Postpartum Obsessive Compulsive Disorder (OCD)
In contrast, to non-postpartum OCD, the postpartum variant typically comes on rapidly, sometimes within a week of giving birth. Research also indicates that postpartum OCD most often involves scary obsessions related to harm befalling the newborn infant (in contrast to obsessions having to do with contamination, paperwork mistakes, order and symmetry, and hoarding). In some instances, sufferers report obsessions having to do with accidental harm, while in others the obsessions involve unwanted thoughts or ideas of intentionally harming the newborn. Some examples of the kinds of postpartum obsessions encountered in our clinic are as follows:
- The idea that the baby could die in her sleep (S.I.D.S).
- The thought of dropping the baby from a high place.
- An image of the baby dead.
- Thoughts of the baby choking and not being able to save him.
- Fears and obsessional thoughts of harming the baby.
Compulsive rituals among mothers with postpartum OCD often include checking on the baby, for example, during the night to make sure that the baby is still alive. New parents with OCD also report mental compulsions, such as praying over and over to prevent disastrous outcomes. Finally, many postpartum OCD sufferers engage in compulsive reassurance-seeking, including looking their symptoms up on the internet and asking others if it’s “normal” to have bad thoughts about the baby. Avoidance is also a problem and many new mothers are afraid to be left alone with their newborns for fear that they might act on their unwanted thoughts about harm.
Many women suffering from postpartum OCD worry that they might act on their harm-related thoughts, or that their thoughts mean they are unfit to be parents. “What if I drown my children like that woman on the news did?” “What kind of a parent thinks about such terrible things? Surely I am losing my mind!” What drives these fears is a lack of understanding of the differences between postpartum OCD and postpartum psychosis.
Both OCD and psychosis can involve strange, bizarre, and violent thoughts. But the similarities stop there.
In postpartum OCD, the sufferer is terrified of committing harm; so much so that it scares her to even think about harming the infant.
Women with postpartum OCD resist their obsessional thoughts; meaning that they try to dismiss the obsessions or neutralize them with some other thought or behavior. The thoughts seem as if they are against every moral fiber of their being. Consequently, the risk of someone with postpartum OCD acting on their violent obsessions is extremely low (one can never say with absolute certainty that the chances are 0%, but in this case it’s pretty close).
In contrast, women with postpartum psychosis tend to experience their violent thoughts much differently. The violent thoughts might be perceived as consistent with the person’s world view. Hence, such women don’t try to fight these thoughts. The thoughts are usually part of delusions; lines of thinking in which the person holds strongly to bizarre beliefs, such as the idea that someone (or the government) is after them, or that they have magical powers that other people don’t have. So, thoughts to harm the baby might be perceived as “a good idea.” Because people with psychotic disorders sometimes act in accord with their delusions, postpartum psychosis poses very serious risks and often requires hospitalization to ensure the safety of the mother than infant.