By: Sireesha Kolli, MD, and Jessica Pizzo, LCSW
The transition to motherhood is often jarring – from the physical recovery, to the sleepless nights and a new world of monumental responsibility. The impact of judgments from others and immense societal pressures, can cause many new moms to suffer in silence. However, postpartum challenges are common. Most research states that around 1 in 7 (about 15 percent) of new moms experience some sort of perinatal mood and anxiety disorder (PMADs), including depression, anxiety, obsessive compulsive disorder, or psychosis. Research shows that for new moms experiencing a postpartum mood disorder, the combination of psychotherapy and medication is often the best course of treatment.
In this article, written collaboratively by a perinatal mental health therapist and psychiatrist, we will be focusing on the experience of Postpartum Obsessive Compulsive Disorder (OCD). Our mission in collaboration is to combat the shame that many moms feel when experiencing postpartum OCD. By providing education, we hope to reduce the feeling of isolation that postpartum OCD can arouse, and inspire hope as you learn about what an evidence-based collaborative team approach may look like for you.
Why Do New Moms Have Scary Thoughts?
Postpartum OCD is a perinatal mood and anxiety disorder that causes unwanted, intrusive (obsessive) thoughts, and repetitive behaviors or mental acts (compulsions). For new moms, common obsessions include fears of harming the baby. These thoughts are horrifying to new moms, as they do not wish to harm their children. Common compulsions include repeatedly checking the baby’s breathing or monitor. Factors such as genetic predisposition, stress and trauma, and personality traits such as a detail oriented tendency can impact likelihood.
If left untreated, postpartum OCD can take a significant toll on the mother’s well-being. This makes it hard for mom to relax and enjoy time with their baby. The feelings of guilt, fear, and shame, can also increase the stress of bonding during this time. Left untreated, the impacts of postpartum OCD can last years. However, treatment is available and effective. With medication and therapy, many moms report relief from symptoms in months.
Diagnosing OCD By Dr. Kolli
Diagnosing postpartum OCD can be challenging. The symptoms often overlap with other postpartum mood disorders, such as postpartum depression and anxiety. However, postpartum OCD is distinct in its presentation. It is characterized by the presence of intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that the individual feels driven to perform in response to the obsessions. These thoughts can be particularly distressing for new mothers, as they often revolve around harm coming to the baby, either through accidents or even the mother’s own actions, which she would never actually want to occur.
The key to diagnosing postpartum OCD lies in the nature of these thoughts and the compulsions that follow. Unlike typical postpartum anxiety, where a mother might worry excessively about her baby’s safety, a mother with postpartum OCD experiences these thoughts as ego-dystonic – meaning they are in direct conflict with her values and desires. This conflict often leads to significant distress and can impair the mother’s ability to function. During the diagnostic process, it is important to differentiate between normal postpartum worries and OCD-related obsessions, as well as to assess the impact these thoughts have on the mother’s daily life.
Medication Management for OCD
By Dr. Kolli
Once postpartum OCD has been diagnosed, a comprehensive treatment plan should be put in place. Medication management is often a key component of this plan, especially when the symptoms are severe or significantly impairing. Selective serotonin reuptake inhibitors (SSRIs) are typically the first line of treatment. Medications like sertraline or fluoxetine are commonly prescribed, as they are generally well-tolerated and have a strong evidence base for treating OCD.
For new mothers who are breastfeeding, the choice of medication is particularly important. SSRIs, especially those with a favorable safety profile in lactation, such as Sertraline (aka Zoloft), are often preferred. It’s important to discuss the risks and benefits of medication with new mothers, including the potential impact on breastfeeding. In cases where SSRIs are not effective or are poorly tolerated, other options, such as serotonin-norepinephrine reuptake inhibitors (SNRIs) or augmentation with antipsychotics, might be considered. However, these decisions should be made with careful consideration of the mother’s overall health, the severity of her symptoms, and her personal preferences.
Psychotherapy for Postpartum OCD
By Jessica Pizzo, LCSW
For moms experiencing postpartum OCD, finding an affirming perinatal specialist to collaborate with your psychiatrist is vital. Affirming care means we respond to your unique needs and preferences. Additionally, working with a perinatal mental health therapist means no conversation is off-limits. You might worry about feeling judged, labeled, or misdiagnosed. If that sounds like you, a neuro-affirming approach to postpartum OCD can assist in reducing shame – you are not your scary thoughts!
The following is a helpful reframe I use in my work with moms with postpartum OCD. These thoughts are showing you your worst fears, in attempts to protect you or your child from experiencing them. With the right support, you can reduce the frequency of these distressing thoughts and feel more in control over how you cope.
Two evidence based techniques I use to treat postpartum OCD in NJ are Exposure Response Therapy (ERP) and Eye Movement Desensitization and Reprocessing (EMDR). Both are proven to assist moms in reducing the frequency of intrusive thoughts and images. Psychotherapy with an affirming perinatal mental health provider means symptoms can be reduced, and confidence can be built. A support person of your choosing (partner, or parent) can be a meaningful part of your support team as well.
Practice radical rest and self-love in small intentional increments. This can be as small as adding a protein shake to your morning to get a head start on providing your body the nutrients that it needs to thrive, or taking 5 butterfly breaths (deep breaths with slow, soft tapping) before you leave the bathroom each time. Safe somatic releases such as stomping on the floor while you breathe and dance, and sensory support such as a weighted blanket or noise reduction headphones can also be helpful!
Therapy And Medicine for Postpartum Depression, Anxiety, and OCD in NJ
By Jessica Pizzo, LCSW
Psychiatrist and psychotherapist collaboration can have a profound impact on the success of your treatment plan. With your consent, phone calls can occur between your treatment team providers to share updates on your successes and challenges. For example, your therapist might share a recent exposure EMDR activity, which assisted in greatly reducing your symptoms of distress. Alternatively, they may share about appetite changes and challenges, or any other symptoms that medication could help manage. Your psychiatrist will update your therapist on any medication updates, and changes. They will communicate about your safety, supportive resources such as group therapy, and health. Your team can also provide referrals to other health professionals, such as a pelvic floor therapist, if needed.
Overcoming Postpartum OCD in NJ
If you are experiencing frequent, scary thoughts regarding the safety of your child, know that you are not alone and help is available. A collaborative team approach (medication and evidence based therapy approaches) to Postpartum OCD can empower you to move forward into motherhood without feeling overwhelmed by fear.
Meet the Authors: Postpartum Anxiety Specialists in NJ
Sireesha Kolli, MD treats postpartum mental health disorders, including postpartum OCD, at Kolli Psychiatric and Associates (KPA). Click here to read more about Postpartum Depression from Dr. Kolli.
Jessica Pizzo, LCSW is a perinatal mental health specialist offering expert care in evidence-based practices like EMDR, ERP, and CBT at Brave Minds Psychological Services. Click here to check out Jessica’s other blogs.
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