Before you read on, I want to say something first. This blog talks about intrusive thoughts, including thoughts about harm coming to a baby. If that is not something you are in the right headspace to read about today, please come back another time. There is no pressure and no judgment. Your wellbeing always comes first. If you are ready, I am really glad you are here. Because this might be one of the most important things I write all week.
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The thought that stops mums in their tracks
You are holding your baby. Or bathing them. Or standing at the top of the stairs. And out of nowhere, a thought flashes across your mind. A horrible, unwanted, gut-wrenching thought. Something terrible happening to your baby. Something you might do.
And then comes the shame. The panic. The absolute certainty that you are a terrible person. That something is deeply wrong with you. That if anyone knew what just went through your head, they would take your baby away.
So you tell nobody. You carry it completely alone. And the thought keeps coming back, which makes everything feel even worse.
If that sounds familiar, I need you to keep reading.
Because what I am about to tell you is something that far too few mothers ever hear.
You are not a monster. You are not dangerous. And you are very far from alone.
Intrusive thoughts in new parenthood are extraordinarily common. Research shows that between 70 and 100% of new mothers and fathers experience unwanted intrusive thoughts related to their baby, including thoughts of harm. ¹ That is not a typo. The vast majority of new parents have these thoughts.
The difference between someone who has an intrusive thought and someone who develops perinatal OCD is not the thought itself. It is what happens next. It is how the thought is interpreted, and how much distress it causes. ²
For most parents, an intrusive thought flashes through and is quickly dismissed. For a mother with perinatal OCD, the thought gets stuck. It feels meaningful. It feels like a sign. And the shame and fear that come with it make it impossible to let go.
What is perinatal OCD?
Perinatal OCD is OCD that occurs during pregnancy or in the postnatal period. It can develop for the first time in women who have never experienced OCD before, or it can be a worsening of existing symptoms. ³
OCD has two main components. Obsessions, which are unwanted, intrusive thoughts, images or urges that cause significant distress. And compulsions, which are the repetitive behaviours or mental rituals a person uses to try to reduce that distress. ⁴
In perinatal OCD, the obsessions almost always centre around the baby. Common intrusive thoughts include fear of accidentally harming the baby, fear of contaminating the baby with illness, fear of deliberately hurting the baby in a moment of madness, and fear of acting inappropriately around the baby. ⁵
The compulsions that follow might look like constantly checking on the baby, seeking repeated reassurance from a partner or family member, hiding knives and sharp objects around the home, avoiding being alone with the baby, or refusing to do nappy changes out of fear of accidental inappropriate contact. ⁴
From the outside, these behaviours can be mistaken for being an anxious but devoted parent. On the inside, they are exhausting, all-consuming and deeply distressing.
Why do these thoughts happen?
It helps to understand why the perinatal period makes people so vulnerable to intrusive thoughts in the first place.
Becoming a parent brings with it a sudden and enormous increase in responsibility for a vulnerable, completely dependent human being. Researchers have suggested that this heightened sense of responsibility actually triggers an increase in harm-centred thoughts in almost all new parents. ⁶ It is thought to be the brain's way of being hypervigilant about protecting the baby.
For most people, this hypervigilance settles down as they find their footing in parenthood. For some, the thoughts become louder rather than quieter, and that is where perinatal OCD can develop.
Hormonal shifts during pregnancy and after birth are also thought to play a role, potentially influencing the brain chemistry associated with anxiety and obsessive thinking. ⁷ This is not something a woman can control or prevent. It is a physiological response to an enormous life transition.
The cruelest part of perinatal OCD
Here is what I think is the most heartbreaking thing about this condition.
The women who experience perinatal OCD are, almost without exception, women who love their babies fiercely. They are not having these thoughts because they want to harm their child. They are having them precisely because the thought of their baby coming to harm is completely unbearable to them.
The distress caused by the intrusive thought is actually evidence of how much they love their baby. The thought is ego-dystonic, which means it goes completely against who the person is and what they want. ¹
And yet the shame keeps them silent. The fear of being judged, of being seen as a risk, of having their baby taken away, means that most women with perinatal OCD suffer completely alone rather than reaching out for help. ⁸
There are no recorded cases of a mother with perinatal OCD acting on her intrusive thoughts. ³ Women with perinatal OCD are not a risk to their babies. They are women who are suffering and who desperately need support.
What perinatal OCD is not
It is worth being clear about one important distinction.
Perinatal OCD is very different from postpartum psychosis. In postpartum psychosis, a woman may experience delusions or hallucinations that could put her or her baby at risk. This is a genuine psychiatric emergency and requires immediate medical attention.
In perinatal OCD, the thoughts are recognised by the woman as unwanted and wrong. She knows they are not real desires. She is horrified by them. That recognition, that horror, is actually a key part of understanding that what she is experiencing is OCD rather than psychosis. ¹
If you are ever unsure, please seek medical advice immediately. But if you are reading this and recognising your own experience in the description of OCD, that recognition itself is an important sign.
What does treatment look like?
The good news is that perinatal OCD is treatable. The recommended first-line treatment is Cognitive Behavioural Therapy, specifically a type called Exposure and Response Prevention therapy, or ERP. ⁴ This helps a woman understand how her OCD works and learn to sit with the discomfort of an intrusive thought without carrying out the compulsion that usually follows. Over time, the thoughts lose their power.
Medication is also an option in some cases and can be discussed with a GP or psychiatrist. Many women are concerned about taking medication during pregnancy or while breastfeeding, which is completely understandable. A specialist can help weigh up the risks and benefits in each individual case.
The most important first step is simply telling someone. A GP, a midwife, a health visitor. You do not need to have the words perfectly formed. You do not need to be able to explain it clearly. You can even print this blog out and take it with you if that feels easier.
If this is you, please hear this
You have not failed. You are not broken. You are not dangerous.
You are a mother who is suffering from a recognised, treatable mental health condition. And you deserve exactly the same compassion, understanding and support as anyone else who is unwell.
The thought is not who you are. It is a symptom. And symptoms can be treated.
Please do not carry this alone. Your GP, midwife or health visitor can refer you to appropriate support. Maternal OCD, the charity run by mothers who have recovered from perinatal OCD, also offers peer support and can be reached at maternalocd.org.
You are not a monster. You are a mum who needs some help. And there is absolutely no shame in that. 💛
Bex x
References
- Policy Center for Maternal Mental Health. Maternal OCD. policycentermmh.org
- Postpartum Support International (2019). Understanding perinatal OCD part 1. postpartum.net
- Royal College of Psychiatrists. Perinatal OCD. rcpsych.ac.uk
- Mind. Perinatal OCD. mind.org.uk
- OCD-UK. OCD during a prenatal or postnatal period. ocduk.org
- Maternal OCD. About perinatal OCD. maternalocd.org
- International OCD Foundation. Perinatal OCD: what research says about diagnosis and treatment. iocdf.org
- PMC / British Journal of General Practice (2013). A hidden problem: consequences of the misdiagnosis of perinatal OCD. pmc.ncbi.nlm.nih.gov