Postpartum Anxiety and OCD: What Every Mom Needs to Know

Unpacking anxiety and OCD can make a huge difference for moms.

This post is co-authored with Tatyana Mestechinka, Ph.D., Founder and Director of CBT For Better Living

Becoming a mother is often portrayed as a magical and fully joyful experience. Yet, for many women, it can be overwhelming, anxiety-provoking, stressful, and lonely. An often misunderstood, yet common experience of postpartum mental health is anxiety, particularly the presence of intrusive thoughts—unwanted, distressing, irrational thoughts or images (e.g., “What if I hurt my baby?” “What if I die in the next three months?” “What if something terrible happens to my baby?”). This experience is usually accompanied by a false sense of urgency and anxiety.

If you are a mom experiencing these thoughts, it can understandably feel bewildering, disturbing, and upsetting — yet nothing is wrong with you! Many moms question whether having these thoughts means they are a danger to their child or are a “terrible mother.” Here’s the truth: intrusive thoughts are incredibly common. Studies indicate that about 90% of people experience intrusive thoughts at some point in their lives, and new mothers are no exception. If anything, moms can be even more vulnerable to this experience, due to the often startling transition into motherhood.

What Is Postpartum Anxiety and OCD?

How do we distinguish the remarkably common occurrence of intrusive thoughts after having a baby from the type that might be more problematic? If intrusive thoughts occur rather frequently and cause significant distress and impairment, they may be part of Postpartum Obsessive-Compulsive Disorder (OCD) or Generalized Anxiety Disorder (GAD). Unfortunately, as many new moms are unfamiliar with this and fear speaking about it, it can feel incredibly isolating and shameful. Understanding, unpacking, and treating these symptoms can help you get through that “fourth trimester” and beyond without being tormented by anxiety.

What Might Postpartum Anxiety Look Like?

• Imagining scenarios in which harm could come to your child

• Checking multiple times that your child is safe

• Asking others for reassurance that your child is safe and/or that you wouldn’t harm them

• Avoiding certain situations due to fear

  
  

Rumination, checking and avoidance behaviors, while understandable in the moment, only serve to fuel and reinforce the anxiety and unnecessarily validate the relevance of the intrusive thoughts. These behaviors reinforce the false alarm signal that the thought itself is important, meaningful, or should be attended to immediately. Treating intrusive thoughts as relevant may inadvertently lead to their increased frequency and intensity. This cycle not only exhausts an already sleep-deprived new mom, it can also begin to disrupt her overall well-being at a time when she is already vulnerable. Instead: Recognize that an intrusive thought is just a thought (we all get nonsensical thoughts from time to time) and should be dismissed as such, especially when danger is in fact unlikely (it is extremely unlikely a new mom will harm her baby).

Why Don’t More Moms Talk About This?

Despite their commonality, the experience of postpartum anxiety and OCD is rarely openly talked about, partly due to the pervasive myth of the “perfect mother.” Society often expects moms to be entirely selfless, fully attuned to their baby’s needs, and endlessly positive about their role. Yet, for many, the reality is much messier, and moms can be left feeling isolated in their struggles, believing they’re the only ones who are experiencing them.

Furthermore, many moms fear being judged or misunderstood, and they may even worry that seeking help will result in unwanted interventions or social services. This can prevent them from discussing their distress openly with friends and loved ones, and they can even be wary of sharing their symptoms with mental health professionals. However, a mental health providers who specializes in this area can offer a supportive, helpful, and judgment-free space. The truth is postpartum OCD and anxiety are treatable! Sharing with trusted people is the first step in overcoming this challenge.

When to Seek Help:

It’s time to reach out when:

• These thoughts start to interfere with daily life (i.e., take up undue attention and energy)

• They affect your mood and well-being

• You’re avoiding things or engaging in excessive checking or reassurance-seeking

Talking to a therapist, especially one who specializes in postpartum care, can be incredibly helpful. Cognitive Behavioral Therapy (CBT), particularly a subset of CBT called Exposure and Response Prevention (ERP) as well as Acceptance and Commitment Therapy (ACT), are highly effective in helping individuals manage intrusive thoughts and feelings. In fact, research shows that 50–60% of people see significant improvement with ERP—and those improvements often last long-term.

What Treatment May Look Like

Through CBT and ERP, moms can reduce the impact of obsessive thoughts, breaking free from the hold these worries can have. The first aspect of therapy will involve openly sharing your experience with your provider. The therapist will assess if your symptoms are a part of a postpartum anxiety, OCD, or a mood disorder (PMAD) and offer you information to help you understand your diagnosis. CBT therapy, particularly ERP and ACT, will help you develop specific tools to manage this distress. You can learn to recognize intrusive thoughts as merely “thoughts” and to refrain from engaging in behaviors that might fuel these thoughts. For example, excessively reviewing the thoughts and engaging in excessive checking (e.g., checking over and over that your baby has not swallowed something) and avoidance behaviors (e.g., refusing to leave the house or leave your baby with a responsible caregiver due to fear of harm) can all reinforce the unwanted anxiety. In exposure therapy, the clinician will encourage a new mom to gradually reduce checking behaviors (e.g., check once, not seven times) and to gradually approach feared situations (e.g., take your baby for a five minute walk around the block, hire a babysitter for 30 minutes while you remain at home).

These exercises are a way to teach your brain that you are no longer responding to these anxiety signals with any relevance. The exposure exercises may be done in the therapist’s office or may be assigned to the mom as “homework” to practice. Exposures are always offered at a pace the mom is willing to do, and therapy can take place in person or via telehealth. To find a CBT therapist who offers ERP, consider asking your internist or searching online.

In Conclusion

Many moms experience postpartum anxiety after having a baby. This can be incredibly isolating if you have no idea what the symptoms are and keep them to yourself. Yet there is good news — effective treatment is available!

Portions of this post have been excerpted from my book, Goodbye, Anxiety: A Guided Journal for Overcoming Worry.