Postpartum OCD: Symptoms and Treatment

By: Suzanne Feinstein, PhD

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Postpartum OCD, also known as postpartum obsessive-compulsive disorder or PPOCD, is a subtype of postpartum depression that affects some 3% to 5% of new mothers, and can be triggered by a sudden fluctuation of hormones, typically within the first few weeks to months after childbirth.  Women can experience intrusive and distressing thoughts or obsessions, often related to the baby’s safety or well-being. In addition, new mothers can experience intrusive sexual obsessions. These unwanted thoughts or images can lead to compulsive behaviors in an attempt to reduce the anxiety or prevent harm to the baby.

Despite the low risks, new moms may worry obsessively that their babies will die of Sudden Infant Death Syndrome and check compulsively that their babies are still breathing. They may engage in excessive cleaning or washing rituals for fear that their newborn will catch an illness. They may check repeatedly that the stoves are turned off, doors and windows are locked, and rooms are cleared of anything that can cause their baby to suffocate. They may avoid breastfeeding, giving their baby a bath or holding their child for fear of acting on a sexual impulse.

Anxiety can be severe enough to cause the mother to doubt her own senses and memory. Do I smell fire? Did I lock the door? Did I touch my baby inappropriately? She may seek reassurance from others and take unnecessary precautions to appease her anxiety.

Here are some key points about postpartum OCD:

Obsessions: Postpartum OCD is primarily defined by obsessions, which are repetitive, distressing, and intrusive thoughts or mental images. These thoughts often revolve around fears of unintentionally harming the baby, and they can be graphic or unsettling.

Compulsions: Behaviors are performed to alleviate the anxiety and distress caused by these obsessions. Individuals with postpartum OCD may engage in compulsive behaviors or rituals. These actions may involve excessive checking, cleaning, counting, or other repetitive behaviors aimed at preventing harm to the baby.

Different from Postpartum Depression: Postpartum OCD is distinct from postpartum depression, even though they can co-occur. In postpartum depression, the primary symptoms are typically related to mood changes, such as sadness and emotional detachment, whereas in postpartum OCD, the primary symptoms are obsessions and compulsions.

Prevalence: The exact prevalence of postpartum OCD is not well-documented, but it is considered a rare condition compared to postpartum depression. However, it may be underreported due to the stigma surrounding mental health issues.

Risk Factors: Postpartum OCD may be more common in women with a pre-existing history or family history of obsessive compulsive disorder or other anxiety disorders. The hormonal shifts and emotional changes that occur during pregnancy and after childbirth may also contribute to its development.

Treatment: Postpartum OCD is treatable, and the most effective approach often involves a combination of psychotherapy (such as cognitive-behavioral therapy or exposure and response prevention therapy) and, in some cases, medication. Support from a healthcare provider or mental health professional is essential to develop an appropriate treatment plan.

These obsessions and compulsions can be distressing and time-consuming. Here are some examples of postpartum OCD symptoms:

Obsessions related to harm: The mother may have recurring, distressing thoughts of accidentally harming the baby, such as dropping the baby, suffocating them, or causing them other types of harm.

Obsessions about contamination: The individual may have obsessions about germs or cleanliness and feel a compulsive need to constantly clean and sanitize everything to protect the baby.

Checking compulsions: Constantly checking on the baby, even when the baby is sleeping soundly, to ensure their safety. This can lead to severe sleep deprivation.

Repetitive thoughts and images: The person may experience distressing mental images of harming the baby or have recurring, irrational thoughts about something bad happening to the baby.

Superstitious or irrational rituals: Developing unusual rituals or behaviors, such as repeating certain phrases or prayers to ward off harm from the baby.

Hyper-responsibility: An intense need to be excessively vigilant and overprotective of the baby to prevent harm, which can lead to extreme stress.

Avoidance behaviors: Avoiding situations or activities that trigger obsessive thoughts, such as avoiding holding the baby or refusing to be alone with the baby.

Intrusive thoughts about sexual or aggressive themes: These thoughts may not be acted upon and can be very distressing for the individual.

If you or someone you know is experiencing postpartum OCD, it’s important to seek help and support. Here are some common treatment approaches:

Therapy: Cognitive-behavioral therapy (CBT) is the first-line treatment for postpartum OCD. Specifically, exposure and response prevention (ERP) is an effective form of CBT for OCD. This therapy involves confronting the obsessions and learning to resist the urge to perform compulsive behaviors. CBT can be done individually or in a group setting.

Medication: In some cases, medication may be prescribed, especially if the symptoms are severe and significantly interfere with daily life. Selective serotonin reuptake inhibitors (SSRIs) are commonly used, and they are generally considered safe during breastfeeding.

However, it’s essential to consult with a healthcare provider to discuss the risks and benefits of medication during the postpartum period.

Support groups: Joining a support group for new mothers or individuals with OCD can provide emotional support and practical advice. Sharing experiences with others who are going through similar challenges can be comforting and helpful.

Education: Learning about postpartum OCD and OCD in general can be empowering. Understanding the condition, its symptoms, and treatment options can help reduce fear and stigma.

Self-care: Taking care of your physical and emotional well-being is crucial. Ensure you are getting enough rest, eating well, and engaging in regular exercise. Reducing stress and practicing relaxation techniques like deep breathing or mindfulness can also be beneficial.

Involving your partner or support network: Share your experiences with your partner, family members, or close friends. Having a strong support system can make a significant difference in managing postpartum OCD.

Consultation with a mental health professional: It’s important to consult with a mental health specialist who has experience in treating OCD, particularly postpartum OCD. They can provide a personalized treatment plan and monitor progress.

Learn more about the supportive treatment we offer for postpartum OCD.

Contact us today  at Advanced Behavioral Health to schedule an initial consultation. Dr. Suzanne Feinstein is an Instructor in Medical Psychology at the Columbia University Department of Psychiatry/NYSPI.

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