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  • Writer's pictureFlatiron CBT

Understanding Postpartum Anxiety and OCD


Feelings of dread as nighttime approaches. Checking and rechecking to make sure the baby is breathing. Hypervigilance. Constant googling. Intrusive thoughts.


Anxiety during pregnancy and in the postpartum period can be extremely debilitating. While new parents may receive some information about the signs and symptoms of postpartum depression, anxiety is often overlooked.


Experiencing some anxiety in the transition to parenthood is completely normal. There are also many societal and contextual factors that make the postpartum period ripe for anxiety, including lack of supports in place for new parents in the United States. However, when anxiety starts to interfere with daily functioning, it can be helpful to access support from a professional. Our goal is to help parents unburden themselves of blame and shame, while equipping them to better understand and work with their anxiety.


The postpartum period presents the perfect environment for anxiety to develop and flourish. There are significant hormonal shifts. There is often a physical recovery process, which can involve grappling with pain and body changes. Sleep deprivation leads to exhaustion, which makes it difficult to think clearly and respond to stress effectively. There is a major life transition and a sudden influx of intense responsibility. Parents may find themselves initially without structure, without predictability, and surrounded by so much uncertainty. There are endless questions and few clear answers. Many parents feel socially isolated. Even in the best of circumstances, these changes are challenging to navigate. Those with a history of anxiety or Obsessive Compulsive Disorder (OCD) may expect to have mental health challenges, while others may be caught off guard by the intensity of their anxiety symptoms.


The Symptoms of Postpartum Anxiety and OCD


How do we distinguish between postpartum anxiety and postpartum OCD? While each can manifest a bit differently, there is significant overlap in how we think about and treat these mental health concerns. It is also important to note that postpartum anxiety and postpartum OCD can affect women and men, birthing partners and non-birthing partners alike.


Postpartum anxiety


Postpartum anxiety is characterized by persistent worry, fear, or dread that impacts quality of life or ability to function on a regular basis. Having some anxiety as a new parent is adaptive—anxiety motivates us to take precaution and helps us remain vigilant when caring for an infant. Anxiety keeps a sick visitor away from a new baby and pushes us to call the pediatrician when something is not right. However, an all-consuming experience of anxiety in the postpartum period can become impairing.


Those struggling with postpartum anxiety may find that their worries and fears seem to jump from topic to topic. These worries and fears often focus on the wellbeing and safety of the child. For instance, a new mother may find herself worrying about the baby’s breathing, the temperature of the nursery, whether or not the baby will sleep and for how long, how serious a diaper rash is—all in the same afternoon. Many parents are concerned about these things, but it is the duration and severity of the worry, the relentlessness, that distinguishes postpartum anxiety. These worries often present as endless loops with no clear resolution. Many find that the worry interferes with being present and enjoying time with the child and with family.


Sufferers often describe feeling keyed up, restless, irritable, and on edge. They may be unable to sit still or feel paralyzed in place, unable to figure out what to do next. There is often the sense that “something is wrong” or “something bad is going to happen” even when everything seems to be okay. Sleep and appetite changes are common. While disrupted sleep is par for the course as the parent of a newborn, those with postpartum anxiety often report that even when there are opportunities to rest, they can’t get themselves to settle down or sleep. Sufferers may feel a sense of dread and hypervigilance and may have difficulty articulating why. Sometimes clients develop depression secondary to their anxiety because they feel so trapped in the worry, fear, or dread. There is a sense of hopelessness around if these feelings will ever end or change.


This kind of anxiety can also be experienced during pregnancy, before the baby is born. Some parents report experiencing anxiety throughout pregnancy and after birth, while others report that symptoms truly began in the postpartum period.


Perinatal or postpartum OCD

OCD is characterized by intrusive thoughts, images, or impulses that are unwanted and distressing, which the sufferer responds to by engaging in compulsions meant to neutralize or reduce distress. Anxiety, fear, and efforts to resolve uncertainty are all huge parts of OCD. OCD can occur during pregnancy and in the postpartum period. The following are just a few examples of how OCD can manifest during pregnancy:

  • Obsessions about chemicals and cleaning solvents impacting the health of the baby

  • Obsessions about environmental contaminants (third-hand cigarette smoke, pesticides in the park, etc.) impacting the health of the baby

  • Obsessions about eating food or ingesting substances during pregnancy that contaminate the baby (listeria, toxoplasmosis, etc.)

  • Obsessions about inadvertently sending “bad energy” or negative emotions to the baby

  • Obsessions about whether or not the pregnant person or partner will be “good parents”

  • Obsession with maintaining order or engaging in superstitious rituals to protect the health of the baby

  • Obsessions about harming the baby in some other way (accidentally consuming alcohol, encountering germs, contracting Zika virus, taking harmful medication, etc.)

  • Obsessions about what the child will be like or intrusive thoughts about whether or not the child is truly your child, despite knowing rationally that the child is yours


After the child is born, OCD sufferers may experience other kinds of intrusive thoughts such as:

  • Obsessions about unintentionally harming the child (fears of dropping the child on a hard surface or tripping down the stairs, fears of the child choking or fears of feeding the child incorrectly, etc.)

  • Obsessions about intentionally harming the child (note: these obsessions are experienced as distressing and against the person’s values, though OCD will make you doubt your values and intentions! Some examples might include intrusive thoughts about throwing the child out the window or veering the car off the road, intrusive thoughts about “snapping” and hurting the child in some way, or fears of touching the child inappropriately)

  • Obsessions about the physical health and safety of the child

  • Obsessions about whether or not the child is happy and doing well emotionally

  • Obsessions about whether or not one is doing parenthood correctly/feeling the right feelings about parenthood/making the right decisions in parenthood


Across pregnancy and in the postpartum period, these obsessions can make a challenging transition that much harder. Obsessions are typically followed by compulsions meant to reduce distress. Compulsions can be visible, as in the case of washing, cleaning, checking, seeking reassurance, confessing, or doing and re-doing tasks. However, many compulsions in postpartum OCD are invisible to an outside observer, and can go on for hours inside the sufferer’s mind. These “mental compulsions” might include ruminating, replaying events, checking for the presence or absence of a feeling, or gathering evidence for and against a fear. Avoidance is also often a part of postpartum OCD. Sufferers may avoid being alone with their children or may avoid entering into public spaces to minimize fear.


The Impact of Postpartum Anxiety and OCD


Postpartum anxiety and OCD strip away self-trust at a time when parents want to be able to trust themselves and feel confident in their new roles. People often speak about “a mother’s intuition,” this sense that mothers know on a gut level when something is right or wrong with their children. When new parents express concerns or anxieties, people will often say “trust your gut” or “you know yourself and your child best.” However, when you have clinical anxiety and/or OCD, you have a false alarm system in your brain that is constantly sending you threat signals. This false alarm system makes it difficult to know what brain noise is important and what is less important. It is difficult to know what to trust. And when it comes to growing and raising a child, everything seems very important and high stakes! Clients we work with will often say, how can I trust my gut as a parent when my gut has been giving me so much faulty information?


Anxiety can also live alongside powerful emotional experiences like irritability, rage, guilt, and shame. Anxiety is rarely just anxiety. Clients may feel anxious about feeling anxious, or feel shame about their intrusive thoughts, or feel angry at their brain for generating so much noise. Further, becoming a parent is a huge undertaking in a world that can feel very scary at times, even without an anxiety diagnosis. Talking about the very legitimate worries and challenges of parenthood must have a place in any therapy meant to address anxiety during pregnancy and postpartum.


How can I get help?


Bouncing a baby to sleep alone in the dark with white noise blasting and thoughts running a mile a minute can be the loneliest experience. If you are struggling with any of the anxiety symptoms described above, you are not alone. There are many ways to get help.


The Perinatal Anxiety Screening Scale (PASS) is a self-screening tool where you can check in on your own anxiety symptoms. Postpartum Support International provides a wealth of information including a provider directory, a help line, and drop-in support groups.


Finally, if you are interested in learning more about the treatments we provide at Flatiron CBT, click here to request a 15-minute complimentary phone consultation. Our team draws from a variety of evidence-based approaches, including Exposure and Response Prevention and Acceptance and Commitment Therapy to help clients struggling with postpartum anxiety and OCD. These treatments will provide with you with a framework for working with your anxiety and learning how to sit with discomfort, uncertainty, and lack of control. We also always make space to talk about the very real challenges and complexities of new parenthood.


Want to learn more? Request a 15 minute phone consultation.

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