Perinatal OCD: Signs, symptoms and treatment

Perinatal obsessive-compulsive disorder (OCD) is a mental health disorder that can affect women during pregnancy or the first year after giving birth. It can impact any parent.

A parent with perinatal OCD typically has uncontrolled, unwanted thoughts — also known as intrusive or ego-dystonic thoughts — often coupled with certain repetitive behaviors intended to make those thoughts go away.

These types of thoughts commonly revolve around harm during pregnancy or harm to the baby.

“A mother might think ‘what if I drop my baby?’ or ‘what if I hurt my baby?’ and can avoid certain situations to prevent that. For example, she might hand the baby to her partner when going down the stairs so she doesn’t drop the baby, or she may remove all the knives from the house to prevent herself from hurting the baby,” says Dr. Sahana Malik, a psychiatrist with Sharp’s Maternal Mental Health Program and affiliated with Sharp Mesa Vista Hospital.

A woman with perinatal OCD may also repeat the same behaviors — called compulsions — to suppress intrusive thoughts and prevent the feared outcome.

They may lock doors multiple times to make sure their baby is protected from an intruder, or wash baby bottles over and over again so their baby doesn’t get sick from germs.

“Intrusive thoughts can be very vivid, scary and intense. They also cause persistent distress and anxiety for mothers as to why they’re experiencing this,” says Dr. Malik.

Barriers to seeking treatment

An estimated 8% to 17% of mothers experience perinatal OCD, but the true figure is likely higher because of the shame and stigma that often prevent women from getting a diagnosis and seeking out treatment.

“Women are so scared they’re having these thoughts that go against who they are and what they believe. They’re also worried their baby might be taken away from them,” says Dr. Malik.

While the direct cause of perinatal OCD is not fully understood, biological factors like drastic hormonal changes that occur during pregnancy likely play a role. Environmental factors, such as lack of support, can be a trigger as well. A history of mental health disorders such as OCD, which can become more severe during the perinatal period, also increases the risk.

Symptoms vary for each person and can occur at any point during pregnancy, but they are typically more common during the postpartum period.

Dr. Malik says loved ones can help by recognizing signs such as exhaustion that interferes with daily functioning, including being too tired to eat or bathe.

“Women with perinatal OCD may not be sleeping even when the baby is asleep due to intrusive thoughts,” says Dr. Malik. “Intrusive thoughts are quite common. Seventy percent to 100% of parents experience them, and it’s important to normalize and destigmatize them. What differentiates having intrusive thoughts from OCD is the level of severity and distress that arise from them and if they interfere with day-to-day functioning.”

One of the biggest misconceptions about perinatal OCD is that women experiencing this disorder truly want to harm their baby. That is not the case.

“These thoughts are not a reflection of a person’s desires or intent,” says Dr. Malik. “Parents are frightened by the thoughts and are trying to protect their baby.”

Misunderstanding perinatal OCD can lead to serious consequences, including unnecessary hospitalization or involvement of Child Protective Services, she adds.

Sharp’s Maternal Mental Health Program offers treatment for perinatal OCD. This includes components of what is known as exposure and response therapy. It allows patients to gradually face their fears in a safe and supportive environment.

The program helps patients tolerate intrusive thoughts instead of avoiding them. “For example, we’ll have a patient practice holding their baby and walking down the stairs, instead of avoiding the activity. We help them overcome fear and regain confidence,” says Dr. Malik.

Some patients may also benefit from medication as part of their treatment plan.

Dr. Malik encourages parents to seek help and get the extra support they need. “You’re not alone. Don’t be afraid to speak up about what you’re experiencing and feeling. We’re here to help.”

Learn more about pregnancy; get the latest health and wellness news, trends and patient stories from Sharp Health News; and subscribe to our weekly newsletter by clicking the "Sign up" link below.