When my first child was born, I was immediately in love. I was also acutely aware of how vulnerable I had now become. With my child being outside my body, I suddenly knew that the most painful thing that could happen to me, was something horrible happening to my child. I remember standing at the top of the stairs holding my beautiful newborn baby and thinking, “what if I drop her down the steps?” The image of her body swaddled in a blanket rolling down the stairs popped into my mind. I thought to myself, “Wow, that was a scary thought.” Four years later, my son was born. I was more experienced and had learned that a new parent can’t control everything nor create the perfect space to raise a child. As I walked with him past the fireplace, the image of his skull being cracked against the edge of the hearth popped into my mind. “Wow, there it is again,” I thought, referring back to past images of harm coming to my first newborn.
Many new parents experience scary thoughts about bad things that could happen to their children, for example, accidentally harming their newborn child. When the thoughts are inconsistent with the parent’s personality, are distressing and interfere with the parent’s functioning, and take up a significant portion of time, it is possible that it may be post-partum OCD (PPOCD). Post-partum OCD is rare (1-3%). It is characterized by obsessions and compulsions. When the parent experiences the thought (obsession), they become frightened or distressed. They may avoid things that remind them of the thoughts. They may not go to certain places because it could result in something scary happening. They may ask others for reassurance about their parenting or supervision during certain activities (for example, bathing the child). New parents with OCD may attempt to neutralize bad images by replacing them with good images or saying special prayers (“I love my baby. I will not harm my baby.”) Avoiding places and reminders, asking for reassurance, and mental neutralizing along with other extreme steps to prevent harm coming to the child would be considered compulsions if they take place in response to the distressing thought.
Avoidance, reassurance seeking, mental neutralizing and other safety behaviors help to reinforce or maintain the distressing thoughts of harm. As a new parent, I had the advantage of being an OCD specialist. I immediately recognized my thoughts as anxiety based and knew that I had to keep walking past the stairs and the fireplace and do nothing further in order to make me feel safe in taking care of my children. Individuals with PPOCD may not be so lucky. Once an obsession is given into and compulsions are performed, it can become an insidious process. New obsessions and compulsions may arise. New parents may find themselves in a world filled with anxiety. Getting relief from the anxiety requires the new parent to refrain from avoidance and safety behaviors or compulsions. For example, if a parent is scared that they might stab their baby even though they don’t want to and the thought fills them with fear and anxiety, they must continue to use knives and sharp objects. By allowing the thought to be there without engaging in the avoidance and safety behaviors a new parent can learn that they already have the skills to create a safe environment for their child. When something bad eventually happens to their child (a natural condition of living in the world), they can handle the situation and their anxiety.
Exposure and Response Prevention (ERP) is a Cognitive Behavioral Therapy and is the gold standard of treatment for post- partum OCD. Parents can try ERP alone or in combination with medications. For more information see https://iocdf.org/expert-opinions/postpartum-ocd/.
About Elizabeth Ellis-Ohr, Psy.D.:
I am a licensed psychologist specializing in treatment of anxiety disorders. The work I do is evidence based which means the treatments have been tested in multiple research studies and have been shown to be effective for most people. My specialty includes Prolonged Exposure Therapy (PE) for PTSD, Exposure and Response Prevention (EX/RP) for OCD, as well as cognitive-behavioral treatment for social anxiety, panic disorder, specific phobias, and generalized anxiety. These treatments are usually time limited, meaning many people experience benefits early in treatment and complete treatment in 10-20 sessions. My goal is to make you the expert in your own anxiety and teach you the skills needed to manage your anxiety independent of regular therapy sessions.
I received my Psy.D. in clinical psychology from Immaculata University in 2009. I completed post doctoral training at the Children’s Hospital of Philadelphia Center for Management of ADHD and the University of Pennsylvania Perelman School of Medicine at the Center for the Treatment and Study of Anxiety (CTSA). I worked as clinical faculty at the Center for the Treatment and Study of Anxiety prior to moving to New Hampshire. I am the Past-President of the International OCD Foundation New Hampshire Affiliate and I am a current active member of the Executive Board. I am also a member of the American Psychological Association, and the Association of Behavioral and Cognitive Therapies.
You can learn more about Dr. Ohr and the services she offers by clicking here