Anxiety can be a common experience among new parents. Some anxiety is normal and as long as it is not impairing your functioning and is short-lived, it is nothing to be alarmed by. Anxiety disorders on the other hand are ongoing, interfere with your quality of life and your functioning.
Maternal mental health has been shown as an important factor in the bond between mother and the baby as well as the child’s development. Unfortunately, anxiety disorders in expecting and new mothers are often misunderstood and undertreated. One example of a particularly misunderstood anxiety-related disorder is Perinatal Obsessive Compulsive Disorder (OCD).
What is perinatal OCD?
Perinatal OCD is characterized by repetitive, unwanted and intrusive thoughts, images, and/or urges called obsessions. Obsessions cause significant anxiety and distress. Obsessions during pregnancy and following childbirth (the perinatal period) often involve the theme of harm coming to the newborn either intentionally or accidentally. Some examples of unwanted thoughts and/or images that new and expecting mothers might experience are:
- What if I drop the baby?
- What if I hurt (ex. shake, drown, stab, burn, etc.) the baby?
- What if the baby suffocates or suddenly dies?
- Thoughts or images of accidents, injury and/or death of the baby.
- Thoughts of baby getting very sick or becoming contaminated.
- Inappropriate sexual thoughts about the baby.
Many new and expecting mothers experience some of these thoughts momentarily. Research has shown that mothers without OCD can experience these thoughts especially if they have been sleep deprived or are unsuccessful in comforting a distressed baby. When the thoughts do not go away on their own, cause significant shame, guilt, and anxiety, and impair a woman’s functioning, then further assessment by a qualified health professional with expertise in OCD is strongly recommended.
- Many new and expecting mothers without OCD (approximately 69-80%) experience unwanted and unacceptable thoughts about their baby.
- Just thinking bad thoughts, does not mean that it happens.
- Thinking bad thoughts does not make you a bad mother! It also does not mean that you want to do anything bad or harmful to your baby!
** a distinct difference between women with perinatal OCD vs. women who actually cause harm to their baby is that women with OCD experience their intrusive thoughts as highly distressing, shameful, and disturbing.**
Since obsessions target what new and expecting mothers highly value (their newborn and the newborn’s wellbeing), obsessions cause intense fear and anxiety. In order to neutralize or reduce the anxiety, the individual is then compelled to perform an action or a mental act which temporarily reduces the anxiety. These mental or physical actions are called compulsions. Some examples of compulsions in perinatal OCD include:
- Excessively checking on the baby (for example, repeatedly checking to see if the baby is breathing when they’re asleep)
- Excessive reassurance seeking such as repeatedly asking medical professionals, family and/or friends about the health and wellbeing of the baby, “googling” symptoms, excessively researching different medical information, etc.
- Mental rituals such as praying over and over again, repeatedly stating the same statements, reviewing scenarios in your mind over and over again
- Excessive washing and cleaning
- Avoidance behavior such as avoiding the baby or avoiding being alone with the baby. Alternatively, being overly attached to the baby, or not allowing the baby out of your sight.
Compulsions do work in the short-term by temporarily reducing the anxiety. As a result, the person is more likely to use the compulsions to cope with the obsessions and the associated anxiety the next time it pops in their mind. However, this worsens the anxiety and the OCD over the long-term because it prevents the person from learning more helpful strategies to cope and gradually can become all-consuming. This is how the vicious cycle of OCD perpetuates.
Assessment and Treatment of OCD
Since women with perinatal OCD experience their obsessions as deeply disturbing, frightening and shameful, they are less likely to disclose their suffering or struggles to healthcare professionals. Additionally, many medical and even mental health professionals are not appropriately trained in the assessment and treatment of OCD which can create additional barriers to appropriate diagnosis and treatment. Finding a qualified healthcare professional with experience and expertise in OCD is an important step in getting the right support.
Cognitive Behavioral Therapy (CBT) and medications such as Selective Serotonin Reuptake Inhibitors (SSRIs) have been shown as effective treatments for all types of OCD including perinatal OCD. The decision to take medication during pregnancy or while breastfeeding can be a challenging one. If you are considering medication, speak with your family doctor or psychiatrist about the benefits and risks of medication so that your doctor can assist you in your decision making process. Cognitive Behavioral Therapy is an umbrella term referring to a particular approach to therapy. Exposure and Response Prevention (ERP) is a specific type of CBT that has been shown as highly effective for OCD. If you choose to pursue CBT, ensure that the therapist you work with has specific training in ERP. Don’t be shy to ask about your therapist’s training and experiences. Your health is important, and a good therapist would be happy to provide you with the information you need to make an informed decision about your treatment.
What you can do at home
There are excellent free online resources for learning about perinatal anxiety and OCD as well as how to cope with them. A couple of my favorite resources that I share with my patients are:
Dr. Jaleh Shahin is a registered psychologist in the provinces of Alberta and British Columbia. Dr. Shahin works in private practice providing virtual psychological services across Alberta and British Columbia. You can learn more about her and her practice at https://upsilonclinic.com or on Instagram @upsilonclinic
Abramowich, J. (2007). Beyond the blues: Postpartum OCD. Retrieved from: https://iocdf.org/expert-opinions/postpartum-ocd/
Hudepohl, N., & Howard, M. (2014). Perinatal OCD: What research says about diagnosis and treatment. Retrieved from: https://iocdf.org/expert-opinions/perinatal-ocd-what-research-says-about-diagnosis-and-treatment/
McGuinness, M., Blissett, J., & Jones, C. (2011). OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behavioural and Cognitive Psychotherapy, 39(3), 285-310. doi: 10.1017/S1352465810000718