OCD in Postpartum And Motherhood

Obsessive compulsive disorder(OCD) requires evidence based treatment which means it’s something that usually needs a specialist with a structured approach. Postpartum OCD comes up a lot with moms in my client sessions. Because OCD requires evidence-based techniques and postpartum OCD is so unique, licensed counselor Jenna Overbaugh is here to help us unpack what obsessive compulsion is and how to know when we might be experiencing it.

Before we go any further, it’s important to say in this episode we’re going to explore some disturbing thoughts and if this is something you struggle with, it could be triggering.

Obsessive Compulsive Disorder

“It takes on average 10-17 years from when someone starts experiencing signs and symptoms consistent with OCD to when they actually get an exposure and response prevention trained therapist,” Jenna Overbaugh said. One reason for this may be because when we talk about OCD culturally or in the media, we tend to focus on compulsive cleanliness and nitpicking behaviors. OCD can display this way, but Overbaugh said, “That may be 15-20% of the clients I work with.” There are a lot of other compulsive behaviors that have nothing to do with cleanliness. Most of them don’t. 

“OCD is really a two-part problem,” Ms. Overbaugh said. The first part could be intrusive thoughts, ideas, images, or feelings. They’re intrusive because they come out of nowhere. You might be cuddling your baby and be hit with the thought, “What if I drive my car over a bridge?” Or eating dinner with a knife and think, “What if I stabbed my baby?” 

These thoughts are intrusive because they come out of nowhere.

These thoughts are intrusive because they come out of nowhere and are often also ego dystonic meaning they’re not consistent with the values and other feelings you have. That can be unsettling. “What does it mean about me that I had this thought about my baby?”

The intrusive thoughts are the first problem. The second problem is the compulsion. The compulsion can be a behavior or it can be something you do in your mind to make yourself feel better about the intrusion. For example, the intrusive thought of stabbing the baby comes and the next thought is “I would never do that.” The compulsion is something you do to make yourself feel better about the intrusive thought.

For Jenna, the intrusive feeling was fear that she might leave her baby somewhere. The behavior of checking to make sure she still had the baby with her became so compulsive, she would pull over on the side of the road and pick the baby up.

OCD latches onto uncertainty and anything you care about.

The Role Intrusive Thoughts Play In OCD

95-99% of individuals throughout the world experience intrusive thoughts at some point in their life. “I think that 5% of people who say they don’t either don’t understand the question or they’re lying,” Jenna said.

Our brains are constantly working, and they’re very good at coming up with things that don’t exist.

Intrusive thoughts are just part of the human experience. Our brains are constantly working, and they’re very good at coming up with things that don’t exist like the iPhone 12 and planes before they existed. But they come up with horrible things that don’t exist too. “Anxiety is a good thing,” Overbaugh pointed out. If our brains didn’t come up with wild scenarios we’d all be dead. Our brains have 1 function: to keep us safe. As soon as we have kids, our brains get a second function: keeping the kid safe. 

Our brains fire these things at us to make sure we’re prepared. We know what to do if it happens. 

Dealing with intrusive thoughts isn’t just a mom thing, but motherhood is prime for intrusive thoughts. If you’re taking care of a newborn chances are you’re not getting much sleep. Even if your kid is older, you only get as much sleep as they do. Motherhood is full of uncertainty. You have no idea what you’re doing from one minute to the next, much less what your child will be, and you’re responsible for another human. With all that combined, this is a perfect setup for intrusive thoughts to spring up.

Intrusive thoughts are becoming a problem when you have to respond to it. If you have a thought that stops you in your tracks so you can tell yourself what a horrible person you are or immediately confess and pray about it, that’s a problem. If you feel a need to do something behaviorally to compensate for it—like you’re so afraid you might drop the baby down the stairs you only leave your apartment when an elevator is available—that also might be a sign that it’s becoming a problem. 

A common compulsion for mom is checking the baby to make sure they’re safe, but there is research to show the more checking you do the less confident you become of your own memories. The act of checking tells your brain this was worth checking which makes your brain want to check it further. You trust your memory less. You’ll have to pile on more rituals.

Recognizing OCD In Pregnancy Or The Postpartum Period

You might be experiencing OCD if you’re acting more out of fear than values, or if you feel like you’re not in control anymore. 

Another thing to look for is when you’re bringing in other people to your rituals or compulsions. So, if you’re constantly checking your child’s safety and then asking someone else to double check, that might be a sign that you need to find a trusted healthcare provider.

Self-care might be your first step.

Self-care might be your first step. Prioritizing sleep—if you’re in the postpartum period you need a plan for this one—nutrition, and movement can help. And if you’ve fed yourself and gotten rest and exercise and the intrusive thoughts and compulsions calm down, you’re probably okay. 

But if you’ve done all of these things and you’re still struggling, you might be experiencing OCD or postpartum OCD. 

Another red flag might be the ability to move on. You have an intrusive thought and you’re either able to avoid the compulsion or you’re able to check on the baby one time and move on, that’s probably okay. But if the intrusive thought comes and you can’t let it go that could be a problem.

Treatment for PPOCD

“Exposure and Response Prevention (ERP) is the gold standard treatment for OCD and really all forms of anxiety,” Overbaugh explained.

Exposure and response prevention is under the umbrella of cognitive behavior therapy(CBT), but it’s way more specific for OCD and anxiety. ERP works by exposing a person to their fear or stressor and practicing no response. “I don’t go on walks with my baby, because I might lose control of the stroller and the baby will be hurt.” The risk is losing control of the stroller and the response is avoidance. To face this fear, you might start with a walk around your own yard or in a hallway and move on from there. Avoiding the walk all together is only further programming your brain to avoid the stroller. 

If you don’t have access to a therapist, there are self-guided ERP programs out there. What you’ll do is expose yourself to anxiety provoking situations and it’s best to do it in a way that’s slow and challenging but still manageable. 

Jenna Overbaugh said where she works they create a fear ladder and label stressors from 0-10. You might want to start with a 3 or a 4. It’s uncomfortable, but you can handle it. But you have to resist the rituals or safety behaviors you would normally do to make yourself feel better. Maybe you put the baby down and only check on her one time.

Part of this is forming a habit. You’re getting used to it. Your body doesn’t like new things, but when you do things repeatedly, then it’s old news. It’s no longer necessary to explore. 

Your body doesn’t like new things, but when you do things repeatedly, then it’s old news.

But you also learn to adjust your threat expectations. Right now you might feel if you don’t check on your baby often enough, they could stop breathing. But by resisting the urge to check on the baby more than once, you’ll learn the baby still wakes up. The threat expectation is unnecessary and your body adjusts.

Acceptance and Commitment therapy compliments ERP for OCD. The idea of acceptance and commitment therapy is to just accept the thought. Oftentimes, someone with OCD or even just general anxiety might respond to ERP with, “But what happens if I let my guard down? Isn’t it bad that I’m not worried about cooking with my baby in the kitchen? Or going for a walk with the baby in the stroller.”

No, it’s not bad. You’re allowed to cook and take walks. If we compliment the ERP with the acceptance and commitment, instead of asking, “Is this thought logical? Rational? Good or bad?” we can simply ask, “Is it helpful?” And if it’s not helpful, let it go.

“Medications can be super helpful,” Jenna said. But she went on to say, “Medications can get you to the starting line, but they won’t run the race for you.” Medication alone won’t resolve intrusive thoughts and compulsive behaviours, but if you’ve had a hard time starting ERP, it can help you get there. And if you’re doing ERP diligently you medication isn’t a must. You can take it if it helps but you have to be willing to do the work either way.

Finding The Right Professional

Unstructured therapy can actually be detrimental for OCD. Talking about the intrusive thoughts might make you feel more justified in them, and without any behavioural intervention, the behaviours will persist. So, it’s not just that talk therapy could keep you from moving forward, it could make the OCD behaviours worse.

If you can find someone who is knowledgeable about postpartum and OCD treatments that would be most helpful. If you can’t find that, you at least want someone knowledgeable in OCD treatment methods. Some good resources for finding a professional are NOCD which is a mobile platform available in all 50 states and the International OCD Foundation.

It’s important to remember that intrusive thoughts are just thoughts. They don’t reflect who you are or what your actions will be. Register for When Your Thoughts Become Scary Workshop to learn how to understand intrusive thoughts and manage them when they pop up, so you can stay in control of your thoughts!