A friend recently reached out to me to ask if I’d ever had any “unwanted thoughts” since having my son. I had to think about it because, while postpartum depression is something most of us are aware of, we don’t hear as much about the anxiety and intrusive thoughts that can happen on the journey to becoming a parent.
As I began wondering about intrusive thoughts, my curiosity led me to Dr. Fiona Challacombe, a researcher and a clinical psychologist with a Ph.D. in perinatal OCD. Dr. Fiona also serves on the Scientific Advisory Panel of Maternal OCD, an organization that has made it its mission to de-stigmatize perinatal OCD.
Dr. Fiona helped answer a lot of questions surrounding perinatal OCD, including how to get help. Always reach out to your healthcare provider if you or someone you know is having trouble dismissing unwanted thoughts.
Postpartum anxiety, depression, and perinatal OCD can feel isolating, but you shouldn’t have to feel as though you’re going through it alone. Please reach out to your doctor, a therapist, or another trusted professional for support.
If you are experiencing suicidal thoughts or actions, please get help immediately.
National Suicide Prevention Lifeline: 988 or 1-800-273-TALK (1-800-273-8255)
Crisis Textline: text CONNECT to 741741
What is perinatal OCD and why does it happen?
If you’re unfamiliar with Obsessive-Compulsive Disorder, or OCD, it’s an anxiety-related disorder largely built around obsessions (recurrent, unwanted, intrusive, and upsetting thoughts) and compulsions (things you repeatedly do to help cope with your obsessions). Perinatal OCD is OCD that occurs during pregnancy or the postpartum period. OCD tends to latch onto what’s important to the person at the time, and with perinatal OCD, it’s often related to pregnancy or to caregiving. While it does not have a distinct diagnosis in any of the diagnostic systems, it’s best to “think of it as OCD that occurs in a specific context”, explained Dr. Fiona.
“Intrusive thoughts are very normal, and we all get them, similar to standing at the subway and having a quick thought you could push someone,” said Dr. Fiona, “but with OCD, it’s how you interpret them which is really the issue. The recipe for intrusive thoughts often includes situations where you’re stressed, you’ve experienced increased responsibility, and you have a higher awareness of threats—and the perinatal period has all of these.”
It was interesting that you don’t need to have anxiety or an OCD diagnosis to experience perinatal OCD. “It’s because it comes down to how you process thoughts and stress levels, for example,” said Dr. Fiona. If you already have an OCD diagnosis, you may have a propensity for it, and the stressful time can increase the likelihood, but it’s not inevitable. Having experience in changing your cognitive thoughts can help prepare for the possibility of developing perinatal OCD.
While the reason behind these thoughts is unknown, we know that psychological, biological, and situational factors play a significant role. Some individuals are just more susceptible to hormonal changes. These various factors manifest into this specific issue based on how one interprets their thoughts, for example, assigning meaning that thinking the thoughts alone makes them a bad person, crazy, or a danger to their baby.
How common is perinatal OCD?
While shame and fear of judgment can prevent people from disclosing their symptoms and have contributed to how difficult identifying perinatal OCD can be, it is still more common than you’d think. Research by Dr. Jonathan Abramowitz, a professor and associate chair at the University of North Carolina, has shown that “as many as 91 percent of new moms and 88 percent of new dads experience thoughts of harm to their children.” Although, those thoughts don’t always equate to perinatal OCD.
Knowing it can occur in either caregiver, regardless of gender, shows that it’s a cognitive issue rather than just a hormonal issue. There is, however, less recognition of it among men as a result of not seeking treatment.
How does perinatal OCD present itself?
There is a spectrum from ruminating thoughts to themes around safety and the self as a potential threat in perinatal OCD, and there are some common ways that it can show up. “One of the most common ways is intrusive thoughts around deliberate harm and yet it is one of the most difficult ones to talk about because of the stigma,” said Dr. Fiona.
This is incredibly daunting because it can often be misinterpreted by medical professionals who are not familiar with OCD. Another common way it can present is when parents have intrusive thoughts about pedophilia when changing diapers, even though they are unlikely to act on it. Fear of harm coming to your child from a failure of making a mistake or doing the wrong thing drives the intrusive thoughts. Between 3-5 percent of mothers/birthing people report feeling as though they “cannot escape these intrusive, irrational, and upsetting thoughts unless they engage in a repetitive act.”
What are ways people can seek help for perinatal OCD?
If you’ve recognized some of these symptoms in yourself or someone you know, the first thing is to be assured that it’s a common phenomenon, and there’s nothing wrong with experiencing them. Dr. Fiona stresses that “there is no evidence that caretakers act on intrusive thoughts, images, or compulsions because we have intrusive thoughts about things we don’t want to happen. Still, your brain will actually go as far as trying to come up with supporting evidence that it could occur”.
Cognitive Behavioral Therapy (CBT) is a recommended treatment for perinatal OCD. While there are different approaches, Dr. Fiona prefers to set a foundation by getting a shared understanding of the intrusive thoughts, looking at how it occurs for you, the meaning you’ve assigned to them, and how you maintain that importance.
“Understanding what the thoughts mean to you is a big tenant in CBT; it’s not the thing but rather what you make of it. Ask yourself, what have I been doing to support the fear that I am a bad or a dangerous person?” said Dr. Fiona. “Utilizing CBT as a treatment for perinatal OCD includes learning that perinatal OCD presents itself as a safety issue, but the real problem is about fear and anxiety.” The more you try not to think about it, the more power you give to it instead of acknowledging the unpleasant thought and letting it go. Thoughts are just thoughts, and it’s about retraining our brains to see it that way. Allow the thought to come into your head without assigning judgment and carry on, building your confidence and trust in yourself.
Untreated perinatal OCD can cause distress, and potential disruption of caregiver-infant relationships, and misdiagnosis can result in a poor quality of life as the problem persists. This is why it’s essential to remove the stigma around these unwanted thoughts and hold space for those experiencing them.
Dr. Fiona advised anyone seeking help to “educate themselves as much as possible and to talk with a medical provider that understands OCD and intrusive thoughts.” Ask questions during the initial meeting to understand their approach to treatment and gauge trust. Dr. Fiona works with Maternal OCD to educate medical providers on what to look for and how to treat perinatal OCD. One of Maternal OCD’s goals is to help medical providers to acknowledge the anxiety and OCD that occurs during the perinatal period instead of dismissing it as just “baby blues”. “It’s important that the average person understands that perinatal OCD is a common, understandable problem that is treatable with the right help and that people can flourish”, said Dr. Fiona.