Postpartum OCD: 101

 When I went to my first counseling appointment, I didn't know that postpartum OCD was a thing. 

In fact, I'd only recently learned that the lineup of postpartum mental health disorders extended beyond depression. A few weeks after Amelia was born, I mentioned to a friend that I had been feeling super anxious lately, and she was the one who first used the phrase "postpartum anxiety." At my 6-week checkup with my OBGYN (really more like 9-10 weeks because #4thchild), they also talked to me about postpartum anxiety, and gave me some options for managing it. 

Option 1: Wait it out.

Option 2: Take medication.

Option 3: Find a counselor.

I chose option 3, and a few weeks later, I walked into the counselor's office, not really knowing what to expect, but certainly expecting to get a "postpartum anxiety" stamp on my paperwork.

After talking for a bit and explaining the things that I had been experiencing, the counselor looked at me and said, "Have you ever heard of postpartum..."

(I probably started shaking my head "yes," so sure was I that she was going to say "anxiety.")


My nod quickly became a shake as I was caught off guard.

"No," I answered, honestly. 

The truth is, OCD wasn't even on my radar. I didn't know what OCD really meant or what it really looked like. I mean, I'd seen Monk...and that was about it. I kind of thought it was extreme perfectionism and an odd affinity for multiples of 10.  

Now that I've learned a bit more about it, I thought I'd give a little overview of it for you all. As I've learned more about postpartum mental health problems (and experienced them), I can say that keeping quiet about our struggles doesn't help anyone. We need to educate ourselves, and we need to help each other. That's how moms feel empowered and supported in getting the help they need. You feel me?

So this post will just be a look into what Postpartum OCD is, in general. I plan on writing another post soon that will talk a little more about what it has looked like for me, specifically. I'd actually love to hear whatever questions you have for me about what I've gone through so that I can address them in the next post, so feel free to leave them in the comments or elsewhere!


What is Postpartum OCD?

Postpartum Obsessive-Compulsive Disorder affects about 3-5% of women who are within 12 months of giving birth, although symptoms usually arise within 2-4 months after giving birth.

At the most basic level, PPOCD involves "obsessions," recurring and unwanted thoughts in the new mother, and/or "compulsions," behaviors meant to keep the obsessions at bay, or to prevent the things you are obsessing over from happening.

What are obsessions?

Obsessions are strong, unwanted, often unwarranted, recurring thoughts or mental images. While they are not real (and people with OCD recognize that they are not real), they are extremely troubling and interfere with your ability to live your life as you "normally" would. They have a very "it's only a matter of time" feel to them, which creates a sense of urgency and anxiety. 

What obsessions do postpartum OCD mothers have?

Usually, mothers with PPOCD obsess over the health and safety of their newborns, but that can be extended to worries other children, a spouse, or the mother herself. It's not uncommon for mothers to see themselves causing the harm. They may obsess over drowning the baby in the bathtub, throwing themselves down the stairs, driving the car into a wall, or stabbing the baby with a kitchen knife. 

Don't all mothers experience this?

Yes, actually. While I guess I shouldn't say "all," lots of new mothers have these "What if...?" thoughts that come in their heads from time to time. It's very normal. What isn't normal is when the thoughts are recurring and intense, to the point where it is practically all the mother thinks about for hours or days at a time. Whereas a normal person may be able to think about a troubling thing, worry a bit, and then move on, an OCD sufferer ends up spending a lot of time on their obsessions, and as a consequence, is less capable of going about with their everyday activities. 

What are compulsions?

Compulsions are any kind of action or ritual, done in an attempt to manage the obsessions. They can be physical or mental, or can involve avoidance, repetitive behaviors, or asking for reassurance.

A major trait of compulsions in OCD is that they are unwanted. The person doesn't want to perform the ritual, but feels compelled to in order to escape the obsession. This is why perfectionism isn't necessarily a trait of OCD. It might be, but simply wanting things to be done a certain way is more of a preference than a way to avoid something terrible happening. 

One interesting thing to note: a book I'm reading actually says that as many as 30% of people who have OCD actually suffer from obsessions alone, without major compulsions. 

What do compulsions look like in PPOCD?

It depends on the mother's obsessions. A mother might mentally review her day over and over to make sure she hasn't done anything to harm her baby. She might clean non-stop to keep germs away from the baby. She might avoid giving the baby a bath, using knives, or walking by a window with the baby. There are obviously many more possibilities, but you get the idea. 

How is postpartum OCD different from postpartum depression or anxiety?

These disorders often go hand in hand, and postpartum OCD and anxiety, in particular, are very similar. The difference from postpartum depression is a little more marked. This is a good resource that highlights the differences; it actually lumps anxiety and OCD together, since they are so interconnected.

From my reading, the biggest difference I can discern between PPOCD and PPA is that OCD seems to focus on singular, intense intrusive thoughts, while anxiety is more like a whirlwind -- so many thoughts and feelings going on that you couldn't possibly just pin one down to obsess over. 

What do I do if I think I have PPOCD?

Talk to your doctor, probably your OBGYN. Right now, today. 

Many women with PPOCD fear that because they are having thoughts about harming their baby, their baby will be taken away from them and they will be hospitalized. The fact is, because you know your thoughts are not also your desires, and because you know they aren't real, this will not happen. 

If you find yourself wanting to act out your obsessions, or are having a hard time separating your thoughts from reality, you may be experiencing postpartum psychosis. This is a medical emergency and should be treated as such -- go to the emergency room. 

What does treatment look like?

Medication is very effective in treating postpartum OCD, and counseling, while perhaps not as fast, is another good option. A counselor will probably employ cognitive behavioral therapy (CBT) techniques to help you retrain your brain. 

Okay, wow, I realize that was pretty long. And I honestly just brushed the surface of what the disorder actually looks like and what should be done about it.

There are tons of good resources out there discussing postpartum OCD and postpartum mental health in general. Postpartum Progress is a good place to start.

Please don't be afraid to ask for help. And don't be afraid to reach out to a new mom and ask her how she's doing. Like I said before, keeping quiet doesn't help anyone.

And seriously, if you have a question about PPOCD -- whether it's a general question or a question about what it's looked like for me -- please don't hesitate to reach out! This has been my life for many months now, and I'd love to help anyone I can who might be struggling, too. 

Update: Here's my next post, with a little deeper look into what postpartum OCD has looked like for me.