Therapy for OCD

OCD in Pregnancy and Postpartum

OCD in the pregnancy and postpartum period is often confused with postpartum psychosis by both nonprofessionals and professionals. Women suffering from pregnancy and postpartum OCD fear that they could actually act on the thoughts of harming their baby. Often, these women feel that they are not fit to parent their baby. Many women do not tell anyone about these disturbing thoughts out of fear of being diagnosed “as crazy or dangerous,” being hospitalized, or having their baby taken from them. However, women suffering from perinatal OCD are NOT a danger to their baby and do not act on their scary thoughts.

Because of the lack of understanding between postpartum OCD and postpartum psychosis, women are at risk of being misdiagnosed. Careful assessment by a therapist or psychiatrist who has experience with OCD is critical. Women with postpartum psychosis experience a break from reality and often cannot tell that they are delusional and that their judgment is impaired. They do not have the experience of being horrified by thoughts of harming the baby and may actually feel like they are trying to protect the newborn. Postpartum psychosis is a medical emergency and requires immediate medical attention. OCD is a mental health condition that is treatable with outpatient therapy and possibly medication.

I have worked with many women who suffered from perinatal OCD. Most of them had never heard of perinatal OCD and many of them delayed seeking help for years due to shame and fear. Perinatal OCD is a disorder that affects between 2% and 5% of pregnant or postpartum women. Many women who suffer from perinatal OCD have never experienced OCD symptoms prior to pregnancy. The effects of perinatal OCD can be devastating. Depression, hopelessness, lack of self-care and suicidal thinking are common, as are problems caring for and bonding with the infant due to fear and avoidance. A mother’s sense of self can be seriously damaged if left untreated.

Fortunately, there is help available. Postpartum OCD, like other sub-types of OCD is treatable with an empirically-validated form of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP). With this method, people learn to and overcome their obsessive fears and the compulsive and avoidant behaviors they use to manage their fears. When seeking treatment for perinatal OCD, it is important to find someone who has had specialized training in ERP.

Common obsessions in perinatal OCD include:

• Images or thoughts of throwing the baby from a bridge, balcony or stairs

• Thoughts of putting the baby in the microwave

• Thoughts of stabbing or suffocating the baby

• Disturbing thoughts of sexually abusing the baby

• Fear of harming the baby because of carelessness and irresponsibility

• Thoughts of accidentally harming the baby by exposing it to chemicals, germs, pollutants, etc.

• Fear of giving the baby a disease such as AIDS, cancer or herpes

• Fear of making the wrong decision about the baby’s welfare (vaccines, certain foods, medications, etc.)

Common compulsions in perinatal OCD include:

• Hiding or throwing away knives or other sharp objects

• Avoiding changing the baby’s diaper for fear of sexually abusing the baby or touching it in an inappropriate way

• Avoiding feeding the baby for fear of poisoning the baby

• Excessive washing and sterilizing of baby’s bottles, clothing, food prep, etc.

• Keeping the baby away from other people for fear they might contaminate the baby

• Rigidly sticking to a baby schedule in

• Avoiding being alone with the baby or caring for the baby

• Repeatedly asking family members for reassurance that no harm or abuse has been done to the baby

• Repeatedly checking on the baby