After her second child was born, Britney Asbell, 29, became obsessed with the thought that someone might break into their home or their house might catch on fire. At the time, she also fixated on the safe where the family’s gun was kept. “I would just sit and spend probably the first hour or two of my day repeating the code [to the safe],” she said. “That was my compulsive behavior then. I had to know. What if something happened and I needed to protect my children?”
Among the mental health disorders that affect new mothers, postpartum obsessive-compulsive disorder just might be the most misunderstood, if it's even recognized at all. Postpartum OCD is believed to affect between 2 and 3 percent of people who have recently given birth, while affecting only 1.08 percent of the general population, according to research published in the Journal of Clinical Psychology. The jury’s still out as to why.
Postpartum OCD is much different from postpartum depression. It’s important to differentiate between the two so that mothers can receive the treatment they need, allowing them to be healthy and happy in their new role. PPD is characterized by intense sadness, loss of interest in things once enjoyed, guilt, worthlessness, and lack of motivation, said Margaret Howard, professor of psychiatry, human behavior and medicine at Brown University.
Obsessive-Compulsive Disorder, however, is characterized by unwanted and relentless thoughts that cause significant distress,” Howard explained. Postpartum OCD also varies from postpartum psychosis, which is characterized by delusions, hallucinations, or extreme feelings of elation. The minimal but developing research on postpartum OCD shows that people managing it do not want to harm their child. Instead they can become consumed with the fear of causing intentional harm to their child, or of something bad accidentally happening to them.
For Asbell, a mom of three in Macon, Georgia, these thoughts play on repeat in her head. One thought, ‘What if I drop baby down my stairs?’ could easily result in hours spent working through that what if question, mentally playing out each potential scenario that could have followed.
The symptoms of postpartum OCD are very specific. Intrusive thoughts are a normal part of the new mom experience, with the vast majority (between 70 and 100 percent) of people who recently gave birth reporting at least some thoughts related to harming their baby unintentionally. As pointed out by BMC Psychiatry, maternal OCD is different than the typical experience, though, because the onset often takes place immediately after birth, because of how frequent and distressing those intrusive thoughts become, and the manner in which people cope with them. The sheer volume of terrifying thoughts is what transforms run-of-the-mill new parent nerves into unmanageable anxiety for people with postpartum OCD.
Stephanie Saunders, a 28-year-old mother of one living in British Columbia, said that her intrusive thoughts became more pronounced and debilitating around five months after she delivered her child. “I was petrified that if I stood on the balcony with her that she would somehow fall off the railing and die, and that I wouldn’t be able to protect her,” she said. Fear of missing a red light and getting into a gruesome car accident made it difficult for her to leave the house. She began avoiding social outings, worried that when her daughter began to cry, the other mothers would assume she was an incapable mother.
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“The response to these distressing thoughts is to engage in behaviors or even mental rituals such as counting or saying certain words over and over, that are believed to ‘neutralize’ the obsessive thoughts,” Howard said. Sometimes, the behaviors individuals turn to for comfort from these obsessive thoughts are obvious—excessive washing and sanitizing in the house to deal with fear of germs, for example. Other times, behaviors may be disguised as “normal” new mom things, like checking their baby’s breathing. Avoiding situations that cause anxiety, like bathtime or leaving the house, is also a common compulsive behavior.
Compulsions may even arise in subtle ways such as thought monitoring, according to Jenny Yip, clinical psychologist and a member of the International-Obsessive Compulsive Disorder Foundation, or IOCDF. Thought monitoring is what’s known as a covert compulsion, which can involve repeated reviewing of thoughts to determine if they’re “right” or “good.” As a mother of twins with a childhood history of OCD, Yip began to experience obsessive thinking after their birth surrounding the fear that she might love one more than the other. She fell into a habit of compulsively checking her thoughts about her babies to manage her anxiety.
According to Howard, screening for postpartum OCD is the first step if I doctor feels their patient could be at risk—that should be followed by a clinical interview that confirms the diagnosis. If diagnosed, a proven method of treatment for it is exposure and response prevention therapy, Yip said. This specialized therapy is recommended to the majority of people with OCD by the IOCDF and works on identifying triggers for obsessive thinking. Then, in a therapeutic setting, individuals are taught to trigger these thought processes and intentionally chose not to engage in compulsive behaviors, which reduces behaviors and anxiety over time.
Unfortunately, people with postpartum OCD often fall through the cracks, Yip said. This is often the result of inadequate screening—regular screening for anxiety disorders like OCD is performed by as little as 20 percent of care providers. And, with so little accurate information about postpartum OCD readily available to new moms, their fear of judgment, or worse, holds them back from seeking help.
“The whole point of the initial postpartum period is bonding,” Yip said. “It’s supposed to be bliss. Instead, you’re going through this really rough period of having the intrusive, horrific images and that interferes with the bonding period.”
This was the case for Asbell, who struggled after the births of all three of her children but didn’t report her intrusive thoughts until her third postpartum period. After her second child, she reached out to her physician at eight weeks postpartum after experiencing what she calls a bought of rage, throwing a toy across the foyer in her home to release pent up, overwhelming emotions. It was hard for her to speak up. She was afraid they might see her act of anger, although it wasn’t directed at her children, as a reason to take her children. Because she felt being honest about her feelings and actions was already “pushing the envelope,” she kept quiet about her obsessive thoughts.
She doesn’t recall being screened formally at all, but was treated for postpartum depression with a prescription. She found her symptoms getting worse. After a panic attack at four months postpartum, she was accepted into an outpatient partial program for PPD. This was the first time it crossed her mind that she might have obsessive-compulsive tendencies. She remained in therapy throughout her third pregnancy and continued on after the birth of her child. It was at this point that she finally felt comfortable voicing her intrusive thoughts and eventually received a postpartum OCD diagnosis.
Many people in her position may fear that they’ll be hospitalized which, unfortunately, isn’t a baseless fear, according to Yip, who explained that there are still physicians who haven’t been educated on postpartum OCD and very well may suggest hospitalization or a 72-hour-hold for psychiatric evaluation. For new moms who want nothing more than to care for their new child, this can be a terrifying thought.
She doesn’t want people to be afraid to speak up. Instead, she suggests that parents who believe they’re experiencing these symptoms should begin by doing their own research to prepare themselves for their follow-up appointment. “If you’re going to your doctor for the purpose of getting help, I would highly suggest you [seek out] information about postpartum OCD,” she says. “Take it to your doctor and tell them, ‘Hey, these are my symptoms and this is what I believe I’m experiencing.’”
Self-advocacy is difficult during a vulnerable time in your life, but it’s often necessary. Lindsey Aerts, a 36-year-old from Salt Lake City, who experienced postpartum OCD after the birth of her first child, doesn’t recall being screened at her six-week check-up and found herself googling “Does having scary thoughts mean I’ll act on them?” before reaching out to her care provider again at three months postpartum. Now, along with Asbell and Saunders, she’s taken to social media to spread awareness about the disorder using the hashtag #PPOCD.
“Luckily, I feel like I got the treatment I needed but I know so many moms who are not in the same situation,” Aerts says of her experience after being referred to a psychiatrist and diagnosed with postpartum OCD.
Ultimately, it seems that OCD is pretty misunderstood in general. Yip points to the media, which focuses largely on quirky behaviors like counting or handwashing, without giving the public a view of the disturbing, obsessive thoughts that may be driving these comforting, compulsive behaviors. The hope is that, with experts like Yip and Howard spreading awareness among professionals caring for new parents, and more people sharing their own stories online, fewer will suffer in silence.
“Once I started sharing, I had friends and even strangers saying, ‘Because you shared your experience, I felt less alone in mine,’” Asbell said. “It made me think that if more women opened up, more women might get the help they need.”