Perinatal Obsessive-Compulsive Disorder (OCD) is often a very scary, confusing, and misunderstood mental health diagnosis that may occur during pregnancy, after delivery, or both. Many pregnant or postpartum individuals don’t talk about their symptoms for fear that those around them will think they intend on harming their child, will want to take their child from their care, become fearful about their fitness to care for their child, and often question themselves, despite knowing that they would never hurt their child. It’s not entirely uncommon that a provider working in maternal health or in general mental health misdiagnoses the individual with postpartum psychosis which can contribute to increased fear and concern about symptoms.

Perinatal OCD may include less concerning, but still overwhelming symptoms of cleaning, checking, obsessing about germs, ordering, counting, checking on the baby, and hypervigilance. I’ve had clients describe visions of having a car accident that hurts the baby or the entire family each time they get into a car. Other clients have visions when preparing food of the knife going into the baby, of standing underneath a ceiling fan and seeing it hit their baby’s head, of themselves or others tripping while holding the baby and dropping the baby. I’ve also had clients who become convinced that the twitch of their eye from sleep deprivation, the pain in their stomach, or the dizziness they’re experiencing must be signs of cancer or another terminal illness. Similarly, they may see unusual behaviors in their newborn or child, or symptoms that cause concern and again convince themselves that there is something terribly wrong with their child. Many individuals report the thoughts and images play like a movie in their mind. These obsessive, intrusive thoughts increase symptoms of anxiety and terrify or horrify the individual because they begin believing that having these thoughts means they want to do these things, or for these things to happen. Please know that it’s important to recognize that these are just thoughts, and experiencing these thoughts or having these images does not mean that you want or intend on harming your child or anyone else.

When an individual experiences these frequent, intrusive thoughts they’re often followed by obsessive behaviors. The parent becomes hypervigilant about avoiding things that trigger them. For example, they may find it hard to drive a car or even be a passenger, they may avoid using knives at any time the baby is in the room, or they may be fearful of anyone, even the child’s other parent caring for the baby, which of course prevents them from getting needed breaks for sleep, eating, personal hygiene, or other items of self-care.

Risk factors for perinatal OCD include a previous personal or family history of OCD, whether diagnosed or recognized prior to symptoms experienced during pregnancy or after delivery. The individual also may have never presented with symptoms prior to getting pregnant or delivering their child. It’s also important to recognize that the other parent may experience these symptoms; they do not happen exclusively to the parent carrying and delivering the child. Additionally, please recognize that it’s likely the individual will also experience symptoms of depression in response to or additional to the symptoms of perinatal OCD.

As I mentioned, perinatal OCD can often be misunderstood as perinatal psychosis and that’s one of the reasons the individual becomes so fearful and tends not to talk about what they’re thinking and how they’re feeling. Things to consider with perinatal OCD include the fact that the parent doesn’t want to hurt their child or anyone else, their thoughts are obsessive and horrifying to them, they take steps to protect their child, and the individual doesn’t have delusions or hallucinations about harming their child. By comparison an individual with perinatal psychosis may have delusional thoughts about the child such as the child is a demon, is evil, or is possessed by the devil, the parent thinks these thoughts are reasonable and may consider acting on the thoughts. Additionally, individuals with perinatal psychosis may experience rapid mood swings or changes in behavior, losing touch with reality. hyperactivity and a decreased need for sleep (not to be confused with the lack of sleep that is common with a newborn), and may also become suspicious and have difficulty communicating.

If you or someone you know experiences any of these symptoms, please know that there is help available. You are not alone, and I can help you to explore your thoughts, normalize your symptoms, and to learn coping skills to assist you when they happen. I can also assist you by providing other resources for help and support with these or other types of perinatal mood and anxiety disorders.