Perinatal OCD: When Intrusive Thoughts Persist After Pregnancy

When the scary thoughts are more than just thoughts

A colleague and I were chatting recently and discussing the implications of having experienced perinatal OCD and our navigation of this, even as mental health clinicians. Having a new baby and starting to experience scary thoughts that become difficult to navigate feels confusing and daunting, even for us in the field.

When parents experience perinatal OCD, intrusive thoughts can feel relentless. Individuals may spend significant time analyzing or checking their thoughts, trying to make sure they aren’t true. It can be very scary and feels highly isolating, because what do you mean to share with someone that I’m having these dark thoughts about my baby?

Absolutely, share. Let someone know what is going on because you deserve to feel better and to know that you are not causing this, or making it happen and can receive treatment.

When intrusive thoughts become persistent and are followed by significant distress, anxiety, depression, and/or compulsions, the thoughts feel much more than “just thoughts.” Perinatal OCD involves unwanted, distressing intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) during pregnancy or after birth. About 2–3% of parents experience perinatal OCD, though it may be underrecognized. It is also more common among those with a history of OCD. OCD often follows a cycle: a trigger → intrusive thought → distress → compulsion → temporary relief.

Obsessions may include:

• Fear of contamination or illness affecting the baby
• Unwanted thoughts or images of accidentally or intentionally harming the baby
• Fear of the baby dying
• Unwanted sexual thoughts
• Fear of losing control or “going crazy”

Compulsions may include:

• Excessive washing or cleaning to reduce distress
• Repeatedly checking the baby, including breathing, position, feeding, or diapers
• Repeating behaviors in a specific or ritualized way
• Mental checking: “Am I still having the thought?” “What if?”

These behaviors aren’t about being overly organized or cautious, they are attempts to temporarily reduce anxiety and distress.

OCD-related intrusive thoughts are ego-dystonic, meaning they go against a person’s values, beliefs, and sense of self. They can be incredibly disturbing, often leaving someone stuck in “What if it’s true?” The person experiencing them is typically distressed by the thoughts and does not want to act on them.

It’s important to remember that OCD is not psychosis, and having an intrusive thought does not mean you will act on it. With perinatal OCD, people may engage in compulsions such as checking, avoiding, reassurance-seeking, or mentally analyzing the thought to feel safe.

Common fears include: “What if I’m going crazy?” “What if I harm my baby?” or “What if I harm myself?” Understanding the difference between perinatal OCD and perinatal psychosis is important, as they are different experiences that require different treatment.

You are not your thoughts. You are not a bad parent. Support is available, and you don’t have to navigate this alone.

OCD thoughts are not command hallucinations

A significant fear when OCD is present; what if I act on the thought because it sounds like a command?

An intrusive thought is unwanted. Again, it clashes with the person's values and sense of self.With perinatal OCD, these thoughts can sometimes sound forceful or demanding, not “What if I do X?” but “Do X.” This can be very frightening and may feel similar to a command hallucination.

The distinction is in the experience of the thought. With OCD, the person is horrified or distressed by the thought (remember, ego-dystonic), does not want to act on it, and often desperately wants to get rid of it. A command hallucination is a perceptual experience, such as hearing a voice or command experienced as coming from outside oneself or as a distinct voice separate from one’s own thoughts.

A frightening thought, even one that sounds like a command does not mean you will act on it.

If you read my last blog about intrusive thoughts in new parents, you already know: you don’t have to wait until things feel bad to seek out support. It’s there and available. In Michigan, you can reach out to book a session with me at Lifeologie Counseling Ada at (616) 929-0248, or find a Lifeologie Counseling therapist near you who can help you work through postpartum and perinatal issues. And if you’re along for our reading journey, up next: my blog diving into perinatal psychosis.