Postpartum and Perinatal OCD

Postpartum and Perinatal OCD
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What are Postpartum and Perinatal OCD?
• OCD that occurs immediately after childbirth is called postpartum OCD
• OCD that occurs during pregnancy is called perinatal OCD.
• Research shows that women who are pregnant, or who have recently given birth, are at an increased risk of
developing OCD symptoms. If they already have OCD, the obsessions and compulsions may worsen during
this time. Because these two forms of OCD are very similar, we refer to them collectively as “pOCD” in this
fact sheet.
How is pOCD different from OCD that occurs at other times?

• In pOCD, the obsessions and compulsions usually focus on the newborn (or unborn) infant. For example,
there may be obsessions about the baby getting hurt, contaminated, or lost; and compulsive rituals
involving checking, mental rituals, and seeking-reassurance. There may also be unwanted sexual
obsessions. The person may also use excessive avoidance, such as avoiding bathing or holding the baby.
• While OCD typically begins gradually, pOCD tends to begin somewhat rapidly, coinciding with feelings of
being responsible for the newborn.
What are the signs of pOCD?

• OCD symptoms that start or worsen around the time or pregnancy or delivery.
• Obsessions involving the fear of harm coming to the unborn or newborn infant.
• Not wanting to tell others about obsessions for fear of being diagnosed with psychosis or being
hospitalized.
• Fear that you might harm the baby even when you don’t really want to.
• Compulsions meant to control or stop the obsessional thoughts, or to prevent fears from coming true (e.g.,
checking on the baby, excessive washing, repeating prayers or requests for assurances).
• Avoiding certain activities with the baby (e.g., bathing, using stairs, holding, diaper changing).
• Feeling overwhelmed by the obsessions and compulsions.
• Feeling depressed (postpartum depression and pOCD often occur hand in hand).
• Needing to have a partner or helper nearby because of obsessional fear.
• Trouble sleeping because of obsessions and compulsive urges.
• Interference with taking care of the child.
Why do obsessions and compulsions focus on the unborn/newborn baby?

• Increased anxiety about having a baby is normal, but it is a major source of stress, so some people
develop anxiety during this time.
• Feelings of responsibility for the unborn or newborn baby.
• Research shows that it is normal to have strange unwanted thoughts about stressful events.
• Thinking upsetting thoughts about your baby seems like the worst possible thing to think about—and
OCD feeds off of these kinds of thoughts because these are the exact kinds of thoughts that you try very
hard to control, dismiss, or fight. But this is how OCD plays a nasty trick—the more you try to use strategies
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for fighting thoughts, the more they backfire, and the more you get caught into OCD’s web of obsessing over
and over. (Do an experiment: try not to think of a pink elephant!).
• Compulsions are performed because they reduce anxiety over obsessional thoughts about the newborn,
but these don’t work well in the long run—they just lead to more obsessing.
Will obsessions about violence or sex lead me to harm my baby?

The chance of someone acting on unwanted, disgusting, distressing obsessional thoughts is extremely low.
But although this risk is low enough that treatment actually involves provoking these thoughts (i.e.,
exposure therapy), it probably doesn’t seem low enough! That’s what leads to obsessional anxiety and fear.
We have worked with many people with pOCD and none have ever acted on their unwanted obsessional
thoughts to harm their children.
Who struggles with pOCD?

The estimates vary, but pOCD seems to affect about 1-2% of pregnant or postpartum women. Some new
fathers can even develop pOCD symptoms because they also bear responsibility for taking care of the new
infant. People with OCD who become pregnant may have a worsening of their symptoms, but this is not
necessarily the case for everyone.
Is pOCD related to postpartum depression?

Yes, but how these problems are related is not clear. When people become depressed they tend to have
more negative thoughts, which can develop into obsessions. Alternatively, obsessions and compulsions can
lead to depression because these are very distressing symptoms. Many people expect pregnancy and
childbirth to be a very happy time. When negative obsessional thoughts occur, the person might feel
extremely sad and anxious because they don’t expect to have these types of thoughts.
Is pOCD related to postpartum psychosis?

No, but sometimes pOCD is confused for postpartum psychosis because both might involve thoughts about
harming the newborn infant. Recently, a few serious cases of postpartum psychosis have received media
attention, leading many people with pOCD to worry that they have psychosis. In postpartum psychosis, the
sufferer develops hallucinations (seeing or hearing things that aren’t really there; e.g., “I saw smoke coming
from the baby’s ears”) and delusions (strongly held beliefs that are not based in reality; e.g., “The baby is
possessed by the devil and I must kill him to save his soul”). Postpartum psychosis is also an extremely rare
condition, affecting 0.1% of new mothers. In some severe instances (but not in all cases), mothers with
postpartum psychosis have actually harmed their infant, acting on their hallucination and delusions. On the
other hand, pOCD is not nearly as rare as postpartum psychosis, and pOCD is not associated with actually
committing violence. Whereas a person with postpartum psychosis believes his or her hallucinations and
delusions are true, pOCD sufferers are afraid of their obsessions and recognize that these thoughts and ideas
are inconsistent with their world view and general sense of morality. People with pOCD try to fight their
obsessions. Finally, there is no evidence that pOCD symptoms can change into postpartum psychosis. These
two conditions are very different problems.
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What are the effects of pOCD?

• Depression (sadness, loss of interest in people and activities, sleep loss or excessive sleepiness, loss of
appetite, suicidal thinking, hopelessness, helplessness, lack of self-care)
• Problems with caring for the newborn because of fear and avoidance
• Problems bonding with the newborn because of avoidance
• Problems with one’s relationship (marriage or partnership) because of extreme anxiety.
Can pOCD be treated?

Yes, pOCD can be treated using the same methods used to treat other types of OCD. Strategies to treat pOCD
include:
• Cognitive-behavioral therapy (CBT)
• Learning that unwanted thoughts are normal and not dangerous
• Challenging how the person interprets their obsessional thoughts
• Gradually confronting situations and thoughts that have been avoided
• Reducing the use of compulsive rituals to deal with obsessional anxiety
• Serotonin reuptake inhibitor (SSRI) medicine
• Most medicines used to treat OCD are probably safe to use for pregnant and breastfeeding women,
although it is important to check with your doctor about whether he or she thinks these medicines will be
safe for you.
How can I help a friend or family member with pOCD?

The first instinct of family and friends of people with pOCD is to tell them constantly that everything is going
to be alright, and to do whatever they can to ease the person’s anxiety. In the short-run, this might put the
person with pOCD at ease, but these types of “help” do not work over the long-run. In fact, sometimes they
make the problem worse! The best thing to do if a friend or family member is suffering is to help them to
arrange a consultation with a skilled mental health treatment provider who can provide the right kinds of
treatment for OCD/pOCD. Rather than trying to “force” them into getting help, it is best to talk to them
about how things would improve if they sought professional help.
Author: Jonathan Abramowitz, PhD, ABPP, University of North Carolina at Chapel Hill
Copyright © 2019 International OCD Foundation (IOCDF), PO Box 96102

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Postpartum and Perinatal OCD

How is pOCD different from OCD that occurs at other times?

What are the signs of pOCD?

Why do obsessions and compulsions focus on the unborn/newborn baby?

Will obsessions about violence or sex lead me to harm my baby?

Who struggles with pOCD?

Is pOCD related to postpartum depression?

Is pOCD related to postpartum psychosis?

What are the effects of pOCD?

Can pOCD be treated?

How can I help a friend or family member with pOCD?

Copyright © 2019 International OCD Foundation (IOCDF), PO Box 96102

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