Perinatal Obsessive Compulsive Disorder

Perinatal Obsessive Compulsive Disorder (OCD) is an anxiety disorder that impacts approximately 3-5% of birthing persons during pregnancy and the postpartum period. Although, this number may actually be higher due to underreporting or a lack of training in identifying symptoms.

OCD is characterized by recurrent and persistent thoughts, impulses, or images that are intrusive or scary, and cause marked anxiety or distress. In addition to compulsions are behaviours or mental acts aimed at preventing, or reducing, some event or negative outcome.

Symptoms

While a certain level of anxiety is normal and healthy during pregnancy and after birth, persistent anxiety that is impacting your day to day functioning should be discussed with your health care provider. Some symptoms to look out for are:

  • Swift onset
  • Mild to severe
  • Obsessive and unwanted thoughts or images that are persistent
  • Thoughts and images may be scary, disturbing, and/or upsetting
  • Compulsions or rituals to minimize or prevent those thoughts/events/worries/fears/negative outcomes
  • Hypervigilance
  • Difficulty sleeping
    • Feel overwhelmed with fear and anxiety

What Does It Look Like?

Simply put, Perinatal OCD includes somewhat of a 3 step process:

  1. Thoughts or images
  2. Anxiousness or fear around those thoughts or images
  3. Some sort of compulsion (e.g., thought or action) to reduce that anxiety or fear

Below are some examples:

Obsessions
  • What if I drop my baby down the stairs?
  • What if I leave my baby in the car?
  • What if my baby stops breathing?
  • What if someone touches my baby and my baby gets a disease?
  • What if my baby gets poisoned?
  • Seeing your baby drown or seeing yourself drown your baby.
  • Worrying about the bottles not being sanitized properly.
  • Seeing yourself harm your baby in some way.
  • What if get so mad that I shake my baby?
Compulsions
  • Avoiding walking down the stairs with the baby.
  • Double checking to make sure your baby isn’t in the car.
  • Constantly checking the baby while they sleep.
  • Avoiding taking the baby out of the house or avoiding visitors.
  • Avoid feeding the baby or feeding the baby certain foods believed to be contaminated or unsafe in some manner.
  • Avoid bathing the baby.
  • Constantly and excessively washing and sanitizing bottles.
  • Avoiding your baby so you don’t them.
  • Praying over and over that your baby will be okay or repeatedly asking others for reassurance.
  • Repeatedly going over the day to ensure nothing happened that could harm your baby

Please note, these are just examples. You may also have thoughts about yourself or others. As well, thoughts can be sexual in nature, about the future, or about intentional or accidental harm.

This isn’t an easy list to read, but whether your thoughts are listed here or you feel yours are worse, know that you are not alone and support is available.

Will I Hurt My Baby?

Scary thoughts and images, and a sense of impending doom often accompany OCD during pregnancy and postpartum. It’s important to know that you are not a risk to your baby. The research shows no correlation between a mother’s scary thoughts and her acting on these thoughts [2]. Karen Kleiman and Amy Wenzel say it best:

“When scary thoughts feel inconsistent with your belief in who you essentially are, your character, and your personality, they are referred to as ego-dystonic thoughts. When a thought is ego-dystonic, it is in conflict with who you fundamentally believe yourself to be. This inconsistency creates piercing anxiety. However, this distress, as disturbing as it feels to you, provides reassurance that these thoughts are anxiety driven and not psychotic [3].”

Risk Factors

  • Family or personal history of mood, anxiety, or substance use disorders
  • OCD in a previous pregnancy
  • Obstetric complications
  • Perfectionist type personality traits
  • Avoidant type personality traits

Treatment

Perinatal OCD is treatable. The most effective treatments are:

  • Exposure and Response Prevention (ERP)
  • Inference-Based CBT (I-CBT)
  • Acceptance and Commitment Therapy
  • Psychopharmacology often in the form of selective serotonin reuptake inhibitor (SSRI) medications 

Please speak with your health care provider and/or a mental health professional about which course of treatment best suits your needs.

If you are in need of immediate assistance, please contact your health care provider, 911, go to your local hospital, contact Crisis Services Canada, or National Suicide Prevention Lifeline.

Get Help

DISCLAIMER: The content of Postpartum Support Yukon’s website, posts, and blogs does not constitute medical advice, nor is it an emergency service. If you have concerns about any health or medical condition, diagnosis, or treatment, you should consult with a licensed healthcare provider. If you are experiencing a medical emergency, please call, or go to, your health care provider, local emergency department, 911 or your local emergency number immediately. Postpartum Support Yukon is intended for informational purposes only.

References

1. Russell EJ, Fawcett JM, Mazmanian D. Risk of obsessive-compulsive disorder in pregnant and postpartum women: a meta-analysis. J Clin Psychiatry. 2013; 74:377-85.

2. Barr, J. A., & Beck, C. T. (2008). Infanticide secrets: qualitative study on postpartum depression. Canadian Family Physician, 54(12), 1716-1717.

3. Kleiman, K., & Wenzel, A. (2011). Dropping the baby and other scary thoughts: Breaking the cycle of unwanted thoughts in motherhood. Routledge.