Postpartum OCD- What you Need to Know
When we refer to "Postpartum Depression", we miss the ball for many, many women who struggle during pregnancy or after giving birth. Sure, tons of women become depressed during pregnancy or after (about 1 in in 5, actually), but even more women struggle with some form of anxiety, whether that be generalized anxiety, panic, obsessive compulsive disorder, or PTSD. I can't tell you how many women wait for a very long time to call me and receive support because they "didn't have postpartum depression because they weren't depressed." In truth, Postpartum Depression (as opposed to general depression) is a very anxious depression, meaning that women not only feel depressed, but feel hugely, unbelievably, and often devastatingly anxious. One of the postpartum anxiety disorders that women might struggle with is postpartum Obsessive Compulsive Disorder (Postpartum OCD). Studies suggest that 3-5% new moms will experience symptoms of OCD, but I truly believe that the numbers are much greater than that. In my Boulder psychotherapy practice, probably 2/3 of the women who I see are suffering from OCD symptoms.... It my world, this illness is very, very common. It's just that there is a ton of shame and guilt that comes along with the very common OCD symptoms, and so many women are afraid to let people know that they are struggling.
And what does "struggling" mean for these moms? Moms who have postpartum OCD suffer repetitive, frequent, intrusive, and often very scary thoughts of harm coming to themselves or their babies. While not all women struggling with postpartum OCD have these characteristic scary thoughts, most of them do, and often in their thoughts they are the ones causing the harm. These thoughts are usually gruesome, disturbing, scary, and unexpected. Women who struggle with postpartum OCD say that these thoughts appear out of nowhere and that they feel that they can not control when these thoughts come and go. Moms who have these thoughts are very disturbed by the very fact that they occur. They know that the thoughts that they are having are wrong, and they are confused by the fact that these thoughts have nothing to do with the ways that they imagine themselves to be as mothers.
And these moms will do everything that they can to keep their babies safe. The "obsessions" in OCD refer to the thoughts, and the "compulsions" refer to the behaviors that accompany those thoughts in an attempt to reduce the anxiety that the thoughts create. These moms will avoid anything that makes them afraid that they might hurt their babies in any way. They might avoid public places or obsessively wash baby bottles. They might hide all sharp objects in their home. They might refuse to give their babies baths, or walk down stairs, or drive in a car. Frequently, when support isn't put into place, these moms will say that they feel like their babies are safer without them. We actually do not worry about moms hurting their babies when they suffer from OCD- again, we know that they will do anything in their power to keep their babies safe. But we do worry about those moms who do not receive adequate support because their symptoms can become unbearable.
And, let me be very clear here- Postpartum OCD is NOT the same as Postpartum Psychosis. Although every mom with OCD feels like she is on the brink of going "crazy", and fears that she will "snap" or do something to her child that she doesn't want to do, the simple reality that she has these fears and that she wonders if she is psychotic lets us know that she is not. Unlike OCD, women who suffer from postpartum psychosis do not know that the thoughts that they are having are wrong. They do not necessarily feel like they are going crazy because they are in their own reality that is out of touch with "right" and "wrong." There is usually a lack of guilt, shame, and anxiety that accompanies the thoughts that occur with Postpartum Psychosis. And unfortunately the women who suffer with PPP who do not always do everything in their control to their babies safe from harm.
(And, yet, every mom who has postpartum OCD and who walks into my office tells me that she is sure that she is going crazy. Suddenly, every hyped-up media story about postpartum psychosis feels very close to home.)
Research tells us that up to 70% of women who suffer from OCD symptoms prior to becoming pregnant will have a resurgence of symptoms during their pregnancies or postpartum period. It is believed that somewhere between 13-59% new moms who experience OCD after giving birth will be experiencing OCD for the first time; and 29% of those women who have suffered from OCD in their lifetime will experience an exasperation of symptoms during the postpartum year (references if you would like them). One of the biggest risk factors in developing postpartum OCD is having a personal or family history of OCD or high level anxiety.
The good news? (yes, there is some)...Postpartum OCD is absolutely treatable. Like with other perinatal mood and anxiety disorders, we know that when women seek out help and follow treatment recommendations, they get well. All of them.
OCD is treated best through a combination of medication and therapy support. We know that OCD is primarily a biochemical issue, and therefore it responds well to SSRIs and other anti-depressant and anti-anxiety medication. Usually, once a woman gets on the right medicine for balancing out her biochemistry, she will notice a relief in symptoms within a few weeks. I see it happen all the time.
And psychotherapy (especially therapy that includes cognitive behavioral strategies) helps mom to develop techniques for stress reduction and changing thought patterns that contribute to anxiety. And, as always, therapy really helps a mom realize that she is not crazy, that she is not alone, and that she is, in fact, a fabulous mom to her kiddo.
So, please, if this all resonates for you or someone who you know, reach out for the help that you deserve.
For a great book on Postpartum OCD: Dropping the Baby and Other Scary Thoughts, by Karen Kleiman, MSW