCD. This form of OCD typically stems from fluctuating or declining post-pregnancy hormones. During the postpartum period, you are at risk of developing a mood disorder (i.e., depression) and/or an anxiety disorder (i.e., OCD). Giving birth can also worsen mental health conditions that already exist. In fact, multiple studies have found that women are most susceptible to postpartum OCD in the months following the birth of their babies.
What is Postpartum OCD?
Postpartum OCD may include a variety of obsessions and compulsions, but the most common manifestation involves contamination, meticulousness, violent intrusive thoughts, and frightening or unsettling urges. Violent intrusive thoughts may be focused on your baby, such as harming or killing your baby or allowing harm (harm OCD) to come to him or her.
Listed below are some scenarios of postpartum OCD:
- If I do not scrub my hands until they bleed after I touch the bathroom doorknob, I will contaminate or “taint” my daughter.
- If I do not pray long enough and hard enough, something terrible will happen to my innocent baby boy.
- What if I intentionally or accidentally touch my little girl inappropriately while cleaning her?
- What if I impulsively try to drown, hurt, drop, throw, or smother my defenseless little newborn?
These highly distressing thoughts can compel you to perform specific actions or engage in certain behaviors (rituals and routines) to relieve your stress, fears, and angst.
These behaviors and actions may involve the following:
- Excessively cleaning and washing everything in sight to prevent your baby from becoming contaminated or “sullied” by germs and bacteria
- Excessively praying to ensure that your baby is healthy, safe, and protected
- Excessively checking and re-checking to make sure your baby is still breathing and not ill or dying
- Seeking reassurance from family members that your baby is fine
Is Postpartum OCD the Same Thing as Postpartum Anxiety?
No, although the two anxiety conditions sound the same, they are different.
The truth is it can be challenging to differentiate between postpartum anxiety and postpartum OCD, partly because the two conditions share many of the same symptoms, such as extreme stress, fear, worry, concern, etc. Keep in mind, however, that a new mom can have both conditions – postpartum anxiety and postpartum OCD.
So, what is postpartum anxiety?
Postpartum anxiety is characterized by excessive dread, fear, and worry following the birth of a baby. This form of OCD is fairly common. In fact, a study found that 10-15 percent of women experience postpartum anxiety after delivering a baby and becoming responsible for his or her care.
Women, who experience postpartum depression are also at risk of developing postpartum anxiety. In addition to extreme fears and excessive worries, moms with postpartum anxiety tend to experience the following symptoms – a constant feeling of being stressed and overwhelmed, elevated heart rates, racing thoughts, violent intrusive thoughts (toward their babies), agitation or jitteriness, and/or insomnia or “sleeplessness.”
What is postpartum OCD?
Postpartum OCD can mimic many postpartum anxiety symptoms, such as extreme fears and excessive worries, however postpartum OCD symptoms may also take the form of obsessions and/or compulsions. Postpartum obsessions may include disturbing or frightening thoughts about the baby and his or her health, while postpartum compulsions may make you think that you must do something to harm and/or protect the baby.
These upsetting thoughts, fears, worries, and urge typically interfere with daily functioning, which in the case of a new mom, means taking care of, loving on, and paying attention to the newborn or infant. For instance, a new mom with postpartum OCD may repeatedly check on her baby to ensure he is not choking and is still breathing or she may “fixate” on protecting her baby from danger (i.e., falling, abuse, drowning, etc.) by avoiding him and limiting who has access to him.
Note: Postpartum OCD symptoms tend to last longer than postpartum anxiety. In fact, researchers have found that new moms, who already struggle with depression, also have a 20% chance of experiencing anxiety, and a 26% chance of developing OCD. The anxiety symptoms appear to ease by the time the child is 6 months old, however, the OCD symptoms may persist longer.
Is Postpartum OCD Common?
Can Men Also Experience Postpartum OCD?
Although, most people associate postpartum anxiety, depression, and OCD with new moms, new dads can also experience these symptoms. In fact, studies suggest that almost 10% of men develop postpartum anxiety, OCD, or depression. And, guess what? Sixty-to-ninety percent of new parents (men and women) experience frightening intrusive thoughts following the birth of a baby. However, the majority of these individuals know they would never harm their babies.
Are People with Postpartum OCD Delusional or Psychotic?
No, most people with postpartum OCD realize that their upsetting thoughts are illogical and are unlikely to act on them.
What Are the Symptoms of Postpartum OCD?
While it is normal to experience “baby blues” for a week or two following the birth of a child, if these feelings persist or linger for more than two weeks, it is important to be evaluated by a therapist. Severe postpartum OCD can trigger psychosis, which could place both you and your baby at risk of harm or death.
Postpartum OCD symptoms are likely to arise by the 6th week following the birth of a baby. Moreover, if you have preexisting OCD (before becoming pregnant and giving birth), you are at risk of a miscarriage, which can also trigger or worsen OCD symptoms. Once you become pregnant and deliver a baby, you are at risk of experiencing postpartum OCD symptoms.
Surprisingly, the symptoms of a woman with postpartum OCD are often different than a woman, who has never delivered a baby, and who has classic OCD symptoms. According to experts, the most significant difference between classic OCD and postpartum OCD is that postpartum OCD “obsessions” are directly related to your baby.
In other words, women with postpartum OCD tend to experience more aggressive obsessions that involve overwhelming fears, urges, or thoughts to harm or kill their new babies, in contrast to women, who have not had babies, but still struggle with OCD symptoms. Women with postpartum OCD are also at risk of developing contamination OCD or a fear that caring for or touching their babies will somehow “sully” or “taint” them. So, they stay away from their babies to counteract their fears and ease their stress and anxiety.
Other symptoms may include: An extreme worry, concern, or fear that your baby will stop breathing, fall, drown, choke, be dropped, or suddenly die, an unrelenting fear of being alone with your baby, and/or a persistent need to count numbers or repeat certain phrases in a certain way to ease your stress and anxiety – and protect your baby from harm.
How is Postpartum OCD Diagnosed?
Diagnosing postpartum OCD can be challenging, mainly because the symptoms may mimic other conditions, such as postpartum depression and postpartum anxiety. Many times, postpartum OCD goes undetected because many parents (men included) are hesitant about reporting their OCD symptoms, especially after the arrival of a new baby. Many new parents chock up their angst and OCD behaviors as “new parent reactions.”
People are usually diagnosed with OCD through online assessments, observations (in-office monitoring and through journals), and labs (to determine if their hormones levels are causing the OCD symptoms).
What Causes Postpartum OCD?
Psychologically, the arrival of a new baby can lead to a host of new challenges, which can be stressful and overwhelming for some new moms. Sometimes, stress and anxiety can trigger postpartum OCD.
Currently, it is unknown why some women experience postpartum OCD following the birth of a baby and others do not. However, some experts surmise that it involves a biological component. For instance, fluctuating estrogen and progesterone levels can trigger OCD symptoms following the birth of a baby. Moreover, fluctuating serotonin levels can impede neurotransmitters (chemical messengers in the brain), which could trigger postpartum OCD.
According to researchers, stress is a major contributor of OCD, and the time after the delivery of a baby (even up to 6 months afterward) can be extremely stress-provoking, especially for new moms, who have inadequate or unhealthy coping skills and strategies.
Some experts also hypothesize that women, who have a family member with OCD or another anxiety condition or a mood disorder, like depression, may be more susceptible to developing postpartum OCD – as compared to women without a family history of OCD or a mental illness.
How is Postpartum OCD Treated?
Like postpartum psychosis and postpartum depression, it is important to treat postpartum OCD as soon as possible, primarily because it can negatively impact the bond between you and your newborn baby. More specifically, postpartum OCD can cause extreme stress, depression, anxiety, emotional detachment, and even panic attacks in you, your baby, and other family members.
If you recently delivered a baby but feel no attachment to him or her, of if you feel like you may hurt or contaminate him or her (contamination OCD) with germs and bacteria (or vice versa), it is important to share your concerns with your loved ones, your primary care physician (PCP), obstetrician, your baby’s pediatrician, therapist, and/or psychiatrist.
Also, if you are also experiencing other symptoms, your doctor will need to do a full “workup” on you that includes your mental and physical medical history, current signs and symptoms, and labs to exclude other causes for your symptoms, such as thyroid dysfunction (hypothyroidism).
Cognitive-behavioral therapy (CBT) is also often used to help people address their postpartum OCD symptoms. CBT is a good treatment for this form of OCD because it prevents your baby from being exposed to antidepressants, like SSRIs, SNRIs, and tricyclic antidepressants, through your breastmilk. CBT does not come with medication side effects.
Another postpartum OCD treatment may involve a “gold standard OCD therapy” – exposure and response prevention (ERP). ERP therapy may be combined with antidepressants to achieve maximum results.
Understand that if postpartum OCD is left untreated it could impair the bonding process between you and your little one. This impairment would likely stem from your avoidance and ritualization coping methods. Untreated postpartum OCD can also damage familial relationships, romantic relationships or marriages, and even friendships. More specifically, loved ones and friends could become irritated and annoyed that they have to care for your baby because you refuse to seek treatment for your postpartum OCD symptoms.
Hormone therapy may also be used to balance a new mom’s hormones and reduce postpartum OCD symptoms. Studies suggest that postpartum mood disorders, like OCD, anxiety, or depression, combined with low estrogen levels can trigger or worsen OCD symptoms. Many women with postpartum depression, anxiety, OCD, or psychosis have been successfully treated with estradiol, a hormone.
It is also important to practice self-care when grappling with and recovering from postpartum OCD. Although, getting proper sleep, adopting a healthy diet, getting regular exercise, and developing a strong support group may not “cure” your OCD, practicing self-care, in conjunction with following your prescribed treatment plan, can boost your odds of “bouncing back” from postpartum OCD.
The truth is many parents have very little time for themselves – i.e., their needs, while caring for a new baby and possibly other children, but taking time to re-energize, rest, and relax not only helps your physical and emotional health but also your baby’s and other children’s health and well-being. If you are functioning at an optimal level, you will be more present with your baby and other children.
Note: Fluvoxamine (Luvox) appears to be highly effective at reducing OCD symptoms in postpartum women. And, although antidepressants can pass through a mother’s breastmilk, studies suggest that antidepressants, like SSRIs, SNRIs, and tricyclic antidepressants, do not have long-lasting effects on the baby. So, it is essential that you discuss the pros and cons of taking medication for your postpartum OCD symptoms with your doctor. Your doctor can help you find the right doctor for your OCD symptoms.
Can Postpartum OCD Be Prevented?
One effective way to prevent postpartum OCD is to attend all of your postpartum appointments. It is also important to voice your concerns to your healthcare providers – i.e., OBGYN, gynecologist, midwife, PCP, therapist, etc. Postpartum follow-up appointments are usually scheduled about 6 weeks after the birth of a baby, but before that time, OCD symptoms can appear or worsen.
However, if you are experiencing upsetting or frightening OCD symptoms, you can schedule a follow-up before the 6 weeks. As mentioned above, it is imperative that you practice self-care following the birth of your baby.
What does that mean? It means taking care of yourself by eating healthy foods, exercising, practicing stress-management techniques (i.e., deep breathing, mindfulness meditation, yoga, etc.), and getting proper rest. It is also important to do things that bring you joy and help you relax during this time, such as visiting friends and family, having a girls’ or guys’ night, getting manicures and pedicures, going on dates with your partner or spouse, etc.
Note: The truth is it can be hard to get proper rest and adhere to a healthy diet with a newborn in tow, however, it is crucial to make time for your own wants and needs. You cannot think clearly, let alone take care of a baby if you are not eating right or sleeping well. So, if you find practicing self-care challenging, ask a loved one – i.e., a partner, friend, or family member, to watch your baby while you eat, sleep, and relax.
How Long Does Postpartum OCD Last?
Postpartum OCD typically develops by the fourth week after the delivery of a baby. However, there is no definitive timeline for how long these symptoms will last. For some new moms, the symptoms occur shortly after the birth of their babies, while for other new moms, it may not arise until a couple of months later. Pregnant women can also experience OCD (perinatal OCD) – with these symptoms worsening following the birth of their babies.
Note: Postpartum OCD symptoms may not go away without OCD treatment – i.e., therapy, medication, lifestyle changes, and/or self-help tools, like Impulse Therapy, an online OCD treatment aid that offers an OCD assessment and a variety of tools and resources. Impulse Therapy can help you gain control over your OCD symptoms (obsessions and compulsions) so you can provide proper care for your new bundle of joy.
Who Should I Talk to If I Think I Have Postpartum OCD?
If you think you may be experiencing postpartum OCD, schedule an appointment with your OBGYN, midwife, or another healthcare provider. This individual will evaluate your symptoms and refer you to the appropriate specialist. You also have the option of contacting a therapist, psychologist, psychiatrist, social worker, or psychiatric nurse practitioner. This mental health provider will assess your symptoms and discuss treatment options with you.
You can contact mental health professionals in your area by using this online therapist directory.
Are There Any Other Resources I Can Use to Help with My Postpartum OCD Symptoms?
Yes, other resources can help with postpartum OCD symptoms.
Several books on the market can help you better understand what you are experiencing – OCD and postpartum OCD.
These books include:
- Pregnancy and Postpartum Anxiety Workbook: Practical Skills to Help You Overcome Anxiety, Worry, Panic Attacks, Obsessions, and Compulsions (A New Harbinger Self-Help Workbook
- The Complete OCD Workbook: A Step-by-Step Guide to Free Yourself from Intrusive Thoughts and Compulsive Behaviors
- A Heart So Full: Inspirational Messages for New Moms
- The Mindful Mama Journal: A 52-week journal for cultivating gratitude, strengthening your mental health, and decluttering your mind; Great workbook for anxiety, depression, and postpartum
- Good Moms Have Scary Thoughts: A Healing Guide to the Secret Fears of New Mothers
- Rewire Your OCD Brain: Powerful Neuroscience-Based Skills to Break Free from Obsessive Thoughts and Fears