Understanding Perinatal OCD
Parenthood can bring profound joy. It can also make you feel like you're losing your freaking mind.
The transition to parenthood can intensify anxiety, uncertainty, and mental health challenges in ways many people don't expect—and that we certainly don't talk about enough.
In recognition of Maternal Mental Health Awareness Month, it's important to talk about a condition that remains widely misunderstood: perinatal and postpartum obsessive-compulsive disorder (OCD).
While pOCD is often discussed in the context of pregnancy and childbirth, it can affect a wide range of parents and caregivers, including fathers, non-gestational parents, adoptive parents, and LGBTQIA+ families.
One of the most painful and often unspoken aspects of pOCD is the overwhelming shame that can accompany intrusive thoughts and compulsions. My hope is that this article can help reduce some of that shame by providing accurate information about what pOCD is—and what it is not.
What is Perinatal OCD?
Perinatal obsessive-compulsive disorder (pOCD) is a subtype of obsessive-compulsive disorder characterized by intrusive thoughts, images, or urges related to one's unborn or newborn child, along with compulsive behaviors or mental rituals aimed at reducing distress or preventing a feared outcome.
These obsessions are unwanted, distressing, and often deeply inconsistent with the person's values and intentions. In response, parents may engage in compulsions—either observable behaviors or internal mental rituals—in an attempt to gain certainty, reduce anxiety, or keep their baby safe.
Technically, OCD that occurs during pregnancy is referred to as perinatal OCD, while OCD that develops after childbirth is called postpartum OCD. Because these conditions overlap significantly—and because OCD is OCD regardless of its theme or timing—I will refer to them collectively as pOCD throughout this article.
Common pOCD Obsessions
Everyone experiences unwanted thoughts from time to time. In OCD, these thoughts, images, or urges become obsessions when they are interpreted as meaningful, dangerous, or requiring certainty or action.
In pOCD, these obsessions often center around the baby's safety, the parent's responsibility, and the fear of causing harm. Some common themes include:
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This obsessional theme involves fears of accidentally harming the baby or failing to protect them from harm. Examples include:
Fear of dropping the baby while carrying them.
Worries about becoming injured during pregnancy and harming the fetus.
Intrusive thoughts or mental images of suffocating the baby or being unable to keep them safe.
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This obsessional theme involves fears that the baby may become contaminated or become seriously ill. Examples include:
Excessive concern about germs, viruses, or environmental toxins.
Fear of passing an illness to the baby.
Worries that everyday objects, people, or places may pose a hidden danger.
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This obsessional theme involves a heightened sense of responsibility and fear of making mistakes as a parent. Examples include:
Fear of making a parenting error with catastrophic consequences.
Persistent doubt about one's ability to be a "good enough" parent.
Feeling completely alone and solely responsible for ensuring the baby's safety and well-being.
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Some parents experience unwanted intrusive thoughts, images, or urges involving violence, sexual content, or other themes that feel horrifying and completely inconsistent with their values. Examples include:
Intrusive images of physically harming the baby.
Unwanted sexual thoughts or images involving the baby.
Graphic or disturbing scenarios that evoke intense fear, guilt, shame, or disgust.
These are only some examples. While the content of pOCD obsessions varies widely, they often share a common theme: an overwhelming fear of causing harm or failing to protect one's child.
Common pOCD Compulsions
Compulsions are behaviors or mental acts performed to reduce distress, gain a sense of certainty, or prevent a feared outcome. While they may provide temporary relief, compulsions ultimately reinforce OCD over time.
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Checking compulsions involve repeatedly monitoring the baby, oneself, or the environment to make sure everything is safe. Examples include:
Checking the baby's breathing multiple times throughout the night.
Repeatedly verifying that the baby is securely strapped into a car seat or safely positioned in a crib.
Constantly monitoring the baby's temperature, feeding, sleep patterns, or other indicators of well-being.
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These compulsions involve excessive cleaning, sanitizing, or avoidance behaviors aimed at preventing illness, contamination, or harm. Examples include:
Cleaning and disinfecting baby items, surfaces, or household objects repeatedly.
Avoiding certain objects, places, foods, or people perceived as dangerous or contaminated.
Excessively washing hands, showering, or changing clothes to prevent exposing the baby to germs or toxins.
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These compulsions involve seeking certainty or reassurance from others, professionals, or online resources. Examples include:
Repeatedly asking family members, friends, or partners for reassurance about the baby's safety or health.
Spending excessive amounts of time researching parenting, pregnancy, or infant health concerns online.
Frequently contacting healthcare providers for reassurance about normal behaviors, symptoms, or developmental milestones.
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Avoidance can function as a compulsion when it is used to prevent feared thoughts, feelings, or outcomes. Examples include:
Avoiding being alone with the baby due to fears of causing harm.
Refusing to allow others to care for the baby due to fears that something terrible might happen.
Avoiding certain caregiving tasks or situations that trigger intrusive thoughts or anxiety.
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Not all compulsions are visible. Many people with pOCD engage in mental rituals aimed at reducing uncertainty or proving to themselves that they are a safe and loving parent. Examples include:
Mentally reviewing events to make sure no harm occurred.
Repeatedly analyzing the meaning of intrusive thoughts.
Trying to suppress, neutralize, or "cancel out" disturbing thoughts.
Mentally reassuring oneself that one would never act on an intrusive thought.
While the specific compulsions vary from person to person, they all serve a similar purpose: attempting to achieve certainty, reduce distress, or prevent a feared outcome. Unfortunately, these strategies tend to strengthen OCD over time rather than resolve it.
Who Can Experience pOCD?
While research on pOCD continues to evolve, current evidence suggests that its development likely involves a blend of biological, psychological, and environmental factors. Hormonal changes, genetic vulnerability, stress, sleep deprivation, and the profound responsibilities associated with caring for a child may all play a role.
Although pOCD is often discussed in the context of pregnancy and childbirth, it can affect a wide range of caregivers. Fathers, non-gestational parents, adoptive parents, and other caregivers can also experience intrusive thoughts, obsessions, and compulsions related to the safety and well-being of their child. pOCD is not limited by sex, gender, or biological relationship to the child.
Thoughts Do Not Equal Danger
Many new parents with pOCD experience intense shame and guilt related to the content of their intrusive thoughts. They may question their worth as parents and as people. This can lead to isolation and reluctance to seek help, often out of fear that they will be misunderstood or judged as dangerous rather than recognized as someone experiencing OCD.
Intrusive thoughts in OCD are not indicators of intent, desire, or risk. Research suggests that individuals with OCD are not more likely to act on their intrusive thoughts than the general population.
What drives the distress in pOCD is not the presence of these thoughts, but the meaning assigned to them. Because the thoughts feel so upsetting and inconsistent with personal values, they become highly alarming—leading to anxiety, shame, and attempts to “neutralize” or gain certainty about them.
In response, people may engage in reassurance seeking, checking, avoidance, or other strategies aimed at preventing feared outcomes or proving they are safe. While understandable, these responses can unintentionally strengthen the OCD cycle over time.
The presence of intrusive thoughts reflects how OCD works—not a person’s character, intentions, or capacity to care for their child.
It Get’s Better
Treatment for pOCD can include specialized, evidenced-based therapy for OCD like Exposure and Response Prevention and Acceptance and Commitment therapy. Treatment also may include medications. A combination of therapy and medication has shown to be most effective in the treatment of OCD of any subtype. Medications vary based on risks/benefits and safety for pregnant and breastfeeding people; always consult your doctor for guidance regarding medications.
Intrusive thoughts, anxiety, and heightened protectiveness are common in early parenthood. pOCD differs in that these experiences become persistent, distressing, and start to interfere with daily life, caregiving, or a person’s ability to feel present with their child.
pOCD is treatable. With appropriate care, many people experience meaningful relief and a reduction in how much space intrusive thoughts take up in their day-to-day lives.
If you are located in Michigan and would like to explore OCD-focused therapy with me or a clinician at Maytree Therapy, you are welcome to request a free 20-minute consultation. If we are not the right fit, referral options can be provided. For those outside of Michigan, the International OCD Foundation provides a directory of trained OCD providers at iocdf.org.
I’ll end this post with a favorite quote about parenting:
“There's no way to be a perfect parent and a million ways to be a good one.”
- Jill Churchill
Disclaimer: It's important to remember that while my blog post can provide insights and tips for managing OCD, it is not a substitute for professional therapy. Therapy offers personalized guidance, support, and evidence-based interventions tailored to your specific needs and challenges. A trained therapist can help you develop coping strategies, navigate difficult emotions, and work towards long-term recovery from OCD. So, while I hope you find this article helpful, I want you to know that it’s okay to reach out for professional help if you're struggling with OCD or any mental health concerns.
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