​What is Perinatal OCD?

 

Perinatal Obsessive Compulsive Disorder (Perinatal OCD) is a form of OCD that develops or worsens during pregnancy or during the first year after welcoming a baby. You may also hear it called postnatal OCD or postpartum OCD, particularly when symptoms begin after birth. 

​

Although Perinatal OCD is most commonly discussed in relation to mothers who have given birth, it can affect anyone with significant caregiving responsibility for a baby, including fathers, non-birthing partners, adoptive parents, foster carers, grandparents, and other primary caregivers.

​

For many people, caring for a vulnerable infant brings an enormous increase in responsibility. OCD often targets the things we value most, and the responsibility of keeping a baby safe can become the focus of intrusive thoughts, doubt, and compulsive behaviours. While hormonal changes are thought to play an important role (particularly for the birthing parent) they are only one factor. Psychological vulnerability, increased responsibility, sleep deprivation, life transition, and pre-existing anxiety or OCD can all contribute to symptoms developing.

​

What Does Perinatal OCD Look Like?

​

Perinatal OCD often centres on the things parents highly value in this period; the safety and wellbeing of the new baby. The thoughts can feel shocking, confusing, or completely out of character. In fact, they represent the very opposite of who you are or what you want to happen.

​

Some common unwanted intrusive thoughts include:

• "What if I accidentally hurt my baby?"

• "What if I lose control and harm my baby?"

• "What if I contaminate my baby with germs?"

• "What if I don't notice that something is wrong?"

• "What if my baby stops breathing while sleeping?"

• "What if I'm a bad parent?"

​

These thoughts are unwanted, intrusive, and distressing. They do not reflect your intentions, values, or character. In fact, people with Perinatal OCD are usually horrified by these thoughts precisely because they love and want to protect their baby.

​

Common Compulsions

​

Given the distress associated with perinatal intrusive thoughts, people often find themselves doing particular things to make sure that everything is ok.

 

Some common examples include: 

• Constantly check that their baby is breathing, checking baby temperature

• Excessively wash or sterilise bottles, clothing, or hands

• Avoid bathing, feeding, carrying, or changing the baby

• Hide knives or other household objects

• Ask loved ones repeatedly for reassurance

• Search online for reassurance about symptoms

• Mentally review events to make sure no harm occurred

• Avoid being alone with their baby

• Monitor their thoughts to determine whether they "mean something"

 

Some of these behaviours are to be expected in anyone that is caring for a new baby, but in perinatal OCD they will only temporarily reduce anxiety. The distressing doubts about the wellbeing of the baby usually bounce back quickly. 

​

Isn't It Normal to Worry About Your Baby?

 

Yes, absolutely.  I am yet to meet a new parent who doesn't experience some level of worry about their baby (myself included!). Most new parents experience occasional intrusive thoughts and worries about their baby's safety. These thoughts are common and usually pass without causing significant distress.

​​

With Perinatal OCD, however:

• the thoughts are frequent and difficult to dismiss

• they cause intense anxiety, guilt, shame, or disgust

• they interfere with caring for your baby or enjoying parenthood

• you feel driven to perform compulsions to feel safe or certain

 

If your worries are significantly affecting your daily life, it may be worth seeking an assessment.

​

Perinatal OCD Is Not the Same as Perinatal Psychosis

 

I often find that many clients with Perinatal OCD have fears that they actually have psychosis: "maybe this isn't OCD... maybe I am actually crazy and I will harm my baby?!"

​

OCD can have you feeling like this, but it doesn't mean that it IS psychosis. 

​

In OCD, intrusive thoughts are ego-dystonic, meaning they are unwanted, inconsistent with your values, and deeply distressing. Parents with OCD typically do everything possible to prevent harm.

​

This differs from postpartum psychosis or perinatal psychosis, which is a rare psychiatric emergency in which a person may lose contact with reality through delusions or hallucinations. The assessment and treatment of postpartum psychosis are very different.

​

Why Does OCD Sometimes Begin During Pregnancy or After Birth?

 

The transition to becoming a parent is one of the biggest life changes many people will experience. It brings increased responsibility, uncertainty, disrupted sleep, and a heightened awareness of potential threats which are exactly the sorts of factors that can make OCD more likely to emerge or worsen.

​

For birthing parents, hormonal changes during pregnancy and after delivery are also believed to increase vulnerability to OCD and other mental health conditions. However, hormones alone do not explain Perinatal OCD.

The condition also affects fathers, partners, adoptive parents, foster carers, and other caregivers who have not experienced pregnancy but have taken on significant responsibility for a baby's wellbeing.

 

Possible contributing factors include:

• Hormonal changes (particularly during pregnancy and after birth)

• Sleep deprivation (!!!)

• Increased responsibility for a vulnerable infant

• Major life transitions

• Pre-existing anxiety or OCD

• A family history of OCD or anxiety disorders

• Stress and reduced opportunities for self-care

​

Often, we find that it is a combination of some of the above factors rather than a single cause that contributes to Perinatal OCD.

 

Treatment for Perinatal OCD

 

The good news is that perinatal OCD is highly treatable.

​

The most effective psychological treatment is Exposure and Response Prevention (ERP), a specialised form of Cognitive Behaviour Therapy (CBT). ERP helps people gradually face feared situations while reducing compulsive behaviours and learning that uncertainty can be tolerated.

 

Depending on your circumstances, treatment may also include:

• Cognitive Behaviour Therapy (CBT)

• Inference-Based CBT (I-CBT)

• Acceptance and Commitment Therapy (ACT)

• Medication, where appropriate, in consultation with your GP or psychiatrist

 

Treatment is always tailored to your individual situation, including pregnancy, breastfeeding, and your family's needs.

​

What Does Treatment for Perinatal OCD Look Like?

 

For many parents, the hardest part of treatment is simply telling someone about the intrusive thoughts. Many people worry:

• "What if my psychologist thinks I'm dangerous?"

• "What if they report me?"

• "What if they think I want to hurt my baby?"

• "What if my baby is taken away?"

 

These fears make sense and are extremely common in Perinatal OCD. A psychologist who is experienced in assessing and treating OCD understands that there is an important difference between having unwanted intrusive thoughts about harming your baby and wanting to harm your baby.

​

In Perinatal OCD, the thoughts are frightening precisely because they are completely inconsistent with who you are and what you value. Parents with OCD are usually deeply caring and highly protective people and one of the reasons they are so distressed by their experience is because they desperately do not want anything bad to happen.

​

During assessment and treatment, your psychologist will carefully explore:

• the nature of your intrusive thoughts

• whether the thoughts are wanted or unwanted

• how much distress they cause

• the compulsions or safety behaviours you engage in

• how OCD is affecting your ability to care for and enjoy your baby

 

Rather than judging the content of the thoughts, an OCD-trained psychologist is interested in understanding how OCD is operating and helping you break the cycle that keeps it going.

​

Treatment typically involves learning about how OCD works, understanding why particular intrusive thoughts are so "sticky," identifying compulsions such as checking, avoidance, reassurance seeking or rumination, and gradually reducing these behaviours through evidence-based approaches such as Exposure and Response Prevention (ERP).

​

The goal of treatment is not to convince you that your intrusive thoughts will never occur again. Instead, treatment helps you learn that intrusive thoughts are simply thoughts (not predictions, intentions, or reflections of who you are) and that you can care for your baby without needing to ensure absolute certainty.

​

Many parents notice that as they reduce compulsions and respond differently to the thoughts, the thoughts become less distressing and take up far less of their day.