Typical parenting worries or something more? What to know about Perinatal Obsessive-Compulsive Disorder (OCD)
By Cerissa Hayhurst, LCSW
It’s 3 A.M., and Kate is feeding her baby. On the outside, it looks like a peaceful scene: red light casting a warm glow that won’t disrupt her melatonin, she’s looking down at her newborn lovingly, and her baby smiles up at her before going back to eating. What you didn’t see were the loop of thoughts and images going through Kate’s brain for the past 10 minutes. Her thoughts sound like:
“Is my baby breathing? Is their chest going up and down? Wait, I don't see their chest rise and fall! OH MY GOSH they’re not breathing!!! Oh wait, no, now that the light is on I can see them breathing. Oh crap, I didn’t wash my hands before feeding them. What if I contaminate them with some deadly disease? What if I am the reason my baby ends up in the hospital because I didn’t wash my hands? Ok, now I have to stand up and put them back in their bed. image of dropping baby as she stands Oh my gosh why am I thinking that? I don’t want to drop my baby.”
Are these thoughts the common parenting worries with a newborn baby, or have we ventured into perinatal (pregnancy/postpartum) OCD territory? Below, we’ll cover what you need to know to better understand your thoughts and gauge whether help from a therapist would be beneficial.
Intrusive Thoughts vs. Perinatal OCD
Intrusive thoughts are a normal experience for many parents during the perinatal period. Research suggests that approximately 70–100% of new mothers experience unwanted thoughts about their infant's safety, and nearly half report distressing thoughts involving intentional harm. While these thoughts can be distressing, you are not alone in having them. Intrusive thoughts are involuntary, unwanted, and inconsistent with the parent's values (aka you have no desire to hurt your baby and feel distress when you had the thought). On their own, intrusive thoughts are not considered a mental health disorder and importantly don’t indicate that a parent is likely to harm their child. To reaffirm, having intrusive thoughts doesn’t mean you’re going to act on them; a thought is just a thought.
Perinatal OCD differs because the intrusive thoughts become frequent, highly distressing, and tend to be followed by compulsive behaviors or mental rituals intended to reduce the accompanying anxiety. Unfortunately, the actions to reduce anxiety reinforce the cycle of OCD and often increase distress over time. An example is fearing your baby is not eating enough, so you track every ounce they consume to reduce your distress, but the anxiety around them not eating enough doesn’t go down; it increases, so your brain starts inundating you with thoughts that you’re a bad parent, and you can’t get the thoughts to stop.
Perinatal OCD
Perinatal obsessive-compulsive disorder (Perinatal OCD), sometimes called postpartum or maternal OCD, is an anxiety-related mental health condition that can develop during pregnancy or after childbirth. It is characterized by recurring, unwanted thoughts, images, or urges (obsessions) and/or repetitive behaviors or mental rituals (compulsions) that are performed to reduce the anxiety created by those thoughts. While intrusive thoughts are common among new and expecting parents, Perinatal OCD is diagnosed when these thoughts become persistent, distressing, and begin to interfere with daily functioning or caregiving.
Common Symptoms
The obsessions associated with Perinatal OCD most often focus on the baby's health and safety. Common themes include:
Fear of accidentally harming the baby
Fear of intentionally harming the baby despite having no desire to do so
Concerns about contamination or illness
Sexual, violent, or religious intrusive thoughts
Excessive responsibility for preventing harm
To cope with these fears, individuals may develop compulsions such as:
Repeated checking on the baby
Excessive cleaning or disinfecting
Constant reassurance seeking
Avoiding situations they fear could trigger harm
Mental rituals such as counting, repeating phrases, or mentally reviewing events
Additional symptoms of Perinatal OCD can include anxiety, panic attacks, hypervigilance, guilt, depression, agitation, fear, and social withdrawal.
How Common Is Perinatal OCD?
Research indicates that Perinatal OCD occurs more frequently during pregnancy and the postpartum period than in the general population. Estimates vary across studies, with reported prevalence ranging from approximately 2–9% postpartum, while some newer research suggests rates may be even higher because many parents do not seek help due to fear or stigma. Symptoms often begin during pregnancy or within the first several weeks after childbirth; however, onset can occur anytime during the first year postpartum.
Although it is most often discussed in mothers, Perinatal OCD can affect all parents, including fathers, adoptive parents, and same-sex partners.
Causes and Risk Factors
Current evidence suggests that Perinatal OCD develops through a combination of biological and environmental influences. Hormonal changes associated with pregnancy and childbirth, particularly those affecting neurotransmitters such as serotonin, may increase vulnerability. At the same time, the significant responsibility of caring for a newborn and heightened concerns about the baby's wellbeing can trigger or worsen symptoms.
Oftentimes, mothers spend 9 months avoiding unnecessary risks because they care about their baby’s wellbeing and want to protect them. Then after birth, there’s the challenge of keeping the baby alive on a whole new level. Plus, you are worrying about something that is not entirely in your control, and that can feel really scary. This context can worsen symptoms.
Perinatal OCD Is Not Postpartum Psychosis
One of the most important distinctions is between Perinatal OCD and postpartum psychosis. Although intrusive thoughts in OCD can involve frightening images of harm, the individual recognizes these thoughts as unwanted and inconsistent with their beliefs. They typically experience significant distress because of the thoughts and actively try to prevent them from occurring.
In contrast, postpartum psychosis involves a loss of contact with reality, including hallucinations, delusions, and severely impaired judgment. Postpartum psychosis is a psychiatric emergency that requires immediate medical treatment, whereas Perinatal OCD is generally treated in outpatient mental health settings.
The Impact of Shame
Many parents experiencing Perinatal OCD avoid discussing their symptoms because they fear others will misunderstand their intrusive thoughts or question their ability to care for their child. This shame often delays diagnosis and treatment. However, intrusive thoughts associated with OCD do not reflect a person's intentions, character, or parenting ability. In fact, the distress these thoughts cause often reflects how strongly the individual values protecting their child.
Increasing awareness of Perinatal OCD can reduce stigma, encourage earlier intervention, and help parents recognize that effective treatment is available.
Key Takeaways
Intrusive thoughts are extremely common during pregnancy and the postpartum period and, by themselves, are not a mental health disorder.
Perinatal OCD develops when intrusive thoughts become persistent, highly distressing, and are accompanied by compulsive behaviors or mental rituals.
The condition commonly involves fears of harm, contamination, or responsibility for the baby's safety, but isn't limited to these topics.
Parents with Perinatal OCD recognize that their thoughts are unwanted and inconsistent with their beliefs.
Perinatal OCD is distinct from postpartum psychosis, which involves hallucinations or delusions and requires emergency treatment.
The condition can affect both childbearing and non-childbearing parents.
Early recognition and treatment can significantly improve symptoms and quality of life.
If you or someone you love is experiencing some or all of these symptoms, please reach out for support. You do not need to navigate this alone.
References
Chance, E. (2024, October 15). Silencing the stigma: Understanding perinatal OCD and letting go of shame. Postpartum Support International. https://postpartum.net/silencing-the-stigma-understanding-perinatal-ocd-and-letting-go-of-shame/
International OCD Foundation. (n.d.). Perinatal OCD overview (for clinical providers). https://iocdf.org/perinatal-ocd/for-clinical-providers/perinatal-ocd-overview/
International OCD Foundation. (n.d.). What is perinatal OCD? https://iocdf.org/perinatal-ocd/what-is-perinatal-ocd/
Jones, E. (n.d.). 5 misconceptions about perinatal and postpartum OCD. Postpartum Support International. https://postpartum.net/5-misconceptions-about-perinatal-and-postpartum-ocd/
Policy Center for Maternal Mental Health. (n.d.). Maternal OCD. https://policycentermmh.org/maternal-ocd/
