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Perinatal Matters

Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

New baby, distressing thoughts

Perinatal OCD is when a parent experiences Obsessive Compulsive Disorder while pregnant or during the first year of their baby life. It is a little known but not uncommon form of mental distress. Perinatal OCD often revolves around unwanted thoughts and images related to a parent’s fear of harming their infant. These intrusive thoughts go against the person’s values and intentions, which is precisely why they are so distressing. Living with perinatal OCD can significantly interfere with the parent’s wellbeing and their experience of pregnancy and parenting.

Everyone experiences intrusive thoughts from time to time (ie unwelcome ideas, images or urges). These uninvited thoughts are usually quickly forgotten and the parent moves on. The themes are sometimes weird or unpleasant. As long as there is no intent to act on these thoughts, there is no reason for alarm. For example, new parents are focused naturally on the safety of their baby and feel particularly responsible for them. Because of this, it’s perfectly normal for a parent to experience a fleeting image of hurting their baby or a thought that food may be contaminated. These uninvited thoughts are usually quickly forgotten and the parent moves on. However, with perinatal OCD, a parent finds that intrusive thoughts get ‘stuck’ in their mind, returning again and again and causing them distress. Often parents with OCD worry that the intrusive thoughts are a sign that they will harm their baby or that they are ‘bad’ parents.

To gain relief from mental distress, the parent takes measures to counter the distressing thoughts and images. These measures are called compulsions, and could be tapping, praying, over-cleaning, or avoidance of doing certain things with their baby (such as using knives around them or giving them a bath). These precautions gradually take more and more time and effort.

Because the thoughts are against what the parent wants to happen, they are seeking absolute certainty that the baby will not come to harm. (Sadly, while some parents do have a desire to harm their baby, this is not the case with OCD.)

Contamination is a common perinatal OCD theme. This theme is about a parent seeking complete certainty that they will keep their baby safe from illness. Harm is another common perinatal OCD theme. A mother or father may have obsessive thoughts related to accidentally or actively hurting their baby. Because OCD is not about desire of intention to harm they may feel deeply ashamed and so may find it difficult to confide in others.

“OCD is a significant but a treatable problem. However, lack of knowledge amongst women experiencing perinatal OCD and the professionals they encounter has sometimes been a huge barrier to accessing treatment.”

– Dr Fiona Challacombe, Maternal OCD Patron

Obsessive Compulsive Disorder

OCD in the postnatal period

This can interfere with your ability to take care of your baby. For example, you may not attend straight away to your crying baby, as you feel compelled to complete a ritual such as cleaning or checking. Some mothers with OCD become obsessive about germs contaminating their baby and may go to great lengths to ensure the baby does not come into contact with anything considered dirty (e.g. changing their clothes many times a day, not allowing the baby on the floor, repeatedly washing the baby’s ears and nose).

Often women feel embarrassed or ashamed about their thoughts and compulsions and it can be very hard to tell someone. However, it is important to tell your doctor as OCD can be treated.

“My obsessive thoughts have ranged from being afraid of accidentally hurting others, hating that the letter M came before N, and not being able to cook a meal without being worried I’d poison someone, to fearing I’d randomly cheat on my husband without meaning to, and worrying I’d run someone over on the footpath. I had thoughts while I was pregnant – and then for at least the first 6–9 months with my first child. I didn’t have anything when my second child was born two years later, but then the thoughts came back with a vengeance when they were four and six years old.” 

–  Sophie* KiwiParent Magazine, June 2021. Read the full article here: Perinatal OCD – A penny for your (intrusive) thoughts?

About 1% of New Zealanders live with OCD. We now know that OCD is more common during the perinatal period than during other times in life. Among women who have recently given birth, there is a twofold increase, possibly more, in the occurrence of OCD. Fathers can also experience perinatal OCD. Symptoms may appear for the first time during a pregnancy or while caring for the baby, or preexisting symptoms may worsen.

“I had images of kicking my son when he was lying on the mat, so I would walk with a gap around the mat or crawl to him on the mat. Changing baby’s nappy and a thought pops up…What if you’re a pedophile? This then turned into…Why would you even think that you weirdo? Does that mean I really am a pedophile?…” 

– Trudy, Mum

It is easier to talk about mental distress if you are confident that others will understand. You could begin by giving a copy of the brochure below to someone you know and trust.

Remember – you are not alone – what the numbers tell us

The number of New Zealanders living with OCD at any time:

50,000

The number of New Zealanders who experience Perinatal OCD in any year:

1,500

Obsessive Compulsive Disorder

What are some common indications of Perinatal OCD?

Each individual’s experience of perinatal OCD is unique but there are some common symptoms. This list of common features may help a parent, friend or whānau to identify the possibility of perinatal OCD, but it requires a health professional to determine whether the condition is actually present.

  • OCD symptoms that start or return during pregnancy or within the first year after the birth.
  • Persistent worry of accidental harm coming to the unborn or newborn infant.
  • Persistent thoughts or images of actively harming the baby, despite the mother or father knowing they don’t want to harm the baby in any way.
  • Repeatedly doing actions meant to control or stop the obsessional thoughts, or to prevent fears from coming true (e.g. excessive checking on the baby, washing, mental rumination, saying prayers).
  • Avoiding certain activities with the baby (e.g. holding, giving a bath, using stairs, changing nappies).
  • Needing to have a partner or helper nearby to provide frequent reassurance related to thoughts and images, to carry out avoided tasks, and as an insurance against carrying out a feared action.
  • Feeling overwhelmed by the obsessions and compulsions.
  • Trouble sleeping because of the disturbing obsessions and time-consuming compulsions.
  • Interference with taking care of the baby.

Obsessive Compulsive Disorder

If you are in mental distress because of intrusive thoughts about your baby, what should you do?

It is normal to worry about the responsibility of being a new parent, and to be careful about caring for and protecting your baby. The great majority of new parents will have unpleasant images or thoughts that pop into their head at some stage. If obsessive thoughts and compulsive behaviours are getting in the way of everyday life or causing significant distress, then it is time to seek help. It is easier to talk about mental distress if you are confident that others will understand. You could begin a conversation by giving this brochure to someone you know and trust.

Fortunately, with the right support OCD is a very treatable condition. If you have a good relationship with your midwife or GP you should talk to them about what is happening. You could show them this leaflet. If you don’t feel comfortable with this, contact the maternal mental health services in your area. Alternatively if you can afford it, contact a psychologist with experience in treating OCD. They can help you to understand why the unwanted intrusive thoughts and emotions are happening and, importantly, how to manage them.

“There were swirling tensions as a father wanting to do the best for my child while at the same time all these horrible thoughts flooded my mind”

– David, Dad

New Dad with OCD

Obsessive Compulsive Disorder

Is it common for people to keep quiet and not tell others that they are experiencing OCD?

One of the hallmarks of OCD is that the intrusive thoughts are in conflict with a person’s values, desires and beliefs. The unwanted thoughts often involve themes around contamination, harm, health, sexuality, gender identity, relationships, morality and religion. Often people initially don’t know that they are experiencing OCD, and instead mistakenly believe that the persistent, disturbing thoughts say something about themselves as a person. It may be particularly difficult to disclose taboo thoughts of a violent, sexual or religious nature.

Contamination is a common perinatal OCD theme. This obsession is about a parent seeking complete certainty that they will keep their baby safe from illness. The parent may feel compelled to repeatedly clean or to be extremely careful about food, even though they know their concern about germs is excessive. The person may keep this private as they recognise that other people might not understand and might judge them.

Harm is another common perinatal OCD theme. A mother or father may have obsessive thoughts or images related to accidentally or actively hurting their baby. Because OCD is not about desire or intention to harm they may feel deeply ashamed and so may find it difficult to confide in others.

“No one could touch the food or surfaces the food was placed on. We had to change how we bought food, stored food and cooked food.”

– Jade, Mum

Everyone experiences intrusive thoughts from time to time (ie unwelcome ideas, images or urges). The themes are sometimes weird or unpleasant.

Intrusive thoughts are like junk mail of the mind. Usually they are hardly noticed, and quickly forgotten.

In someone experiencing OCD, some intrusive thoughts get stuck in the mind, returning again and again, and the person feels very distressed.

Obsessive Compulsive Disorder

Do people who experience Perinatal OCD have signs before they become parents?

Sometimes OCD emerges for the first time in the perinatal period. However, often when they look back, a parent sees signs of OCD from their childhood or adolescence. The content of the obsessive thoughts and nature of the compulsions may have changed. As a child they might have felt a need to perform rituals such as ‘checking’ to keep people safe whereas as a young adult they might have experienced intrusive sexual thoughts. In hindsight, the person may recognise an underlying pattern: wrestling with unwanted thoughts and uncomfortable emotions, and seeking relief by doing mental and/or physical actions.

Rather than intrusive thoughts, some people have an unsettling sense that something doesn’t feel right. Sometimes people feel compelled to arrange objects again and again or balance sensations on one side of the body by achieving exactly the same sensations on the other side of the body.

Obsessive Compulsive Disorder

Can Perinatal OCD be treated?

Fortunately, with the right support OCD is a very treatable condition. A clinical psychologist experienced in OCD treatment can help you to understand why the unwanted intrusive thoughts and emotions are happening and, importantly, how to manage them.

Treatment options for Perinatal OCD include:

  • Exposure Response Prevention (ERP) therapy in which the person changes how they respond to their obsessional thoughts, gradually building up tolerance of uncomfortable emotions and reducing the use of compulsive behaviours.
  • Mindfulness can be a useful complement to ERP therapy because it helps you to notice intrusive thoughts without engaging with them.
  • Selective serotonin reuptake inhibitor (SSRI) medicine. This medication helps to decrease the intensity of obsessive thoughts and so makes it easier to undertake ERP therapy. It can be helpful to have a psychiatrist’s guidance when establishing the optimal medication for you. Some medicines used to treat OCD are probably safe to use for pregnant and breastfeeding women, and it’s important to check with your doctor about which medicines are safest for you.

Obsessive Compulsive Disorder

How can I help a friend or family member with Perinatal OCD?

If you are concerned that a friend or family member might be experiencing OCD, ask about the thoughts and behaviours that you are noticing in a nonjudgmental and calm way. If they are experiencing mental distress, you can help them to arrange a consultation with a health professional. Rather than trying to ‘force’ them into getting help, it is better to talk to them about how things would improve if they sought professional support.

When a parent has perinatal OCD, often the first instinct of family and friends is to do whatever they can to ease the person’s distress. This may mean giving frequent reassurance that a feared event will not happen, or making adjustments to everyday living so that feared situations can be avoided.

In the short-run, these accommodations might put the person at ease. Although well intentioned, these types of ‘help’ don’t work in the long-run because they unintentionally reinforce the obsessive-compulsive thought cycle.

Rather than make abrupt changes, which would likely be very distressing, be guided by the advice of a therapist about the best way to address feared situations. You could offer practical support to keep the household running. It can be helpful to learn about OCD, but it is mainly love, warmth and encouragement that is needed.

Obsessive Compulsive Disorder

Perinatal OCD Resource

Click here to download the resource; Perinatal OCD – New baby, distressing repetitive thoughts.

Obsessive Compulsive Disorder

PADA Popup chat video #20 Perinatal OCD with Marion Maw from Fixate

The following video was from our Popup chat #20, featuring Marion Maw from Fixate. Check out our full series of PADA Popup chats and vignettes on our Video page.

YouTube video

Obsessive Compulsive Disorder

Fixate – OCD Online Community

A Facebook community group for friends and families of people with Obsessive Compulsive Disorder

Fixate is a Facebook-based online community in Aotearoa New Zealand for people living with OCD, and for those who support someone with OCD. We bring together people to share experiences and information, to form connections and to advocate for OCD awareness. If you’re interested in learning more, please visit our website or email us: [email protected]

To become a group member, please ask to join Fixate on Facebook.

Visit Website: www.ocd.org.nz

Perinatal OCD – a father’s perspective

An informative, moving interview which includes a father’s experience of Perinatal OCD.

Geoff is a member of Facebook-based support group Fixate and shares his story on the international podcast series The OCD Stories, which includes a father’s experience of Perinatal OCD.

“In this episode we discuss his OCD story, harm obsessions, postnatal harm obsessions, working through grief for his brother, suicidal themed OCD worries, his compulsions, his advocacy in New Zealand, and much more.”

The OCD Stories is a free weekly podcast hosted by Stuart Ralph, which you can access through any podcast app, Spotify, the website or YouTube. There are hundreds of episodes featuring experts, and people experiencing OCD symptoms.

Listen to Geoff’s story here

Perinatal OCD

Obsessive Compulsive Disorder

Living with Perinatal OCD by Catherine Benfield

This article was first published online:  1 Nov 2018  |  British Journal of Midwifery  |  Vol. 26, No. 11  | Mother’s voice

Obsessive compulsive disorder can have devastating effects on new parents, but is under-researched and poorly understood. Catherine Benfield explains the condition and what midwives can do to help.

“If you had told me 5 years ago that at some point in the future I would be talking to midwives about the nature of my intrusive thoughts, I would be amazed. Amazed and terrified. That’s because 5 years ago I was unknowingly experiencing perinatal obsessive compulsive disorder (OCD). I was having the most intensely graphic, unwanted, recurring intrusive thoughts about harming my newborn son and, as lovely as I’m sure you all are, you were the last people I wanted to tell about it. I was worried that if I did, you’d begin the proceedings to have my son taken out of my care.”

Read the full article here

Catherine runs the blog Taming Olivia, where she blogs about her experiences with OCD, focusing on perinatal and postnatal OCD. You can also listen to a podcast where she talks about her experience with Perinatal and Postnatal OCD.

OCD Information – Aotearoa New Zealand specific

www.ocd.org.nz

Fixate Facebook Group

Recognising and Managing OCD in primary care – bpac nz – The Best Practice Advocacy Centre New Zealand

Improving outcomes for people with Obsessive Compulsive Disorder – NZ Doctor article, August 2022

About Obsessive Compulsive Disorder – Mental Health Foundation, Sept 2022

 

International Sites OCD support

 

www.ocduk.org/ocd/ocd-during-prenatal-postnatal

www.maternalocd.org

www.iocdf.org

Vimeo: Maternal Obsessive Compulsive Disorder (from UK based charity Best Beginnings)

 

Content for this resource comes from: www.ocd.org.nz | Marion Maw, a member of Fixate | Dr Natalie Flynn, DipSWSP, BA Hons, DClinPsy at Emotional Health Services