What is Perinatal OCD?
OCD is an anxiety disorder characterised by unwanted intrusive thoughts that create intense distress. These thoughts lead the sufferer to feel compelled to do something to prevent harm being caused to either themselves or others. Those with OCD feel overly responsible to prevent harm and can spend hours and hours completing rituals that they believe will stop or lessen the likelihood of this happening.
Perinatal OCD is diagnosed when someone experiences distressing, intrusive thoughts during the perinatal period with a focus on causing or preventing harm to baby. They also attach negative meaning to these thoughts such as ‘I am a bad mother for thinking this’ or ‘I am dangerous because I have thoughts about harming my baby’. This meaning gives rise to lots of emotional distress, anxiety, panic, and fear. This then leads the sufferer to perform actions and rituals (compulsions) to relieve the distress.
Signs and Symptoms to Look Out For
- Distressing, repetitive intrusive thoughts focused on causing/preventing harm to baby.
- Excessive worrying about the nature of the thoughts.
- Anxiety, worry, fear and panic about these thoughts and doing all you can to minimise this distress.
- Performing different compulsions (or actions) to reduce distress and worry about danger.
- Finding it hard to relax until the compulsions have been performed in a way that reduces anxiety and distress.
What Are Intrusive Thoughts?
Intrusive thoughts are often egodystonic which means they are completely at odds with the individual’s moral/value system. This makes the thoughts repugnant to the individual and leads to distress.
With Perinatal OCD, intrusive thoughts are often focused on the baby (in or outside the womb) and some form of harm coming to them, either by someone else or by you. Examples of intrusive thoughts include:
- What if I accidentally hurt my baby?
- I might drown my baby in the bath.
- I could let go of the pram and the baby will get run over.
- What if I put the pillow over the baby’s head when they’re crying?
- I love looking at my baby’s cute little bum, does that make me a paedophile?
- I want to stab my partner.
- Other people might abuse my baby when they are looking after him/her.
Thoughts like these can randomly pop into your head and feel extremely unpleasant. A loving, caring mother could end up very distressed by a thought about harming her baby because she may start to wonder why she had that thought and what it means about her as a mother/person.
The intrusions are not the main problem in Perinatal OCD (although they can really feel like it!). We all experience intrusive thoughts, and they can be more common in the perinatal period. The bigger issue is the negative meaning we attach to having the thought in the first place.
What are Compulsions?
A compulsion is the urge you experience when you have an intrusive thought. It tends to be a behavioural action which can be either internal or external. Internal compulsions can be things like trying not to think about distressing thoughts (also known as thought suppression) or counting to a certain number in your head. External compulsions are things we would see someone do, such as excessive cleaning of baby bottles and toys, or avoiding being on your own with your baby in case you cause harm to them.
Compulsions often start as the solution to the distress associated with the intrusive thought. It makes total sense that if you have a thought about hurting your baby, you’d try to think of something else. However, this pattern often gets repeated, so the initial solution starts to become a problem.
Compulsions can have a huge impact on our lives. They can take lots of time to perform, they can mean we avoid going to certain places or being with certain people. Life can feel even more challenging when we are constantly trying to reduce the distress we feel as a result of the intrusions.
Compulsions also serve to reinforce the negative meaning we attach to the intrusive thoughts. For example, I may have the belief that I am completely responsible for preventing any harm coming to my child, leading me to excessively clean their toys. When they stay well, it reinforces the idea that cleaning has prevented my child from getting ill and my excessive behaviour is keeping them safe. The negative belief is maintained, and the vicious cycle continues.
Treatment
CBT is the recommended treatment for Perinatal OCD and will help you to break the cycle between intrusions, meaning attached, distress caused, and actions performed. You can learn more about CBT here.
Sometimes, Perinatal OCD can be linked to past trauma. If this is the case, I would use either Trauma-Focused CBT or EMDR Therapy first. It may be that once the trauma is reprocessed, the symptoms of Perinatal OCD reduce or even go completely. If symptoms haven’t completely gone, or there are any leftover compulsions, we can address these using CBT. You can learn more about EMDR therapy here.
Tips for Coping with Perinatal OCD
- Remember intrusive thoughts are normal and we all get them.
- Recognise thoughts as ‘just thoughts’.
- Identify what you think these thoughts mean about you as a person (see examples above)
- Keep a record of intrusive thoughts (the content and how they made you feel), as well as a record of compulsions performed as a result.
- Notice any patterns and themes.
- Try to resist the action you get the urge to perform. For example, resist calling your mum to ask whether she thinks you are a bad person and are likely to act out the intrusion of harming your baby. Reassurance is often short lived and as soon as another intrusion comes your way, you’ll need more reassurance to feel better. This in itself is another vicious cycle. Read Excessive Reassurance Seeking and Anxiety for more information.
Useful Links
Intrusive Thoughts in Parenthood
What is Perinatal Mental Health?
