Postpartum OCD and Psychosis
Postpartum OCD (Obsessive Compulsive Disorder), is a mental illness that affects a small number of women (less than 5%) postpartum, but is a very serious condition that all women should be aware of before giving birth.
The postpartum period refers to the first 2-3 months after a woman delivers a baby. During this period, it is very common for women to suffer from acute mental illnesses that are brought on from drastic hormonal shifts such as the baby blues.
Upwards of 60-80% of all new mothers suffer from the baby blues for anywhere from the first few days to weeks postpartum. Symptoms of the baby blues do not warrant treatment and will go away on their own. A smaller percentage, anywhere between 10-20% of postpartum moms will suffer from postpartum depression which is more severe, lasts for up to a year sometimes and requires mild treatment.
Postpartum OCD refers to obsessions that are seen in new mothers that usually revolve around fear or want to purposely harm the new baby. This type of psychosis requires doctor intervention and treatment.
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What Causes Postpartum OCD
According to the International OCD Foundation, there are two possible explanations for postpartum OCD, a biological model and psychological model.
The biological model involves the extreme fluctuation of hormones that occurs during and after pregnancy. Specifically, progesterone and oxytocin are in extreme flux immediately postpartum and oxytocin is linked to serotonin production which is a neurotransmitter that has a role in OCD.
This model is not very well tested however and does not explain why obsessive tendencies revolve around harm coming to the infant rather than obsessions such as hoardings, contamination or order. It also does not explain the fact that postpartum OCD has also been known to occur in a low number of new fathers as well.
The psychological model was developed by Dr. Nichole Fairbrother and Dr. Jonathan Abramowitz. They believe that postpartum OCD begins when new parents experience an unwanted thought related to the infant such as thoughts of the infant choking and not being able to save the infant because they never took the CPR class, and they attach deep significance to this thought.
These doctors believe this has to do with the rapid increase in responsibility causing an extreme level of anxiety. This anxiety leads to ritualistic, or obsessive compulsive thought patterns and behaviors.
Symptoms of Postpartum OCD
The symptoms of Postpartum OCD can differ greatly from mom to mom; however, there are many common obsessions and compulsions that are seen in most mothers. Most women with Postpartum OCD also have Postpartum depression and may have all or most of those symptoms as well.
Postpartum OCD is often misdiagnosed as being only depression because many new mothers are afraid and embarrassed to admit their obsessed thought about their children. If you have any obsessions or compulsions like the ones listed below, make sure to divulge these to your health care provider to ensure you get proper treatment.
Common Obsessive thoughts:
- Intrusive thoughts or daydreams of wanting to harm, or suffocate the infant
- Unwanted visual thoughts or images of dropping or throwing the baby
- Disturbing fantasies of sexually abusing your newborn
- Fear that you will harm your child through neglect or carelessness
- Worry that you will accidentally harm your child through exposure to medications, toxins, bacteria, germs, chemicals, or new foods
- Fear that you will give your child a disease
- Irrational fear that a decision you make will lead to an outcome that will put your child in danger or hurt your child, or be fatal.
- Thoughts of wanting to shake the baby to see what would happen
- Thoughts of wanting to put the baby in the microwave or oven
- Picturing the baby dead in your arms
- Thoughts of the baby choking and not being able to save him
- Wanting to poke the baby in the fontanel
Common compulsions seen in Postpartum OCD:
- Throwing out anything in your home that could be used as a weapon
- Asking your partner to hide anything in your home that could be used as a weapon
- Avoiding changing your child’s diapers in fear that you will sexually abuse them
- You avoid feeding your child because you worry you might poison them
- You need family reassurance that you are not harming your child or have abused them
- If breastfeeding, you avoid ingesting certain foods or medications because you are convinced they can harm your baby
- You monitor yourself for perceived sexual arousal when you are near your child
- You excessively check on your infant to make sure they are still breathing
- You constantly reviewing the events of the day to ensure that you have done nothing that could have lead or did lead to harm coming to your child.
- Praying over the baby constantly or adding the baby to numerous prayer chain requests
When you begin to feel symptoms of depression, baby blues, or postpartum OCD, you should let your health care provider know, especially if the feelings do not go away after a few weeks postpartum. Your OB/GYN can make a recommendation to refer you to a mental health care provider if he believes you are suffering from postpartum OCD or a severe case of Postpartum depression.
Most Psychiatric centers and individual mental health care professionals can offer individual or group therapy sessions and many different treatments.
If you are diagnosed with Postpartum OCD, there are treatment options available to you that are outpatient based and work on challenging the validity of the thoughts you are having. This type of therapy is called Cognitive Restructuring.
A Cognitive Behavioral Therapy known as Exposure and Response Prevention, or ERP, is a very common method of treating OCD and is used to treatment postpartum OCD as well. If you are only dealing with the obsessional thought patterns and not the compulsions, there is another treatment method called imaginal exposure that involves journaling and story writing based on your obsessions and then using those stories in ERP sessions.
One of the most frequently used methods, and also known to be the most effective, is Mindfulness Based Cognitive Behavioral Therapy. This treatment helps patients accept uncomfortable psychological experiences in a nonjudgmental way. This helps moms be able to experience their feelings without reacting to them or trying to control or make the feelings go away. We learn to accept that the feelings are there, and then move on. This is a vital coping skill that will eventually make these feelings dissipate on their own.
There are also medications that can be used to treat postpartum OCD that use serotonin reuptake inhibitors to help balance your hormone levels. These are usually taken in conjunction with CBT therapy; however, the risks to fetal development and infant that are breastfed is not well known or tested.
Postpartum OCD vs Postpartum Psychosis
One thing that is important to realize about Postpartum OCD is that women that suffer from this disorder have a very LOW chance of ever actually harming their child. Although they have strange, bizarre, and often violent thoughts about hurting their children, they are often horrified by these thoughts and engage in behaviors to push these thoughts out of their minds, often worrying themselves to the point of obsession i.e. checking on the baby numerous times throughout the night, compulsions such as throwing out all the knives in the house etc.
With Postpartum Psychosis, the violent thoughts are not disturbing to the new mom and start to become acceptable to her. The thoughts may become part of her world view and seem normal or relevant to her. Delusions are often part of these violent thought patterns and moms experiencing postpartum psychosis may no longer be able to tell reality from their delusions anymore.
Postpartum Psychosis is dangerous and requires much more extensive and often time, inpatient, treatment to ensure the safety of both the mother and other family members.