The Misunderstood, Misdiagnosed World of Postpartum OCD
As soon as she delivered her daughter in 1983, Shoshana Bennett, Ph.D., a clinical psychologist in Orange County, CA knew something was terribly wrong.
She started seeing horrifying images of someone stealing her newborn, a nurse suffocating her baby, or she envisioned herself dropping her baby, seeing the head smashed and blood on the ground.
When she returned home with her daughter, even innocuous objects around the house — the microwave, a vacuum cleaner cord, the dishwasher — seemed like potential weapons. Every 15 seconds or so, she'd imagine someone or something hurting her baby. Worse, with little, horrifying video clips on replay in her mind, she'd see that she was the perpetrator.
She didn't tell her husband what was happening. She didn't tell anyone what was happening. Instead, she spiraled into deeper, scarier thoughts. Her pain continued for years. "I missed the infancy and toddlerhood of my firstborn," she tells InStyle. "It was just one long nightmare."
When she experienced similar symptoms after having her son a few years later, a psychologist made her feel even more scared and confused by making incorrect assumptions about her own childhood, predicting a negative bond for her and her baby. Her ob-gyn dismissed her experience as normal.
She gave up trying to find help. This would be the rest of her life, she assumed. She became suicidal.
What Bennett didn't know at the time — what she came to understand in years to come — is that she was suffering from postpartum obsessive-compulsive disorder (OCD), the most misunderstood and misdiagnosed of the perinatal mood and anxiety disorders (PMADs).
Postpartum OCD Symptoms Can Be Debilitating and Isolating
Bennett's personal experience led her to pursue a Ph.D. and get a license to practice as a psychologist specializing in postpartum OCD. Today, she's one of the leading voices in the field.
About 15 to 20 percent of women experience a PMAD, and perinatal depression is the most common. (The term "perinatal" includes pregnancy through postpartum.) But about 3 to 5 percent of new mothers and some new fathers experience symptoms of perinatal OCD.
OCD has its own chapter in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the "bible" of psychiatric disorders. But if it crops up in pregnancy or postpartum, it can be particularly debilitating, confusing, isolating, and anxiety-provoking since symptoms often revolve around the baby.
Symptoms of postpartum OCD include obsessive thinking; repetitive, intrusive images and thoughts that persist and seem to come "out of the blue"; and compulsive behaviors such as washing the same load of clothes four times or frequently checking the baby's breathing. There is also usually a fear of being left alone with the baby. And many women with postpartum OCD have an understanding that their thoughts are unwanted and unreasonable.
Some women with postpartum OCD have more "classic" OCD symptoms associated with compulsive cleaning, checking, or having things in order. Others suffer from intrusive "what if" obsessions (what if I drop the baby? What if I accidentally stab her while I'm cutting fruit?). Some experience both.
Common triggers for intrusive thoughts include heights (stairs), water (driving over bridges), sharp objects (knives or scissors), traffic, or situations where sexual intrusive thoughts — what if I molest my baby? — can crop up (changing a diaper), explains Birdie Gunyon Meyer, R.N., director of certification for Postpartum Support International (PSI).
Another potential trigger: the current day climate. Gunyon Meyer, who hosts virtual PSI support groups for women with PMADs, says that last week in one particular group, all 12 women in the group mentioned that the COVID-19 pandemic had set them back in recovery and set off a slew of intrusive thoughts. "We just keep adding the support groups because they're always full," she says. "This has increased many people's anxiety, fear, and OCD and intrusive thoughts. You can only imagine if you were already washing your hands a lot, people can be washing their hands to the point that they're bleeding and cracking."
Postpartum OCD is often misdiagnosed, too. In part, that's because a diagnosis often involves a diagnosis of other PMADs. Obsessive thoughts about harming your baby, for example, aren't unique to postpartum OCD; some research finds they've been reported in more than 57 percent of women with postpartum depression.
Additionally, not all therapists are trained in PMADs or are able to recognize symptoms, making a diagnosis even more complicated.
It Can Affect Any New Mom – But Some Are More Susceptible
Postpartum OCD isn't necessarily limited to just new moms: "All primary caretakers including grandparents, adoptive parents, and fathers are susceptible to perinatal OCD due to sleep deprivation and stress, especially if there is a personal history of OCD," Bennett explains.
However, women who have given birth may be more susceptible. "Pregnant women and birth mothers have the added factor of intense hormone shifts which can exacerbate the condition," she explains.
And while any mom can get postpartum OCD (PMADs don't discriminate), those with a family or personal history of mood disorders or OCD (knowingly or not) are high risk. "I've rarely seen a mom with perinatal OCD who hasn't experienced OCD previously — not necessarily diagnosed — or at least had a close blood relative with OCD," says Bennett. "At our most vulnerable times — during pregnancy and postpartum — anything that's hanging around in the genes can go from just feeling like a personality quirk to a real disorder."
Differentiating Between Postpartum OCD and the Scary Thoughts of New Parenthood
Intrusive thoughts and "what if" thinking are a common part of new parenthood. Some 90% of new parents report them, according to research. To some extent, your brain is hardwired for increased vigilance postpartum (this helps you protect your baby). It's something that holds especially true now as new parents head home amidst a pandemic and are worried about not only their new baby, but the safety of the world around them.
Most people can see "what if" thoughts as mental noise; disturbing but not based in reality, explains Jonathan Abramowitz, Ph.D., a professor of psychology and neuroscience at the University of North Carolina at Chapel Hill. "People with OCD judge the thoughts as literal, important, and as having some sort of consequence."
Largely, the difference between new parent vigilance and postpartum OCD boils down to three factors: how thoughts are interpreted, how much they interfere with daily functions, and how often they're happening. "Women with postpartum OCD describe getting up, brushing their teeth, starting to have thoughts and not being able to stop having them," explains Gunyon Meyer.
Essentially, with postpartum OCD, the part of your brain that has thoughts about protecting your baby starts thinking about the worst possible thing that could happen — and so begins the terrifying reel of images in your mind of that thing happening. "The mind tries to anticipate any possible danger as a way to help protect the child," explains Bennett.
Without education and proper help, though, there's tremendous guilt, shame, and overall horror around these kinds of images and this "what if" thinking, including the scariest thought of all: What if I snap and do the horrible thing I'm seeing in my mind?
"Moms with postpartum OCD are often afraid that they're going to snap and become psychotic," says Bennett. But she points out that OCD intrusive thoughts do not turn into postpartum psychosis, a rare and entirely different illness marked by delusions and hallucinations. Intrusive thoughts are anxious in nature — not delusional — and postpartum OCD and postpartum psychosis are different disorders.
Experts also point out that repetitive, intrusive thoughts have a very low risk of being acted upon. "We educate women that thoughts do not equal action. They are thoughts — not facts," says Gunyon Meyer.
With postpartum OCD, it's far more likely, in fact, that you'd take steps to avoid potential harm to your baby.
How You Can Heal
Education surrounding postpartum OCD (and PMADs in general) is important. Gunyon Meyer also notes that it's on healthcare providers to do more — to ask women about scary or intrusive thoughts postpartum. And not all doctors do.
If you're suffering, these five strategies can help you feel better. And with the proper help, you will feel better.
1. Find a qualified therapist.
With a therapist who's not trained in perinatal mood issues, you risk getting inaccurate or unhelpful information, being misdiagnosed, or — in extreme cases — even having a professional call Child Protective Services, which is many women's worst fear, says Gunyon Meyer, who notes she's seen it happen. Working with someone who has been properly trained can help you understand that you're not at risk of harming your baby and will help you gain coping skills to feel better. To find a professional trained in perinatal mood disorders in your area, contact a local PSI support coordinator or search their online database of international providers. Motherfigure, a newly launched maternal wellness startup, also offers a directory, The Motherlode (like a Yelp for new moms), where you can search for experts who specialize in PMADs, including postpartum OCD.
2. Consider meds.
Medications such as selective serotonin reuptake inhibitors (SSRIs) are very effective for postpartum OCD, Gunyon Meyer says. If you think you could need or benefit from medication—even during pregnancy—talk to your doctor. Antidepressants appear to have a low risk of causing any birth defects and you and your doctor can decide what's best for you.
3. Recognize thoughts as thoughts.
"Thoughts are not good or bad. Thoughts are just private experiences — neurons firing in our brain," says Abramowitz. Bennett often tells women that intrusive thoughts mean that they're careful, protective mothers. "OCD is all about safety," she explains. "We obsess about things that terrify us because we're looking to protect our babies." If you have a scary thought, observe the thought as "just an OCD thought" and move along with your day. "When you dwell on a thought, you're putting a magnifying glass on something that's not worth your time."
4. Build a support system.
Talk to your partner, your mom, your doctor, a therapist. PSI also hosts online groups for women experiencing PMADs. Connecting with other women experiencing similar symptoms can help you feel less alone and help you find tools and resources that can help.
5. Make time for yourself.
Small bouts of exercise, healthy eating, and time away from your baby and with your partner, family, or friends (even virtually if need be). Prioritizing the things that help you feel good helps you keep up with your own mental health, which is key, says Abramowitz.