by Auti Scolman

Obsessive-Compulsive Disorder, or OCD, is a disorder distinguished by the presence of obsessive thoughts and/or compulsions that soothe the distress brought on by the obsessions. OCD can manifest in many different ways and often revolves around a theme, like contamination, sexuality, harm, or needing things to be “just right.”. A lesser spoken about manifestation of OCD can occur during pregnancy and/or the postpartum period, called Perinatal or Postpartum OCD (-). “Perinatal” refers to the time during pregnancy and “postpartum” refers to the time immediately following birth. The rates of Perinatal/Postpartum OCD range from 7-11% in the perinatal period and typically peak around 8 weeks postpartum. Folks who are pregnant or have recently given birth are vulnerable to developing Perinatal/Postpartum OCD symptoms, especially if they experienced symptoms prior to pregnancy. Although it is normal to feel stressed or anxious about a major life transition like having a child, there are certain markers that can help differentiate expected anxiety and Perinatal/Postpartum OCD.

Common symptoms of Perinatal/Postpartum OCD:

Symptoms that begin or worsen at the time of pregnancy or birth
Unwanted, obsessive thoughts about harming the unborn or newborn baby that cause significant fear and distress
Secrecy around the experienced symptoms for fear of being judged, hospitalized, or having the child removed
The presence of compulsions meant to control the obsessive thoughts (i.e. excessive checking on the baby, washing, etc.)
Avoidance of activities that may cause the baby harm (i.e. using stairs, changing diapers, handling sharp objects around the baby, bathing, etc.)
Co-occuring symptoms of postpartum depression (research shows up to 70% of folks with Perinatal/Postpartum OCD have postpartum depression)
Overwhelm or obsessional fear getting in the way of caring for baby
Needing to have a partner nearby when handling the baby out of worry or fear
Issues bonding with the baby because of Perinatal/Postpartum OCD symptoms
Trouble sleeping

Why does Perinatal/Postpartum OCD happen?

The occurrence of Perinatal/Postpartum OCD is due to a combination of factors including hormone changes and environmental contributors. The levels of oxytocin and neurotransmitter, serotonin, are impacted during and after pregnancy. Research suggests that an imbalance of oxytocin can then shift levels of serotonin and this may play a role in the development of OCD. Along with hormonal changes, the responsibility of having a child will likely cause increased stress and anxiety. It is important to note that Perinatal/Postpartum OCD can show up in all parents, not just the birthing person.

How is Perinatal/Postpartum OCD treated?

The treatment for Perinatal/Postpartum OCD looks similar to treatment for OCD and will typically involve Exposure and Response Prevention (ERP), a form of Cognitive-Behavioral Therapy (CBT) that has strong research evidence supporting its efficacy. ERP involves safely confronting avoided situations and lessening the exercising of rituals to manage obsessive fear and worry. Another treatment intervention is the use medicine, particularly selective serotonin reuptake inhibitors (SSRI). Please check with your medical doctor to assess the safety of these medications while pregnant or breastfeeding.