Great article on PPOCD and Intrusive Thoughts

Bill Meyer, facilitator for the pregnancy/postpartum support group at the Duke University Medical Center, sent me this article today from the Washington Post that appeared on March 7 about postpartum obsessive compulsive disorder (PPOCD). The article is called "Scary Thoughts" by Stacey Colino. (You may have to register to see the article – registration is free.) I suffered PPOCD during the birth of my first child and the article is definitely on target. Here are quite a few highlights that I think are important (the underlining is my emphasis):

"Indeed, some women … develop clinically significant symptoms of OCD during pregnancy or the postpartum period — a phenomenon that is vastly under-recognized, experts say.

While reliable statistics on postpartum OCD are lacking, the lifetime incidence of OCD in the general population is believed to be 2 to 3 percent. What distinguishes OCD symptoms from normal intrusive thoughts is partly the extent to which these ideas are anxiety provoking, irrepressible and persistent.

'To have a real obsession, it's an intrusive, unbidden thought, idea, or image that comes to your mind that you do not want and actively try to resist,' explains Gerald Nestadt, a professor of psychiatry at the Johns Hopkins Medical Institutions in Baltimore. 'You can't get rid of the thought' …

Some experts believe postpartum OCD occurs primarily in women who already have the condition, sometimes in a mild and undiagnosed form.

Complicating matters, postpartum depression and OCD often go together, but many women and their clinicians focus exclusively on the depressive symptoms. Yet a study at Case Western Reserve University in Cleveland found that postpartum depression is accompanied by obsessive thoughts in 57 percent of new mothers.

The extensive media coverage of mothers who kill their kids (as in the widely reported 2001 incident where Andrea Yates drowned her five children) makes some new parents with intrusive thoughts worry whether they're headed down a similar path. In most cases they are not. But just being exposed to such stories can fuel the thoughts, Abramowitz says. 'You read things in the news, and it's normal to incorporate that into your experience' …

There are key differences between obsessive thoughts and postpartum psychosis, explains Shaila Misri, a reproductive psychiatrist and director of the reproductive mental health program at BC Women's Hospital and Health Center in Vancouver, B.C.

Obsessive symptoms tend to be 'repetitive, unwanted thoughts that the person is aware are not normal even though she is unable to stop them,' she explains. With psychotic symptoms, 'the repetitive, unwanted thoughts are actually delusional, and the person who is having them believes they are real.' While women with OCD rarely harm their children, Misri adds, 'those with postpartum psychosis are in very real danger of doing so' …

Yet there's often a 'don't ask, don't tell' dynamic surrounding this subject in the physician's office, experts say. While many doctors screen for postpartum depression these days, few ask about intrusive thoughts, Misri says. Meanwhile, new mothers often feel guilt and shame and stay silent.

'A lot of times people are afraid to mention these symptoms because they think if other people knew, they'd lock them up or take the baby away,' Dell says. 'When I ask [new mothers] if they're having unwanted, intrusive thoughts, they are often quite relieved to hear that this happens to other people and that there are probably some biological reasons for this' …

Says Nestadt, 'The very sad thing is that many people who have experienced an onset or exacerbation of OCD during pregnancy or the postpartum period and didn't receive or respond to treatment may be unwilling to have other kids after the experience. . . . To have OCD and worry constantly day after day is dreadful.'"

That about covers it!! I had horrible thoughts; I knew they weren't real but they scared me to death; I thought I would never be the same; I was afraid to tell anyone because I thought they'd lock me up and throw away the key; When I finally got help I was relieved to find out what was really happening and that I would be ok; It turns out I probably had mild OCD my whole life, and it was simply exacerbated by pregnancy; I was very afraid to have another child, etc., etc. I hope you find this article helpful.

Tags: intrusive thoughts postpartum OCD postpartum psychosis PPOCD

About Katherine Stone

is the founder of Postpartum Progress. She has been named a WebMD Health Hero, one of the fiercest women in America by More magazine, and one of the top 20 Social Media Moms by Working Mother magazine. She is a survivor of postpartum OCD.

Tell Us What You Think


  1. What a wonderful site you have. It's so true that it is such a relief to discover that other mom's have 'scary thoughts' too. And that it's not your fault! Thank you for all of your hard work.

  2. Robert Lindsay says:

    Key element here is resistance. The person with OCD tries very hard to resist the thoughts and knows they are nuts. It is the thoughts themselves that frighten the person, the very thought that the person is having such and such a thought. The person with a psychosis thinks the thoughts are real and never tries to resist them, EVER, not even one time. They are simply accepted as reality, however scary reality may be.
    They are usually not embarrassed by the thoughts and they do NOT EVER think that they are crazy. Ppl with OCD ALWAYS think that they are nuts. If you think you are crazy, or the thoughts that you have are crazy, then you are not crazy, it is that simple. Furthermore, psychotic delusions are not necessarily repetitive. They are ego-syntonic. OCD is ego-dystonic.
    An OCD thought can be about anything in the whole world, including a thought that may appear psychotic on the surface. It is the way that the thought presents itself, NOT THE THOUGHT ITSELF, that determines whether or not you are dealing with obsession or psychosis.

  3. Sarah Myers says:

    I have had depression and OCD for ten years now and my medication was keeping me on track. Then my son was born, I was excepting to be fine because of the medication I was on, that was not the case. I was hospitalized for two weeks. I told my doctor everything I thought and felt, I just wanted to get back to normal so I could enjoy being a mother to my son. I would rather risk the shame than experience those thoughts again.

  4. cynthia harman says:

    i have ppocd, and i got my son taken away because of my intrusive thoughts…i need help explaining to them that the intrusive thoughts are part of a disorder…any suggestions?

  5. Hello,
    I just wanted to add something that may help anyone reading this.
    I suffered from the above symptoms. 6 months downs the line, it has got better, a LOT better. I have bad days still, where I’m exhausted, and/or lonely, and my defences are down.
    One thing I managed to convince myself of was this: I love being a mother. My son is happy, beautiful and healthy. My anxieties do NOT impact on him. I certainly have his best interests at heart and everyone says I am a great mum. Sound familiar? Well I have realised that these thoughts, be they about a nearby knife or whatever, are just an extreme way of recognising a potential danger to your baby. You have absolutely no intention of causing said danger, but you are hyper aware of it. In effect, this makes you a better mother as you are really looking out for your little one. I repeat, you are just recognising a potential danger. Unfortunately, due to your OCD, your mind runs away, and this is where medical help is useful. I will be going to the doctors to seek some help, I deserve it, so do you! So do our kids.
    Thank you for this article. I’m sure you know how much it helps for people to read they are not alone in this situation. We all want to be ‘normal’ and talking about this makes it so much easier.

  6. This is a great read. When I had my child I ignored my ‘Crazy’ thoughts and pushed them aside. However now my child is 9 years old and my partner and I have decided to have another, I have found the ‘Crazy’ thoughts have come back again. Is it possible that because I did not deal with this all that time ago that this is why they are back even more so? I want to deal with this now once and for all. Any advice as to how I can find the right counsellor would be greatly appreciated.