Intrusive Thoughts and OCD During Pregnancy and Postpartum

Pregnancy or having a baby changes lives in many ways … the excitement of entering a new stage of life, adding another member to a family, disrupted sleep and baby snuggles. Unfortunately, something parents are less likely to expect but are likely to experience are scary or intrusive thoughts that may be a symptom of perinatal obsessive compulsive disorder (OCD).

Intrusive thoughts are unwanted, persistent and distressing thoughts, urges or images.

One study shows that 65 percent of new parents report experiencing intrusive thoughts. Most were fleeting and did not significantly affect their mood or daily life. But, in some cases, these thoughts were highly distressing and led to behaviors that impact the parent’s interaction with their newborn or family.

With intrusive thoughts being common in parenthood, how can we tell when the thought may be an adjustment to being a parent and when it may be perinatal OCD?

Obsessive-compulsive disorder is characterized by the experience of obsessions and compulsions:

• Obsessions are intrusive thoughts which cause heightened anxiety or distress when experiencing them. A person may try to make the thought go away or neutralize it by performing an action or compulsion.
• Compulsions are our mind’s attempt to cope by trying to control intrusive thoughts or prevent them from coming true.

Signs and symptoms of perinatal obsessive-compulsive disorder

For OCD to be diagnosed, a person must experience obsessions, compulsions, or both and these must be time-consuming and cause a high level of distress or impairment in an important part of their life such as relationships, work and meeting daily needs.

The main difference between OCD and perinatal OCD is that perinatal OCD occurs during the perinatal period (20 weeks gestation to first year postpartum) and obsessions and compulsions will concern the baby.

For example, a new parent’s intrusive thought may involve the baby being injured, so the compulsion may look like:

• Checking on the baby excessively
• Avoiding certain activities
• Seeking reassurance from partner or other adults
• Internal thoughts to “neutralize” the intrusive thought

Compulsions will help the parent feel better in the moment, but the relief is brief and can lead to worsening symptoms.

Treatments for perinatal obsessive-compulsive disorder

The good news is, there is treatment for perinatal OCD.

Medications

There are medications shown to be effective in helping treat perinatal OCD and can be used while pregnant or breastfeeding. Meeting with a medication provider like a primary care physician, OB-GYN or psychiatrist can be helpful to start pharmaceutical treatment.

Behavioral therapy

Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) is an effective behavioral treatment for OCD. Look for a therapist who can provide this type of treatment and is familiar with perinatal mood and anxiety disorders.

Support groups

Connecting with others who are experiencing similar symptoms and life stages can be helpful. Support groups give participants the opportunity to talk about experiences and symptoms in a safe place, learn tools and resources to manage symptoms, and feel supported by their peers.

The experience of perinatal OCD can be intense and scary! But finding that these symptoms have a cause, and knowing you are not alone in this experience can be lifesaving