What Is Postpartum OCD?
Postpartum OCD is a type of postpartum anxiety disorder that can be severe and often requires treatment to manage and control symptoms.
If you have had intrusive thoughts or behaviors in response to a perceived danger toward your baby, you may have postpartum OCD. These thoughts and behaviors are constant and repetitive, and you may have noticed they can disrupt your daily life.
Most women with postpartum OCD are aware of their intrusive thoughts but cannot control them. Instead, the thoughts cause counteractive behaviors and other uncomfortable symptoms as well.
With treatment that includes therapy and medication, many women can successfully manage their postpartum OCD symptoms and return to their sense of normal.
Postpartum OCD Symptoms
Postpartum OCD symptoms include a combination of obsessions and compulsions. These manifest as thoughts and behaviors.
Some common obsessions mothers with postpartum OCD experience:
- Unwanted images of hurting the baby, such as dropping or throwing him/her
- Concerns about accidentally causing the baby harm through carelessness
- Intrusive and unwanted thoughts of suffocating or stabbing the baby
- Unwanted and disturbing thoughts of sexually abusing the baby
- Being scared of making poor decisions that will cause the baby harm or death
- Fear that the baby will develop a serious disease
- Fear of exposing the baby to toxins, chemicals, and other environmental pollutants
- Fear of exposing the baby to germs or contamination
Note that mothers who suffer from postpartum OCD are hyper-vigilant and sensitive to anything that may be related to child abuse, whether physical, sexual, or otherwise.
Common compulsions experienced by those with postpartum OCD:
- Getting rid of sharp objects such as knives or scissors
- Not feeding the baby out of fear of poisoning him/her
- Not changing diapers out of fear of sexually abusing the baby
- Not consuming certain foods or medications out of fear of harming the baby
- Not letting anyone else hold or watch the baby out of fear they will be harmed
- Deliberately avoiding watching or reading the news when it involves child abuse
- Continuously monitoring self when it comes to possible inappropriate sexual thoughts
- Obsessively checking the baby while he/she sleeps
- Asking family members for reassurance that the baby has not been harmed or abused
- Going over the day’s events mentally to ensure that nothing bad has happened to the baby
Postpartum OCD symptoms typically start showing up in the first 2 to 3 weeks after giving birth.
However, symptoms may not be noticed by the woman or her family until months later. Without treatment, postpartum OCD symptoms can evolve and worsen and may not go away independently.
Who Does Postpartum OCD Affect?
Postpartum OCD is uncommon, affecting as little as 2% and as high as 24% of women after giving birth, depending on the study. New fathers have also been known to exhibit signs of postpartum OCD.
Though not common, like postpartum blues, postpartum OCD is likely underdiagnosed. This is due to the embarrassment and shame that women with postpartum OCD feel and the fear that they will lose their baby if they speak up.
These Thoughts Are Not Intentions, and They Do Not Mean You Are Dangerous
This is the part that matters most, and it is worth holding in mind alongside the symptom lists above.
The American College of Obstetricians and Gynecologists states that “most women who find these thoughts distressing (ie, ego dystonic) will not act on them; as such, there is low risk of infant harm.” Ego-dystonic means the thoughts feel wrong and unwanted to you. The fact that a thought horrifies you is the thing that tells a clinician what it is.
Research supports this. In a study of 388 new mothers, women who had unwanted thoughts of intentionally harming their baby were no more likely to behave aggressively toward their baby than women who never had those thoughts. The same was true for women with postpartum OCD.
Describing one of these thoughts to a perinatal clinician will not surprise them, and it is not on its own a child protection matter. There is more on this on our page about intrusive thoughts.
Another reason is that postpartum OCD symptoms are often confused with anxiety or depression, so it is often misdiagnosed as well. There is also limited awareness about postpartum OCD as its own unique condition, which further prevents reporting and diagnoses.
Sadly, many women do not come forward about their OCD symptoms after giving birth and suffer silently instead.
Postpartum OCD Causes
Like with most mental health conditions, there is not an exact cause of postpartum OCD. Its onset has to do with your own unique mental health history and other elements in your life.
One factor that may contribute to postpartum OCD symptoms is a sudden and drastic hormone decrease after giving birth.
These changes, combined with chronic fatigue and overwhelming feelings while caring for a new baby, can lead you to develop severe anxiety that evolves into OCD.
Furthermore, if you had OCD before childbirth, you may find that having a baby worsens your symptoms. A new baby provides more uncertainties and responsibilities that can aggravate intrusive and anxious thoughts.
Postpartum OCD Risk Factors
While there is no single cause for postpartum OCD, there are several factors that can lead to an increased risk of developing it.
Here are some possible risk factors for developing postpartum OCD:
- A history of OCD at other times in life
- Having a family history of OCD or other mental health disorders, including mood disorders, bipolar disorder, and personality disorders
- Unmet expectations regarding motherhood that cause negative thoughts and self-doubt
- Being a first-time mother
- The baby was born preterm or through a C-section
- Having experienced other pregnancy complications or witnessed infant harm
- Experienced trauma during childhood
Postpartum OCD in men doesn’t share the same biological causes as postpartum OCD in women.
Therefore, a significant contributing factor to developing postpartum OCD is the natural fear and anxiety that comes with the pressure and responsibility of caring for an infant.
Postpartum OCD vs Postpartum Anxiety
Postpartum OCD often occurs alongside postpartum depression, but it is a distinct condition with its own characteristics rather than a form of it.
Postpartum depression is different from anxiety conditions primarily in that its symptoms are sadness, hopelessness, and crying frequently.
Key differences between postpartum OCD and postpartum anxiety include:
- Postpartum OCD is characterized by intrusive thoughts that focus on the baby. Postpartum anxiety is characterized by excessive worrying both about the baby and about things in general.
- Postpartum OCD involves engaging in compulsive behaviors as a reaction to anxious thoughts. Postpartum anxiety does not necessarily involve compulsions.
- People with postpartum OCD avoid certain situations because they fear something will happen to the baby. People with postpartum anxiety may avoid certain situations to avoid experiencing physical anxiety symptoms or panic attacks.
On the other hand, both postpartum OCD and postpartum anxiety can be extremely disruptive in a woman’s life, and both can benefit greatly from treatment.
How Long Does Postpartum OCD Last?
How long postpartum or perinatal OCD lasts depends on numerous personal factors, including:
- The severity of the OCD
- Whether the person has a previous history of OCD
- Whether they seek professional treatment
OCD is generally a condition people learn to manage rather than one that disappears on a set date, and symptoms can ease and return. That is not the same as a life sentence. In a 2024 study following new mothers across the first postpartum year, unwanted thoughts of infant-related harm were most intense in roughly the first eight weeks and, for most women, became less frequent or went away by six months.
This is why treatment is essential for women with postpartum OCD, especially in terms of early intervention.
Many women learn to manage their symptoms well enough that they stop interfering with daily life or with caring for their child.
Diagnosing Postpartum OCD
To be officially diagnosed with postpartum OCD, you will need to be evaluated by your doctor or a mental health professional.
This means recognizing obsessive-compulsive symptoms within yourself and discussing the symptoms you are experiencing with your physician.
In addition to discussing your symptoms, you may also fill out questionnaires and other screening tools to rule out other disorders.
Once diagnosed, you can discuss how you would like to proceed with treatment.
Postpartum OCD Outlook (Prognosis)
OCD is generally a condition people learn to manage rather than one that disappears on a set date, and symptoms can ease and return. Many women are symptom-free for long stretches, and perinatal-onset OCD is not a life sentence.
Treatment and mental health care for postpartum OCD focuses on managing symptoms and making the woman more comfortable and able to function, not necessarily in curing her.
Early intervention makes a measurable difference to the outlook, which is the reason to raise this now rather than wait to see whether it passes.
It is important not to give up on yourself if you do develop postpartum OCD. You can successfully manage your OCD with treatment and dedication.
Postpartum OCD Treatment
Postpartum OCD treatment is available to new mothers and fathers struggling with this condition. Treatment options usually combine medication and therapy to manage symptoms and help the person cope fully.
Cognitive Behavioral Therapy
Psychologists, psychiatrists, and other mental health professionals understand mental health issues and teach coping skills to improve quality of life.
This can be done with various types of therapy, though cognitive behavioral therapy (CBT) is considered the most successful type for treating OCD.
CBT and other forms of psychotherapy help people work through their intrusive thoughts in a safe and non-judgmental environment. It also teaches them how to replace their negative thoughts with positive ones.
The specific type of CBT that is used with postpartum OCD is called exposure and response prevention (ERP).
This type of therapy exposes people to their triggers gradually over time and allows them to become more adjusted and comfortable with them.
Medications
Physicians and psychiatrists will likely also suggest a course of medications such as antidepressants, specifically selective serotonin reuptake inhibitors (SSRIs), which are the best-studied medication for OCD. Medication is usually combined with exposure and response prevention rather than used instead of it.
Benzodiazepines are sometimes used short term for severe anxiety, but they are not a treatment for OCD itself. ACOG recommends avoiding them or prescribing them sparingly because of side effects and the risk of dependence, and prefers lorazepam, oxazepam or temazepam when one is needed. Alprazolam (Xanax) should be avoided because of its high addiction potential and withdrawal risk.
You do not have to choose between treatment and breastfeeding. ACOG recommends against stopping mental health medication just because someone is breastfeeding, and sertraline in particular passes into milk in very small amounts. Bring the specific drug to your prescriber rather than the general question — our page on antidepressants during pregnancy and breastfeeding has the drug-by-drug numbers.
Manage Postpartum OCD with Professional Help
Experiencing postpartum OCD can be scary and confusing, but you can feel like yourself again with the proper treatment and care.
If you are looking for a therapist during the postpartum period, browse our directory of highly qualified therapists.
With the right therapist to listen and guide you through the healing process, feeling better and improving your well-being can be one call away.
If you are having thoughts of harming yourself or your baby, call or text 988. The National Maternal Mental Health Hotline is also available around the clock at 1-833-852-6262. Both are free, confidential and open 24 hours a day.
Postpartum OCD FAQs
What is an example of postpartum OCD?
One example of postpartum OCD involves excessive checking on the baby to make sure that they are safe.
This can be disruptive and dangerous for the mother if she is sacrificing her own sleep or needs to keep watch over her baby.
Is it normal to have intrusive thoughts postpartum?
Yes, intrusive thoughts are typical and very common after giving birth, with studies suggesting they affect up to 80% of new mothers.
If your intrusive or obsessive thoughts are becoming disruptive in your everyday life or preventing you from properly caring for yourself or your baby, it may be a good idea to speak with a mental health professional.
Why did my OCD get worse after having a baby?
There are a few different reasons why your OCD may have become worse after having a baby, including because of hormonal changes as well as additional stress and sleep deprivation.
Psychological factors can also contribute if you are a new parent and have fears of your baby being harmed or if you have a previous experience with your children being harmed.
