Postpartum OCD, or PPOCD, is another manifestation of Obsessive Compulsive Disorder (OCD). While it has its own name, PPOCD can be considered a further subtype of Harm OCD, which is a colloquial name used to describe a specific cluster of symptoms found within an OCD diagnosis.
What is Postpartum OCD
PPOCD consists of unwanted intrusive thoughts, urges, and mental images pertaining to harm against one’s child or children and manifests shortly after the birth of a new child. While mostly women experience this manifestation of OCD, PPOCD is also known to occur in new fathers. Generally, people who develop PPOCD have a history of OCD symptoms, or have been diagnosed with and treated for OCD. However the stressful event of and hormonal changes occurring around childbirth can influence PPOCD expression.
Harmful thoughts against one’s newborn child are common among those with and without OCD, however they are often kept secret. 80% of new mothers, even those without PPOCD, will experience harm related thoughts toward their newborn child shortly after birth. The neurotypical person experiencing these thoughts will likely move past them easily and categorize them as simply “odd” or a result of poor sleep. The OCD sufferer, however, will personalize and ruminate on these thoughts.
Symptoms of PPOCD
Obsessions for Postpartum OCD
- Violent mental images of harming one’s child
- Mental images of children being hurt or killed in various ways
- Intrusive thoughts like “What if I drown my baby?”
- Discomfort being alone with one’s child
- Discomfort using knives around one’s child
Compulsions for Postpartum OCD
- Avoiding dangerous or perceived dangerous items while holding the baby
- Avoiding being alone with the child.
- Resisting bathing a child alone
- Asking others for reassurance that you’ll never hurt your baby
- Telling one’s self “I’m not violent”
- Reading about mothers who have killed their children and looking for similarities to and differences from one’s self
Postpartum OCD vs Postpartum Psychosis
People with PPOCD often question whether their violent thoughts are the result of OCD or whether they genuinely are a danger to their children. In researching the meaning of these new intrusive thoughts, people often come across news stories or articles about new mothers experiencing Post-Partum Psychosis and actually harming or killing their children. Not surprisingly, stories about parents having violent thoughts resulting in violent acts toward their children would terrify someone with PPOCD. Therefore, the distinction between Post-Partum Psychosis and PPOCD is important to recognize.
Unlike people with Post-Partum Psychosis, people with PPOCD experience shame, guilt, and disgust simply at the presence of these thoughts. The thoughts are seen as completely counter to who they are and strive to be. The person with Post-Partum Psychosis sees nothing wrong with the thoughts. In fact, people with Post-Partum Psychosis view their thoughts as legitimate solutions to their problem and therefore are not concerned about them. Studies show that only 4% of people with Post-Partum Psychosis go on to harm their child, while no cases of PPOCD have resulted in harm.
Postpartum and Perinatal OCD
Parinatal OCD differs from Postpartum OCD in the time in which it is diagnosed and the time during which it occurs. Perinatal OCD is a slight variation on Postpartum OCD by focusing on the themes of harming a child in utero. The term PPOCD can be used to include both Postpartum OCD and Parinatal OCD subtypes.
Many factors can lead to the manifestation of Perinatal OCD, just like Postpartum OCD. While the tremendous shift in hormones during pregnancy contribute to the onset, the emotional roller-coaster of having a child and being a parent, sometimes for the first time, can trigger a flood of worries and “what ifs.”
In addition to behavioral treatment, medication management can also be considered with the help of a doctor or psychiatrist. Medication can be an effective tool to manage the anxiety and distress associated with the intrusive thoughts, but can also serve as a trigger for future obsession. Indeed it can be a double-edged sword. For example, an expectant mother suffering from Perinatal OCD may choose to take medication to help relieve their anxiety but find they begin to obsess about whether the medication itself is causing harm to the developing fetus. To avoid this, the same mother may avoid or discontinue medication only to find a spike in their anxiety and a resulting obsession about the effects of increased cortisol and chronic anxiety on the baby.
Treatment for Postpartum OCD
Post-Partum OCD can be effectively treated with Cognitive Behavioral Therapy (CBT), Exposure and Response Prevention (ERP), and mindfulness based treatment, like Acceptance and Commitment Therapy (ACT). The goal of treatment is to help someone re-think the meaning and significance of their thoughts to develop a balanced and more rational perspective. This grounded re-evaluation then allows clients to slowly approach their thoughts and fears while resisting unnecessary compulsions. Through progressive exposure to the feared situations or triggering objects, clients experience a reduction of the discomfort associated with these triggers.
Exposure therapy will be geared toward the individual’s specific obsessions and compulsions, and are intended to help the sufferer interact with their child and engage with life as they want. For example, a client’s goals may simply be to change their child’s diaper or bathe them alone. Therefore, exposures would be designed to progressively help them perform these routine tasks while tolerating their thoughts and learning that they can indeed do these without acting out on their feared thoughts.
Over time, clients learn that their thoughts do not make them dangerous, and that they can have violent thoughts around their child without harming them or engaging in unnecessary compulsive behaviors.
To learn more about PPOCD, or to schedule an assessment, please contact me.
FearCast Podcast episode about PPOCD with Kelley Franke, MA
The California OCD and Anxiety Treatment Center offers specialized therapy for Hypochondria in its Fullerton offices. In addition to serving North Orange County, Los Angeles, and the Inland Empire, CalOCD offers online therapy, group therapy, and Intensive Out-Patient treatment.