Post-partum OCD: What causes the unthinkable anxiety disorder and how to get help.

New parenthood is naturally an anxious time. The middle of the night breathing checks, the constant inspecting of bumps and rashes, the frequent calls to the doctor – most parents can identify with the feeling of being on high alert. But the stress takes a different turn for 2-3% of women, who are tormented by recurring, aggressive thoughts about hurting their babies. Postpartum OCD is not commonly talked about, but psychiatrists are understanding it more and more. Meanwhile, brain researchers wonder if this anxiety disorder might be an adaptive parenting mechanism gone awry.

Moms with OCD have visions of stabbing, drowning or suffocating the baby repeatedly throughout the day. Along with fears of contamination or rigid ideas about feeding or bathing, these images pop into their minds over and over. A mom might pick up a knife to cut broccoli and think, “What if I . . . ” Merrill Sparago, a Los Angeles psychiatrist who specializes in helping women in pregnancy and postpartum, says that almost all new moms have bizarre thoughts, but for moms with OCD they are repeated and intrusive. After awhile, the mom begins to doubt herself, worrying that if she’s thinking this way she might actually be capable of following through.

Moms with postpartum OCD hide the kitchen knives, or avoid the baby as much as possible, fearing that they might act on a disturbing thought. But according to Sparago, these moms are not dangerous. Postpartum psychosis – a separate disorder in which a mom loses touch with reality and her aggressive thoughts seem logical to her – requires immediate medical attention. This was the diagnosis in the famous case of Andrea Yates, who drowned her children in the bathtub because she believed she was saving them from evil. In contrast to this, the very fact that a woman with OCD is bothered by her thoughts and wants them to go away means she’s no more likely to hurt her baby than any other mom.

James Swain, a scientist at the University of Michigan, says that a new parent’s brain is wired for anxiety. He argues that having a certain level of this emotion in the post partum is evolutionarily adaptive – it has helped us keep our babies out of harm’s way for thousands of years. Swain and other researchers at Yale found that, even for a normal parent, the sound of a crying baby triggered brain regions associated with anxiety and OCD. The problem with the full-blown disorder is that a woman becomes stuck in thought patterns that are no longer adaptive and disturbing thoughts or fears become caught in the obsessive-compulsive machinery.

Not surprisingly, a mom with OCD is likely to keep her thoughts to herself, fearing that the rest of the world, or even her partner, might think she is crazy. Sparago stresses that the correct diagnosis is key (distinguishing OCD from post partum depression or psychosis), because the treatment that follows will be tailored to the mom’s needs. Along with medication, cognitive behavioral therapy helps moms slowly approach their fears. The key is to separate the obsessions from a mom’s self-concept. “It takes a long time to convince a mom with OCD that she’s not crazy,” says Sparago, “and to accept that her thoughts are the fault of the disease – she is not a bad person.”

If you think you might need support during your pregnancy or postpartum, help and information is available through Post Partum Support International.

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