Perinatal OCD Explained: Signs and Steps Towards Healing
By Erin Jones, LCMHC, PMH-C
Have you ever held a newborn baby and had that pop-up thought “What if I drop this baby?” Or perhaps you’ve felt stuck worrying about whether or not you might make an awful mistake and hurt your child because of it. If this is the case, you are not alone.
Studies have shown that more than 80% of new parents struggle with intrusive thoughts, or unwanted, distress thoughts often pertaining to concerns about their child’s wellbeing. I think that the number is probably closer to 100%, though it can be difficult to discuss due to stigma and worry that these concerns reflect who we are as parents.
Reducing this stigma and increasing understanding is part of why I work with parents with Perinatal OCD: when Obsessive Compulsive Disorder takes place in pregnancy and postpartum. This article will cover what Perinatal OCD is, how it differs from everyday parenting worries, and suggestions on getting help:
What Is Perinatal OCD?
Obsessive Compulsive Disorder (OCD) involves the presence of both intrusive, unwanted
thoughts (or images, urges) and either mental or physical compulsive behaviors that are
performed in an attempt to neutralize the related distress and discomfort. Though everyone can
experience intrusive thoughts and compulsive behaviors at times, it becomes OCD when the
cycle is recurring and impairing in one’s life.
Perinatal OCD is still OCD, but it occurs either during pregnancy or in the year after birth
(postpartum). Many parents also experience OCD symptoms involving worry about their
children in the years beyond the initial postpartum month. For some, perinatal OCD can be a
flare up of existing OCD, or it could be the first time that someone experiences more noticeable
Symptoms.
Common worries or themes of OCD in the perinatal period often include, but are not limited to:
● Fear of harm coming to the baby (physical harm, illness/contamination, etc)
● “Just right” OCD or urges to engage in certain tasks until they feel right
● “Relationship OCD” – Fear of lack of love for the child or worry that the parent doesn’t
want the baby
● Unwanted taboo/sexual thoughts
● Excessive worry about being a bad parent
Intrusive thoughts in terms of OCD are ego-dystonic, meaning that they are unwanted and
separate from one’s worldview. For example, when a parent with OCD experiences the intrusive
thought “What if I make a terrible mistake and hurt my baby?” They don’t actually want to do
that. In fact, its quite the opposite and the thoughts bring on fear. However, the distress that the
thoughts bring on can make them feel so real and meaningful (when they’re just scary thoughts).
Studies have shown that more than 80% of new parents struggle with intrusive thoughts, or unwanted, distress thoughts often pertaining to concerns about their child’s wellbeing.
Common Compulsions during the perinatal period are:
● Checking (baby’s breathing, the monitor, temperature, looking back to make sure no
harm occurred)
● Cleaning and Sanitizing
● Reassurance-Seeking: Repeatedly asking a partner, loved one, or others on the internet
questions to get the sense that things are okay
● Avoiding the baby or specific situations that could provoke intrusive thoughts
● Mental Compulsions (ruminating, self reassurance, replaying events in one’s mind)
OCD vs “Normal Mom Worries”
A lot of people that I work with often ask, “Is this normal or is it OCD?” It can be difficult to tell
sometimes, especially due to the fact that there’s so much variety in all of our daily lives. I like to
remind folks that I really have no idea what normally actually is. However, there are some signs
that a worry is more “normal” vs one that will spark an OCD cycle:
When considering if something is more everyday vs part of the OCD cycle, you want to think
about the time, duration, and intensity.
- “Normal” worries stem from genuine concern and tend to
feel proportionate to the actual event. They tend to fade either with less attention or with proper
addressing of the concern. - OCD intrusions, on the other hand, tend to be more excessive (even
if focused on everyday life) and feel more distressing/intense. They also often lead one to
engage in compulsions, such as those listed above.
For example, a parent might wonder “Hmm, I think I might have left part of the car seat unbuckled. I’ll double-check.” However, a parent withan obsession around safety might think about the car seat before, during, and after the car ride.
They may think something like “I can’t stop checking the car seat and researching car safety
because If I don’t- Something bad could happen and I’d be a terrible parent.” It’s not ultimately
about the worry itself, but how one responds (or doesn’t respond) to it.
Steps Towards Healing
Although OCD can be distressing and difficult, I want everyone reading this to know that it is
extremely common- You’re not alone. Just as important- OCD is treatable using evidence-based
treatment approaches, such as Exposure and Response Prevention (ERP) and medication
when applicable.
I would suggest reaching out for help if worries or rituals are interfering with your daily life, such
as bonding with your child or sleeping. I would also consider reaching out for help if you are
avoiding certain activities because of fear. If you’re feeling confused about what is a “normal”
worry vs OCD, I’d consider meeting with a trained professional to learn more.
I recommend finding a well trained specialist to work with OCD. The International OCD
Foundation (IOCDF) has a list of providers. Postpartum Support International (PSI) also has a
list of providers certified in perinatal mental health. They also have various virtual groups,
including one for perinatal OCD. Connecting with others can be incredibly supportive and
healing for parents in general, but especially those who struggle with OCD.
It can also be helpful to practice self-compassion. OCD can come with increased feelings of
guilt and shame. Self compassion can help one move through these difficult feelings and
support oneself through difficult times, rather than focusing on self judgement. For more
information on self compassion check out my previous blog post on self compassion for Moms!
I also recommend prioritizing rest and self-care. This is of course difficult during the perinatal
period, though not impossible. If you’re pregnant or in the early stages of parenthood, work with
your providers and loved ones to make a plan for rest, nutrition, and shared caregiving.
Please keep in mind that if you struggle with intrusive thoughts or OCD, it has nothing to do with
your worth as a parent. Help is available!
About Erin Jones, LCMHC, PMH-C. Erin is a Licensed Clinical Mental Health Counselor (LCMHC) with over 5 years of experience providing evidence-based practice counseling services for individuals with Obsessive Compulsive Disorder (OCD) and related diagnoses. She works at Bull City Anxiety and OCD Treatment Center, where she sees individual clients, manages an intensive Exposure and Response Prevention (ERP) program, and runs some groups. She is especially passionate about the self-compassion group for Moms with OCD. She is the treasurer for OCD North Carolina, local affiliate of the International OCD Foundation. Erin is passionate about all things OCD-related and perinatal care.
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