Post-partum OCD: What causes the unthinkable anxiety disorder and how to get help.
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.
Wow, I had no idea that this existed. I suffered slight “blues” after the birth of our daughter, but this…
Thank you for the insight.
Thank you for this. I suffered with this after both of my children were born. I felt shame for having these thoughts and helpless. I was treated successfully both times and was able to function like a ‘normal’ mom. But that road is really rough, and it’s hard to be patient when you want so desperately to be a good mom/wife. I don’t think a lot of mothers know that this and post partum depression often hits at about 12 weeks post partum when there’s a huge hormone shift. Get help, the people around you love you, and you can and will feel better.
In addition from distinguishing OCD from psychosis, checking for co-morbidity (where both OCD and psychosis are present) is important as well.
So many women are tormented by OCD. Doing peer support I have often found that just knowing she is being more of an “overprotective mother” and not “bad mother” is often a huge relief to the new mom.
Thanks for the article.
Please don’t forget that this kind of OCD can affect Dads too… it takes a lot of courage to admit that the intrusive thoughts are happening, and I applaud anyone who recognizes themselves in this description and seeks help.
To the poster that say’s a co morbidity is possible with a OCD AND a psychosis. I’ve never heard of that and it disturbs me, being a mom of an 8.5 month old and having moderate PP/OCD. How is this possible? Can you explain please?
You either have OCD or Psychosis…….not both from what I’ve heard…..
I know that I’ve heard this several times: that if the mom is disturbed by what she is experiencing, she has PP OCD and not postpartum psychosis. However, this myth, most often perpetuated by doctors, is the very reason why doctors kept sending me home when I had postpartum psychosis – because I was very disturbed by what was happening to me, they kept assuming that I did not have postpartum psychosis.
Even when you look at the case of the San Antonio mom, Otty Sanchez, who brutally murdered her son, she had a sense that something was wrong and first went to seek help from a hospital and then from her sister. Additionally, many of the postpartum psychotic moms I’ve helped have a sense that something is wrong or feel disturbed by what they are experiencing – some want to kill themselves because they don’t want to harm their child, etc.
Therefore, the fact that a woman is bothered by her thoughts should not be seen as conclusive evidence that a woman is suffering from PP OCD and not postpartum psychosis. A woman may very well be disturbed by what she is experiencing because she feels forced (by outside forces) to do something she absolutely does not want to do, which means her symptoms are indicative of psychosis and not OCD.
I always resent it when people oversimplify something as complicated and misunderstood as postpartum psychosis.
Thank you for writing this. I was diagnosed with PP OCD, and was very surprised by this. I thought OCD meant super clean people like Monk, or my MIL. I didn’t think one could be as disorganized as I and be OCD as well. However, intrusive thoughts fall into this. I tried googling the term Intrusive thoughts and a lot came up.
Amazing piece – Thank you Heather for raising awareness. It’s so important to get people talking about it!
I suffered from OCD and may have slipped that slippery slope into psychosis when “outside” sources (voices) were trying to convince me to do some major harm. In either case, the entire experience was terrifying. I’ve learned from a few therapists that OCD can have “psychotic tendencies.”
Whatever the label, I can relate to any mother having a difficult, possibly terrifying, postpartum experience. It was eight years ago and I’m just now beginning to forgive myself for all those horrifying thoughts that kept rolling around in my head over and over again. It was like being forced to watch a horror movie with all my loved ones in starring roles. I hate horror movies. Even today, I’m very careful about censoring what I hear, read or watch because it can trigger anxiety attacks.
Carolyn Brink (two-time PPD survivor) and I created http://www.mommiescrytoo.com. It’s a peer-to-peer website to support sufferers and survivors.
Take care and be well!
Kelly
As a Psychiatric Nurse, and a PPOCD survivor, I think it’s important to clarify about OCD having “psychotic tendencies.” What that typically refers to is that the tangled web of OCD can get to the point of having highly irrational thoughts that may resemble psychosis, but are not psychosis in the sense of being disconnected with right and wrong. For example, a Mom with PPOCD or OCD in general may have intrusive thoughts that she may think are hallucinations…they pop out of nowhere, are evil, terrifying thoughts, but they’re not hallucinations. The key point is that women who experience anxiety / feel disturbed and disgusted after having these thoughts are in a sense TOO in touch with reality….even if they may feel like they’re in a fog, their constant state of anxiety and hypervigilance are indicators of knowing right from wrong. People who are psychotic can also feel anxiety / be disturbed from what they are experiencing, but there is typically a fixed belief of what they are experiencing is real. Someone with OCD intrinsically knows the intrusive voices aren’t real, but due to their anxiety and overall vulnerability, they might doubt their own sanity. Of course, we haven’t even mentioned women with Postpartum Bi-Polar Disorder, which can also have psychotic elements to it. What it all boils down to is that brain chemistry presents with an individual set of symptoms and an individualized experience. What is true for one person with a particular type of symptoms may be true, partially true, or not true for someone else.
For all of those women out there with PPOCD, please don’t worry….I survived this wretched disorder, and you will too. Your bonding with your baby will come. Don’t put a timeline on your recovery! I remember reading posts when I was hit with this in 2002, and I would analyze them to death, and would have accompanying intrusive thoughts that would say “But that’s not you….you’re going to be the exception and hurt your baby.” It’s all a bunch of brain garbage….like a ganglion cyst in your wrist that has far-reaching effects. If you don’t put up the OCD roadblocks, their trenches will get deeper and deeper. The OCD might look for another route, but you just put up another roadblock. You can do this. You can.
Take care,
Jennifer
P.S. Excellent book: “Brain Lock” by Dr. Jeffrey Schwartz, MD, Head of OCD Dept. at UCLA
I was wondering how long it took for those of you that have suffered from PPOCD for the intrusive thoughts and anxiety to subside? I have been suffering with this for almost 3 months now. I have good days and bad days but on some of the bad days I feel so hopeless…like I should be over this by now. I feel like my situation is a bit unusual since I didn’t develop intrusive thoughts or anxiety until my daughter was 9 months old. I have been taking zoloft 200mg for 2 months and it has helped some but its not a cure. My psychiatrists has told me to just keep taking the zoloft and I will feel better. Any suppor/ reassurance would be much appreciated. Lisa