I often would call the babysitter to check if Josie was ok. I struggled mightily not to turn the car around and return home just to be with her, to be sure she was safe. Because what if I didn't? Then, if something happened to her, it would be all my fault. She could die. And it would be because of me. I didn't love her enough to turn around. My thoughts spiraled and grew darker.

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I knew about postpartum depression. I was, certainly, depressed and overwhelmed. But was it just the normal fatigue of being a new mom? And what about these terrifying thoughts? I was a grad student in clinical psychology, for God's sake. Shouldn't I know what was wrong with me? Was there something wrong with me?

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I had not yet learned about OCD. And, as it happens, I shouldn't have known about Perinatal OCD. The field of clinical psychology itself didn't recognize it until the early 2000s, after my daughter was born. I was, for all intents and purposes, alone.

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Even though we have learned much about Perinatal OCD in the past few decades, sufferers often still feel alone, and many well-intentioned clinicians do not feel equipped to treat it. We at the New England Center for OCD and Anxiety intend to change all of that, starting with providing evidence-based information about what Perinatal OCD is and isn't.

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So What Is Perinatal OCD, Exactly?

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Perinatal OCD is the onset or significant worsening of obsessive-compulsive disorder during pregnancy or in the months following childbirth. It may appear out of nowhere in someone with no prior psychiatric history, as it did for me, or it may be a flare of pre-existing OCD, triggered by the hormonal and emotional upheaval of becoming a parent. You may also hear it called postpartum OCD, maternal OCD, or postnatal OCD. These terms are often used interchangeably, and all of them describe the same thing.

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Like all OCD, it has two core features. First, obsessions: intrusive, unwanted, distressing thoughts, images, or urges that arrive without invitation and refuse to leave. Second, compulsions: repetitive behaviors or mental acts performed to try to make the anxiety stop. Calling the babysitter to check. Turning the car around. Running through every possible catastrophe in your mind, just to be sure. These behaviors provide temporary relief, but they feed the OCD rather than quieting it.

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What makes the perinatal presentation distinctive is what the obsessions are about. In this period, they almost always center on the baby. Fears of accidentally harming them, terrifying images of something going wrong, or an overwhelming sense that if you don't check, if you don't make sure, then whatever happens next will be your fault.

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Here is the most important thing to understand about these thoughts: they are ego-dystonic, meaning they are completely contrary to who the sufferer actually is. They do not reflect the parent's desires, values, or intentions. The very fact that the thoughts feel so monstrous, so horrifying, is evidence of how deeply this parent loves their child. OCD attacks what we love most. It exploits that love ruthlessly.

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Who Gets Perinatal OCD?

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More people than you might think, and more people than the research has historically captured, because so few sufferers ever come forward.

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Conservative estimates suggest perinatal OCD affects somewhere between 2 and 9 percent of new mothers following birth, compared to roughly 1-2 percent of the general population. That's a significant increase in risk, and yet it remains dramatically underscreened and underdiagnosed.

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It is also not only a condition that affects mothers. Research shows that new fathers and non-birthing partners experience perinatal OCD at comparable rates, with similar intrusive thoughts and similar difficulty asking for help. Becoming responsible for a tiny, vulnerable life is terrifying regardless of whether you gave birth, and OCD responds to that terror.

Family history matters too, and it's worth saying plainly: OCD runs in families. If a parent, sibling, or close relative lives with OCD or significant anxiety, your own risk is meaningfully higher. Think of it the way you might think of a family history of heart disease – the condition itself isn't guaranteed, but the underlying vulnerability can be inherited. The hormonal shifts and emotional intensity of the perinatal period can be enough to switch that vulnerability on.

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Why So Many People Never Say a Word

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Given how common perinatal OCD is, you might wonder why so few people seek help. The reasons are understandable, and heartbreaking.

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The most powerful barrier is fear. Specifically, fear that if you tell someone; a doctor, a therapist, anyone, about thoughts of harming your baby, that baby will be taken away from you. This fear is so pervasive, and so paralyzing, that many parents suffer in silence for months rather than risk it. I understand that fear intimately.

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There is also profound shame. The content of perinatal OCD, vivid, often violent images involving a newborn, is among the most stigmatized inner experiences a person can have. Sufferers frequently believe their thoughts reveal something fundamentally wrong with them, something dark and secret that no one else could possibly understand. They are wrong about that. But shame doesn't respond well to logic, especially when you're sleep-deprived, hormonally destabilized, and desperately trying to keep a new life alive.

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Many sufferers also simply don't recognize what's happening as OCD. Without knowing that intrusive, unwanted thoughts are a hallmark of the disorder rather than evidence of dangerous intent, there is no framework to make sense of the experience. I didn't have that framework. Many parents today still don't.

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And then there is the well-founded worry about being misunderstood by the very clinicians they turn to. As we'll discuss below, that worry is not unfounded.

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A Note for Sufferers

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If you are reading this because you are living with thoughts like the ones I described, please hear this clearly.

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Having these thoughts does not make you a bad parent. It does not mean you will act on them. It means you have OCD.

The horror you feel in response to these thoughts is not a warning sign. It is the disorder. The fact that they are unbearable to you, that you would do anything to make them stop, is itself the evidence that you are not dangerous. Parents who genuinely intend harm are not tormented by the possibility of it.

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You are not alone, even when it feels completely that way. Tens of thousands of new parents are experiencing exactly what you are experiencing right now. And the large majority recover fully with the right treatment.

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A Note for Clinicians

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I want to speak plainly here, because the stakes are too high for anything less: perinatal OCD is being missed, and when it is missed, it causes real harm.

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It is most commonly mistaken for postpartum depression, with which it frequently co-occurs but from which it is diagnostically distinct and requires different treatment. In more serious cases, it 

is misidentified as postpartum psychosis, a psychiatric emergency, with consequences that can include inappropriate hospitalization, unnecessary child protective involvement, and a traumatized parent whose OCD is now dramatically worse. I have seen this happen. The research has documented it happening at scale.

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The single most important clinical skill here is assessing ego-dystonicity. A parent with perinatal OCD experiences their intrusive thoughts as alien, repugnant, and completely at odds with who they are. A parent in psychosis may experience thoughts about harm as believable, even reasonable. That distinction, not the content of the thought, but the sufferer's relationship to it, is what separates a person who needs ERP from a person who needs hospitalization.

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Standard screening tools, including the Edinburgh Postnatal Depression Scale, were not built to catch OCD. Direct, compassionate inquiry about intrusive thoughts is essential, and it needs to happen in a space where the patient genuinely feels safe disclosing. Most will not volunteer this information on their own. Not because they're hiding it maliciously, but because they are terrified of what happens if they do. Make it easier for them to tell you.

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Risk factors worth tracking include: personal or family history of OCD or anxiety disorders, premenstrual mood worsening, a first pregnancy, obstetric complications, and limited social support. For anyone with a prior episode of perinatal OCD, recurrence rates following a subsequent birth are estimated at 25–75%, which means proactive monitoring is not optional, it is responsible practice.

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Treatment works. Exposure and Response Prevention (ERP) is the gold standard, and it is highly effective. SSRIs are also a strong option, with medication decisions made collaboratively given the patient's preferences around pregnancy and breastfeeding. The conversation about treatment is nuanced. The decision not to treat at all is not.

 

 

The Cost of Silence

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Untreated perinatal OCD doesn't simply fade on its own. It is associated with deteriorating quality of life, impaired parent-infant bonding, and in some cases the parent avoiding the baby entirely. The very outcome they feared most. Research has shown measurable effects on children's developmental outcomes when a parent's perinatal OCD goes unaddressed. The cost of missing this diagnosis is not abstract.

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I was lucky. I eventually found my way to understanding what had happened to me, and to treatment. But I lost time, and I suffered unnecessarily, and I was a clinical psychology graduate student with access to resources that most new parents simply don't have.

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We can do better. Better screening, better clinical training, better public education, and a culture that allows new parents to say, without shame, that becoming a parent has been terrifying in ways they never anticipated.

That culture starts with conversations like this one.

If you are a parent struggling with intrusive thoughts, please reach out to your OB, midwife, primary care provider, or a mental health professional with experience in perinatal mental health or OCD. You can also contact us directly at the New England Center for OCD and Anxiety. Effective help exists – and you deserve it.

 

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Resources — For Sufferers, Families, and Clinicians

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You do not have to navigate this alone, and you do not have to figure it out from scratch. The following resources offer evidence-based information, referrals to specialized care, and, for clinicians, training and consultation.

 

New England Center for OCD and Anxiety www.newenglandocd.org

Our center specializes in the assessment, diagnosis, and treatment of OCD and anxiety disorders across the lifespan, including perinatal OCD. We offer clinical services for individuals and families, as well as consultation and training for clinicians who want to build competency in identifying and treating perinatal OCD and other OCD presentations. If you are a sufferer unsure where to start, or a clinician looking to deepen your clinical skills in this area, we welcome you to reach out directly.

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International OCD Foundation (IOCDF) www.iocdf.org

The IOCDF is the leading nonprofit organization dedicated to OCD and related disorders. Their website offers a wealth of evidence-based information about all forms of OCD — including a dedicated Perinatal OCD Resource Center — as well as a therapist finder to help sufferers locate specialists in their area. The IOCDF also hosts an annual conference and offers training resources for mental health professionals.

 

Postpartum Support International (PSI) www.postpartum.net

PSI is a leading resource for perinatal mental health, with specific information on perinatal OCD, a helpline (1-800-944-4773), and a directory of trained perinatal mental health providers. Their volunteer coordinators can help connect new parents with local support and specialized care.

 

Maternal OCD (UK) www.maternalocd.org

An organization founded and run by people with lived experience of perinatal OCD, Maternal OCD offers accessible, compassionate information for sufferers and families, as well as guidance for healthcare professionals on recognizing and responding to the condition.

 

Beyond OCD www.beyondocd.org

A patient- and family-focused resource offering clear, accessible information about OCD in all its presentations, including perinatal OCD, with guidance on finding treatment and supporting a loved one through recovery.

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If you are a parent in distress right now, please reach out to your OB, your midwife, your primary care provider, a mental health professional, or directly to one of the organizations listed above. If you are a clinician who would like consultation or training support specific to perinatal OCD or other OCD presentations, we at the New England Center for OCD and Anxiety are here for that conversation too. Effective help exists. You and your patients deserve it.