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Postpartum OCD affects an estimated 1-3% of new moms. While it is rarer than some other perinatal and postpartum mood and anxiety disorders, like postpartum depression and anxiety, it is categorized by the World Health Organization as one of the top ten most debilitating mental health disorders.
If you are experiencing scary thoughts about yourself or your baby, it can feel like the weight of the world is pressing down on you. That’s why we sat down with Jenna Overbaugh of NOCD to break down postpartum OCD, guide you through seeking a diagnosis, receiving treatment, and coping with your new normal.
Jenna is a licensed therapist who has been working with people who have OCD and anxiety for over a decade. When she experienced her own struggles with postpartum OCD, anxiety and depression, and medical gaslighting, she shifted her focus and her professional approach. Now, Jenna is a self-described cheerleader of compassion and empathy for mothers struggling with OCD, and hopes to end the stigmatization around new moms needing mental health help.
Here’s what we learned during our chat with Jenna…
Obsessive Compulsive Disorder is a complex and often misunderstood mental health condition. In its simplest terms, the disorder is categorized by recurring, unwanted thoughts, often called intrusive thoughts, mental images, urges, impulses, or even sensations that result in feelings of disgust, fear, or excessive guilt (obsessions). These obsessions also will lead a person to perform some action to find relief or get away from the thought—these could be anything from counting to cleaning, checking for bodily reactions to ruminating or forcing yourself to try and find a distraction. Most people will repeat the action to try and get rid of or avoid the thoughts (compulsions).
“OCD does not just have to be about the fear of germs or needing everything to be clean and orderly. Although those manifestations do happen, it can be with anything. So the content of OCD is really only limited by one’s imagination.” — Jenna Overbaugh, LPC
OCD has many subtypes: relationship, religious, sexual-orientation, contamination, and harm being a few. Any subtype of OCD ultimately comes back to the basics of obsessions and compulsions—postpartum OCD really just refers to OCD that occurs after one has a child. Perinatal OCD, or OCD during pregnancy, also exists.
Ask any new parent and they will probably all say the same thing—worrying about accidentally hurting your child, doing something wrong, or being a “bad” parent are normal. While mothers with anxiety tend to overthink these worries, the difference is how one engages with their thoughts. OCD thoughts are often “irrational,” in nature and can become sticky, plaguing a sufferer’s mind. It’s also important to note that OCD thoughts are typically ego dystonic, meaning they cause a person feelings of repulsion and distress or are not in line with one’s morals and self-values. Ultimately, the act of repetitive behaviors to find relief from the anxiety is what separates anxiety and OCD.
“A common obsession that’s very taboo and not often talked about, but very, very real and common for women and new dads as well, is unwanted sexually intrusive thoughts. These are unwanted—I can’t underscore that enough. These thoughts cause disgust, fear, and a lot of avoidance.” — Jenna Overbaugh, LPC
Remember that these lists are not exhaustive, OCD thoughts can be about anything.
Perinatal and postpartum mood and anxiety disorders, or PMADs, is a term used to describe anxious, distressing, or excessive sadness and other feelings, that occur during pregnancy (perinatal) and throughout the first year after pregnancy (postpartum). There are several mood disorders than can arise specifically during pregnancy and postpartum. Some of those conditions are more common than others, like the baby blues, perinatal anxiety, and postpartum depression.
For women experiencing postpartum OCD, the issue of depression can present itself in two ways. One, a new or soon-to-be-mom can become anxious about negative thoughts, forcing herself to isolate and exacerbate the issue. This can sometimes lead to depression on top of OCD. On the other hand, if you are depressed initially, it can lead to an uptick in negative thoughts. This can lead to increased obsessive tendencies. While it doesn’t always happen the same way, the answer to this question is ultimately yes, it is possible to be diagnosed with both depression and OCD at the same time.
Postpartum psychosis is also an extremely rare condition, affecting 0.1% of new mothers—but because the content of intrusive OCD and psychosis thoughts can sometimes be similar, it is possible for improper diagnosis and subsequent incorrect treatment. For women seeking treatment or diagnosis of postpartum OCD, it is important to understand the differentiators between OCD and psychosis. With psychosis, women are curious about or act on their impulses of harm. Psychosis can also materialize as delusions and strongly held beliefs or hallucinations, both visual and auditory. For those with OCD, the thoughts are the opposite of what a person believes or wants, and they almost never act on their thoughts.
A quick note on anxiety disorders: Postpartum OCD may not present with another PMAD, but it can co-exist with different types of anxiety disorders. These include trichotillomania (hair pulling), excoriation (skin-picking), body dysmorphia, or even hoarding.
If you, or someone you love, are displaying signs of postpartum OCD, you may wonder how to get a formal diagnosis. It’s understandable to hesitate on asking for help. You may also feel unsafe sharing the full content of your intrusive thoughts. Jenna’s number one tip for seeking treatment is to come prepared and be ready to advocate for yourself.
“Be very clear in how much it is that you’re struggling so that your doctor takes you seriously. Also, be sure that you communicate that these are ego dystonic thoughts, that these are thoughts that you do not want to have, and that these are actually very characteristic of obsessive compulsive disorder.” — Jenna Overbaugh, LPC
Depending on where you live, the technicalities may be different, but according to the International OCD Foundation, only a trained healthcare or mental health professional can diagnose OCD.
Therapists will look for three things: 1. You have obsessions. 2. You have compulsive rituals or behaviors. 3. Your obsessions and compulsions take time out of or greatly affect your daily life.
After you have received your diagnosis, the next step is to begin treatment. While there are a variety of methods for addressing OCD, Exposure and Response Prevention Therapy is the “golden standard.” Depending on your schedule, budget, and willingness, you can explore what feels right for you—be sure to talk with your doctor or therapist if you aren’t sure where to begin or are feeling overwhelmed.
ERP is a form of another common therapy type called cognitive behavioral therapy (CBT). ERP can help people with OCD, PTSD, and other phobias learn to identify and cope with their triggers. It works by gradually exposing a person to something that would provoke an obsession, but asks them to not act on their compulsions. In this way, they are eventually able to sit with any discomfort they might be feeling, but free them from the cycle of ritualistic behavior. In a nutshell, you get used to your anxiety, and you can get back to living your life.
“ERP is tried and tested, and has the most trophies behind it when it comes to evidence-based OCD treatment. It is is a gradual way of working with a person to approach their fears in a way that’s challenging, but manageable while reducing their safety behaviors or reducing their compulsions.” — Jenna Overbaugh, LPC
Acceptance and Commitment Therapy (ACT) is another therapy that falls under the CBT umbrella and has many similarities to ERP. In this type of therapy, the patient is asked to engage in a concept called psychological flexibility—being in your present moment, experiencing whatever thought you may be having, without actively trying to change or avoid them, and instead changing your behavior based on your decided on goals and values. ACT may be beneficial for people who are struggling with ERP.
Certain psychiatric medications can help control obsessive thoughts and compulsions. Antidepressants are usually the first choice, and though they are named antidepressants, it does not mean you are or have to be depressed to use them. These types of medications work by altering chemicals in the brain and can take several weeks or months to produce results. It is also not uncommon to have to try different medications, different doses, and combinations of medication and other techniques.
If medication feels like a good choice for you, be sure to talk to your doctor about potential side effects. Ask if there is an increased risk of suicide, concerns if you are breastfeeding, or if there could be interactions with other medications you may take.
We want to preface this section by saying that there is no way to meditate your OCD away. Instead, think of mediation as a tool in your wellness kit—like a companion to other therapies. Meditation and mindfulness with OCD means you may observe and accept unwanted thoughts without judging or attaching meaning to them. Meditation also has many researched-back benefits for OCD sufferers, like lowering stress, decreasing cortisol, and boosting dopamine.
We know that this is probably the question most people with OCD will ask when they set out on their journey to overcome it. While the answer isn’t a clear yes or no, we do have some good news. OCD may not ever fully go away. It could be something you live with forever, but you won’t always meet diagnostic criteria for it.
What that means is, OCD can wax and wane. Anxiety is a natural part of life, and something could trigger you weeks, months, or years down the road. Once you have a diagnosis and begin therapy, or whatever treatment you choose, you’ll hopefully feel better prepared and able to move through any hard spot that comes your way.
“I know plenty of people—including myself, who used to meet diagnostic criteria for OCD—who would no longer meet diagnostic criteria for OCD. It doesn’t mean that I still don’t have triggers every once in a while… We’re all gonna get anxious every once in a while and we’re gonna sit with discomfort and we’re gonna have to try to challenge ourselves.” — Jenna Overbaugh, LPC
If you are currently experiencing unwanted intrusive thoughts, let us be the first to say that you are not alone. Jenna recommends educating yourself via resources online, in the OCD community, or on the NOCD app as a first step. You might also check out the All the Hard Things podcast, hosted by Jenna, that explores OCD and mental wellness.
New mothers are already up against so much. From navigating changes in your schedule to hormonal fluctuations and lack of sleep… If you, or someone you know, are experiencing obsessions and compulsive behavior, you are not a bad mother. Thoughts can feel consuming and real in the moment, but you can learn to grow around them.
Seeking treatment as soon as you can will help to avoid worsening symptoms. Many treatment options are available for postpartum OCD. From medications to therapy, your mental health provider or doctor can help you decide on the right path for you.
If you want to learn more about Postpartum OCD, be sure to listen to our interview with Jenna Overbaugh, LPC now on the Expectful App. During the Interview, Jenna shared her tips for getting a diagnosis, resources for those newly diagnosed, and other tools for overcoming OCD.
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