Obsessive-compulsive disorder (OCD) involves intrusive thoughts and repetitive actions that relieve psychological distress. If you develop these symptoms after having a baby, you may have postpartum OCD.
Obsessive-compulsive disorder (OCD) is a mental health condition that involves obsessions and compulsions. Obsessions are intrusive thoughts, urges, or images you experience, while compulsions are mental or physical actions you perform to get rid of negative feelings from intrusive thoughts.
Experiencing new-onset OCD in the first weeks after pregnancy is known as postpartum OCD.
Perinatal vs. postpartum
“Perinatal” refers to the time immediately before and after giving birth. It includes the postpartum period, which is the time immediately after birth.
Postpartum conditions are sometimes referred to as perinatal conditions to help encompass symptoms that may start to appear before labor.
The exact prevalence of postpartum OCD is varied, according to a
Postpartum OCD is one of a handful of perinatal mood and anxiety disorders (PMADs). PMADs are conditions involving emotions and are specifically seen during pregnancy and the postpartum period.
Other PMADS include:
- postpartum depression
- postpartum panic disorder
- postpartum psychosis
- postpartum post-traumatic stress disorder (PTSD)
Postpartum OCD is considered one of the most underrecognized PMADS.
Postpartum OCD symptoms
Postpartum OCD, like other types of OCD, features obsessions and compulsions. Unlike OCD diagnosed during other points of life, postpartum OCD involves thoughts and actions directly related to your new baby.
Erin Davis, a licensed clinical mental health counselor from Taylorsville, North Carolina, explains that postpartum OCD goes beyond typical new parent concerns, which can already be naturally excessive.
“A huge difference in postpartum OCD and typical postpartum experiences is [postpartum obsessions] cause intense, frightening, and disturbing images that provoke [a birthing parent’s] nervous system to set off [their] internal ‘fire alarm,’” Davis says.
These obsessive thoughts can be graphic and disturbing. They’re generally related to a new parent’s worst fears.
Davis notes that common obsessions in postpartum OCD include worries and anxiety about:
- the baby being dropped
- sanitation of baby items
- whether the baby is breathing
- caregivers mistreating the baby
- mistakes that will cause the baby to get sick
These worries can then lead to compulsions, such as:
- constant checking on the baby
- excessive cleaning routines
- avoidance behaviors (like not allowing the use of kitchen knives out of fear someone will harm the baby)
Obsessions in postpartum OCD tend to be ego-dystonic. This means that the thoughts go against a parent’s values, beliefs, and wants. For that reason, they don’t typically lead to intentional infant harm.
This sets them apart from similar symptoms in other PMADs, like postpartum psychosis, where intrusive thoughts are ego-syntonic. This means they are aligned with a parent’s current values and beliefs.
Obsessions in postpartum OCD can sometimes lead to unintentional harm, though. Excessive baby washing, for example, could cause skin irritation. Avoidance of holding the baby for fear of dropping them could lead to attachment issues later in the child’s life.
Experts do not fully understand the exact causes of postpartum OCD, which likely involve multiple factors.
Certain genes may increase your risk of developing OCD in general, and changes in genetic expression during pregnancy
Davis indicates that some parents experiencing postpartum OCD likely live with subclinical OCD. This refers to OCD that’s mild and doesn’t affect your daily functioning.
But when a baby is born, there’s suddenly a reason for OCD to potentially flare.
“Normally, my clients recognize, ‘Oh yeah, I did ask my mom for reassurance at least 5 times a day until it felt ‘just right,’’ when thinking on an earlier time in their life,” she says, regarding undiagnosed or subclinical OCD. “OCD loves to fester and grow in our areas of vulnerability. Nothing is more precious and vulnerable than our newborn child.”
Genetics and pre-existing OCD aren’t the only factors thought to contribute to postpartum OCD. Sleep deprivation, immune system dysfunction, and fluctuations in hormones and neurotransmitters could all affect OCD emergence during the postpartum period.
“There are wonky hormones, a lack of sleep, the stress of being a new mom, adjusting to a mature body image (whether we like it or not), and the lack of time to get self-care,” Davis adds. “All of these factors can ramp up anxiety as well as create the perfect storm for OCD.”
What is the link between postpartum OCD and depression?
Postpartum depression is considered the most common PMAD, affecting as many as
Postpartum OCD and depression can occur simultaneously, though the link between the two is unclear. The
Polymorphisms are naturally occurring genetic variations that affect gene expression and function. Shared genetics may suggest that if you’re predisposed to one of these conditions, you’re naturally predisposed to the other.
You may have an
OCD that emerges postpartum can become a lifelong condition if left untreated. You may notice symptoms improve significantly after the postpartum period, but that does not mean OCD has disappeared.
Can postpartum OCD go away on its own?
OCD symptom severity can change. You may feel like it’s improving, but postpartum OCD is not likely to go away on its own.
Davis explains that though the postpartum period is temporary, you may continue to experience OCD symptoms even once it ends. For this reason, Davis stresses the importance of seeking treatment to help you manage your symptoms.
OCD is treated with psychotherapy and medication. Cognitive behavioral therapy (CBT) formats, like exposure and response prevention (ERP), help you face the underlying anxieties of OCD in a managed and safe setting.
Doctors may also prescribe medications like antidepressants to help regulate mood and balance neurotransmitters that may contribute to OCD symptoms.
Experts recommend the same approaches for postpartum OCD.
“The gold standard treatment for OCD is exposure and response prevention,” Davis says. “ERP consists of a gradual buildup of exposures starting from small fears and progressing to bigger fears. During these exposures, the individual is not allowed to engage in a compulsion.”
Examples of ERP exercises include:
- audio recording worst-case scenario scripts until anxiety lessens
- allowing the other parent to hold the baby, progressing to walking around with the baby and then taking the baby out of sight or for a ride in the car
- washing the baby bottle with a pre-determined, acceptable amount of soap for a reasonable amount of time
- scaling down the number of times the baby monitor gets checked
Postpartum OCD treatment can look different for everyone. Your mental health professional may incorporate other therapy models based on your specific symptoms and any other conditions you have, like postpartum depression.
Postpartum OCD is OCD that emerges in the weeks immediately after childbirth. It features symptoms of obsessions and compulsions focused on the well-being of your baby and on child care.
Although postpartum OCD occurs during the postpartum period and may improve after that time, it’s considered a lifelong condition. Treatment can help you face the underlying anxieties of OCD and can teach you how to manage symptoms.