There’s no question about it — having kids changes your life. It’s normal to experience anxiety after the birth of a child, but how do you know when your anxiety about keeping your new tiny creature safe has taken a dangerous turn?
As women speak out about their experiences with postpartum depression, it’s becoming less stigmatized. We can now do a better job of supporting folks with PPD and understanding that it’s far more complicated than just being sad and has nothing to do with how much you love your kid. But other postpartum mental health issues exist that we’re not talking about, including postpartum obsessive-compulsive disorder.
PPOCD manifests in intrusive, repetitive and hyper-vigilant thoughts regarding the safety and well-being of your child. You know these thoughts are bizarre, you’ve never experienced them before, and you want them to go away, so you do things to stave off the anxiety, such as never leaving the side of your child’s crib, refusing to take the baby outside for fear of germs, etc.
You do not need to have had a previous diagnosis of OCD to experience PPOCD. PPOCD is associated with changes in serotonin levels, which are in flux after you give birth, but it’s not limited to folks who have been pregnant. Postpartum mood disorders can impact those who have adopted children as well as dads.
Samantha was diagnosed with PPOCD in 2009. Her obsessive thoughts came in the form of being afraid someone would murder her and her baby. “I was afraid to leave the house and would check the locks repeatedly,” she told me. “Sometimes I would have panic attacks as well. It finally was so upsetting to me that I called my doctor crying one day and was given a prescription and referred to a therapist, which started the healing process.”
“People laugh it off — you’re a new mom, you’re neurotic,” says Kimberly Hershenson, a clinical social worker in New York City who works with issues with pregnancy. “The difference is when it starts impacting the functioning of the mother’s life and the baby’s. You can’t shower because you’re afraid to leave the baby; you can’t let anyone else hold them.” She reports seeing PPOCD more often with a first child, but also with those who have a baby after experiencing a miscarriage or a high-risk pregnancy.
Angela Wurtzel, a marriage and family therapist in California, emphasized that PPOCD is not the same as postpartum psychosis, a rare thought disorder in which a mother experiences delusions and hallucinations that can lead to suicide and/or infanticide. It’s not knowing the difference between these two that can prevent folks from seeking help for PPOCD.
“Thinking about harm is not the same thing as wishing harm,” says Wurtzel. “PPOCD is about taking actions to avoid repetitive, unwanted thoughts — you’re afraid of drowning the baby, so you don’t give them a bath.”
It’s not uncommon for those suffering from PPOCD to know something is wrong, like Samantha did, or to have maladaptive behaviors pointed out to them by family or friends. Because PPOCD is often related to hormonal imbalances, it can go away once postpartum hormones resolve themselves.
Cognitive behavioral therapy is often used to address PPOCD, helping the patient to dismantle patterns of thinking and behaviors that cause stress and anxiety. For example, if you constantly think your baby is going to die, a CBT-trained therapist will ask that you produce evidence contrary to this, like that your baby has been to the doctor and is healthy, and that you have access to resources to help keep her growing and thriving. Wurtzel also recommends postpartum support groups, finding a therapist who can address prenatal and postnatal concerns and talking about your anxiety in general, whether or not you have a diagnosis.
“The women I work with want to be good mothers,” says Wurtzel. “That’s why they might not want to talk about these thoughts they’re having — they think it makes them horrible people. We have to normalize the fact that some days you feel great about being a mother, about your baby, and some days you don’t. That’s normal, and without it, you’re not seeing your baby, or yourself, as a whole person.”