Postpartum OCD(PPOCD) Explained: Symptoms, Diagnosis, and Effective Interventions

From conceiving to giving birth, the journey of parenting gives a feeling of absolute joy, happiness, worry and feelings of caution. Ever wondered why some parents are a bit more cautious about every tiny action regarding their baby? Or do they always doubt their parenting ability? Pregnancy, labour, and the initial stages of infancy can feel overwhelming for any parent.

Mrs A is now a parent. Whenever she is near a staircase, she experiences continuous thoughts about catastrophes happening to her baby, such as her baby falling from the stairs because she couldn’t hold the baby. Before touching her baby, she makes sure to wash her hands several times. Her relatives report her being extremely caring or cautious about her baby. 

Well, this is a clear case of a mother or a parent experiencing Postpartum Obsessive Compulsive Disorder (PPOCD). In this article, the following aspects will be discussed: The base: Pregnancy, Postpartum period, Postpartum OCD, Symptoms, Causes and Risk Factors, Postpartum OCD and Postpartum Depression. 

Complexity of Pregnancy

Conceiving a baby is a moment of sheer joy and happiness, but the mother has to experience emotional ups and downs, Physical changes, along with the fear of taking utmost care of the fetus inside. Pregnancy is a critical period for any mother. Several bodily changes take place, such as hormonal changes, emotional changes, and physical changes, such as hairfall, weight gain, sudden occurrence of general illness, such as Diabetes, high blood pressure, or any kind of allergy. A mother has to ensure that the child gets enough nutrients, protein, vitamins and an overall positive environment. During such complex times, support, affection and care from the family members are much needed and can be proved very crucial. All a mother and her baby need is Warmth. 

At times, some parents tend to conceive their first baby after several attempts. Such parents have to make use of artificial ways in order to become parents. Some techniques involve Artificial Insemination, In-Vitro Fertilisation (IVF), Surrogacy, etc. These procedures have a lasting impact on the physical and mental health of a mother. Before understanding postpartum OCD, it is essential to consider the complexity that pregnancy poses for a mother.

Read More: Why Do Women Face Mental Health Issues During And After Pregnancy?

Understanding Postpartum

Delivery of a baby happens in two ways. When we consider vaginal birth, a mother has to push through to deliver the baby. This type of birth is known as a normal delivery. On the other hand, a C-section is a second method of delivering a baby. In which an incision is made on the stomach of the mother to take the baby out. Which is again quite painful. 

What follows after these procedures is the period of Postpartum. Postpartum simply means the period after childbirth, especially the first 6 to 8 weeks after childbirth. The period where a mother gradually starts to recover. At times, it persists beyond 8 weeks. Parents and caregivers must take great care during this period. The period of Postpartum varies from individual to individual (Cleveland Clinic,2024).

Read More: New Research Study: Psilocybin and Postpartum Depression 

Postpartum OCD: Knowing the unknown

According to the Cleveland Clinic, postpartum OCD begins after the birth of the baby. Mental health professionals use the same criteria for Obsessive-Compulsive Disorder (OCD) to diagnose it. Here, OCD manifests in a way where parents have certain obsessions and compulsions, such as constant thinking about harm coming to their child, constantly checking on the baby, seeking reassurance from others, whether they are a capable parent, having fears about germs, insects and parasites, which can cause harm to the baby. Let us now understand the causes, signs and risk factors involved in the PPOCD. According to Fairbrother et al. (2021), the prevalence rate for Postpartum OCD was 16.9 %. In both the DSM -5 and ICD – 11 Postpartum OCD is not listed on its own. They do not have a specific criterion in the DSM – 5 and ICD – 11. Postpartum OCD is mentioned within the Specifiers. 

Symptoms of Postpartum OCD

1. OCD Symptoms start or worsen around the time of pregnancy.
2. Obsession involving the fear of harm towards the infant.
3. Individuals have a fear of Psychosis.
4. Fear of causing harm to the baby.
5. Showing avoidance behaviour.
6. Lack of sleep
7. Wanting someone by their side. 

Read More: Postpartum Psychosis: Symptoms, Causes, Risk Factors, and Recovery

Causal Factors Involved in Postpartum OCD

According to Abramowitz and Fairbrother (2008), Postpartum OCD can be explained with a Biological and Psychological Lens : 

1. Biological Lens

Considering Postpartum OCD, there are some neurochemical explanations for it. First, being The Serotonin Hypothesis of OCD. Though research has shown inconsistent results. This hypothesis lays an emphasis on dysregulation in the serotonin system. The release of estrogen and progesterone alters serotonergic transmission and reuptake. Another explanation is the concentration of oxytocin during pregnancy. This hormone plays an important role in the uterine contractions, and researchers have found a correlation between OCD severity and cerebrospinal fluid oxytocin levels among untreated patients with OCD. 

2. Psychological Lens

The cognitive behavioural model explains that everyone experiences intrusions ( thoughts, images, impulses that intrude on consciousness). When these intrusions end up developing in a clinically distressing way, that is when it makes the day-to-day functioning dysfunctional. Individuals tend to suppress their thoughts. Individuals start to engage in behaviour where they start to prevent events even before they take place. This model further explains that individuals don’t tend to share what they feel, thinking that society will judge that the individual is unfit to become a parent. This creates a chain of thoughts and avoidance behaviour where the individual never gets a chance to correct themselves. 

3. Sociological Lens

The environment may also impact Postpartum OCD. If the individuals are pressured to raise an extremely healthy baby, then it creates a demanding situation for the parents. Another possible reason could be that if the family has been practising strict child-rearing practices for a long time, then it creates a silent expectation. These are the causes of Postpartum OCD. It is essential to understand that any psychological phenomenon is caused by the amalgamation of these three factors(Bio – Psychology – Socio ) Model. 

Risk Factors

After understanding the causes, it is important to consider the risk factors as well. Risk factors can contribute before and after the pregnancy. According to V.Sharma (2015), the early Postpartum period is extremely crucial, history of depression, OCD, avoidant personality disorder, etc. In one study, it was found that risk was higher with the mothers with a personal history of psychiatric illness and obstetric complications in pregnancy or delivery. Other risk factors can include becoming a parent for the first time, experiencing high stress levels, etc. 

Treatment/ Intervention: According to Abramowitz and Fairbrother (2008)

• Psychological Treatment – Cognitive Behavioural Therapy (CBT) works for Postpartum OCD. The first step in CBT is assessing functional cues, obsessional cues and feared consequences. Cognitive Restructuring helps in modifying the dysfunctional interpretations. Cognitive Behavioural Therapy gradually focuses on the thoughts that create distress. 
• Exposure Therapy: Individuals are gradually exposed to the situations. For example, if a parent has a habit of giving away the baby to someone else the moment they are stepping down a staircase. Ask them to take at least 5 steps from the staircase, then 10 steps. 
• Acceptance and commitment Therapy: Therapists here focus on inculcating acceptance among the individuals. 
• Pharmacological Treatment:  As serotonin is involved in Postpartum Obsessive Compulsive Disorder, Serotonin selective Reuptake Inhibitors (SSRIs). It is essential to check any other pre-medical conditions before prescribing the medications. 

Postpartum OCD: Underrecognized

According to Gorbis (2023), PPOCD is one of the least recognised or diagnosed aspects. The primary reason being nobody wants to feel and let others know that they are having malicious thoughts about contaminating the baby, harming the baby, etc. When it is not discussed, how an individual feels the disorder often remains hidden, or it never gets recognition. 

Postpartum OCD and Postpartum Depression: Understanding the difference 

Postpartum OCD is often misdiagnosed with Postpartum Depression because of a lot of symptoms and signs like high anxiety, sleep disturbances, severe guilt and intense shame. This shows the comorbidity of OCD and Postpartum Depression and postpartum obsessive-compulsive disorder. Research has shown that there is some relationship between Postpartum OCD and Postpartum Depression. Considering the thoughts that involve thoughts of unwanted harm to the infants. It is said that obsessional thoughts are symptoms of Postpartum Depression. In other words, obsessional thoughts give rise to Depressive Symptoms( hopelessness, social isolation, dysphoria) (Abramowitz & Fairbrother, 2008). 

There lies a lot of comorbidity in Postpartum Depression and Postpartum OCD. Hence, at times, it becomes difficult to diagnose. If mental health professionals use a clear set of criteria for both PPD and PPOCD.

Conclusion

This article focused on how complex the period of pregnancy is. Furthermore, before understanding the phenomenon of Postpartum OCD, the base was understood to be the Postpartum period – a period after giving birth lasting for approx six to eight weeks. Major symptoms of PPOCD include: Compulsive thoughts, insomnia, and doubtful parenting.  Postpartum OCD has three causal factors: biological, cognitive, Cognitive and Sociological factors. Treatment/Intervention includes: CBT, ACT, Exposure Therapy, etc. It also includes SSRIs. Healthcare professionals mostly prefer combined treatment options for effective results. 

Postpartum Obsessive Compulsive Disorder (PPOCD) is one of the disorders that should get its recognition in both DSM-5 and ICD-11. This anxiety-related disorder is not much discussed, unlike Postpartum Depression. More concrete research would enable better treatment options, Psychoeducation during pregnancy counselling sessions, and a sense of understanding among family members. Recognition of both Postpartum OCD and Depression will lead to awareness among other members of society. This would make the journey of parenting a lot more convenient and easy – going.

References +

• Abramowitz, J. S., Schwartz, S. A., & Moore, K. M. (2011). Postpartum obsessive-compulsive disorder. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(6), 680–690. https://doi.org/10.1111/j.1552-6909.2011.01294.x
• Anxiety and Depression Association of America. (n.d.). The unexpected OCD of postpartum. https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/unexpected-ocd-postpartum
• Brandes, M., Soares, C. N., & Cohen, L. S. (2004). Postpartum onset obsessive-compulsive disorder: Diagnosis and management. In J. L. R. Rubenstein & M. T. Craft (Eds.), Women and mental health (pp. 139–154). American Psychiatric Publishing.
• Cleveland Clinic. (2026, April 8). Could you have postpartum OCD? Signs and symptoms explained. https://health.clevelandclinic.org/postpartum-ocd
• International OCD Foundation. (2014). Postpartum OCD fact sheet. https://iocdf.org/wp-content/uploads/2014/10/Postpartum-OCD-Fact-Sheet.pdf
• Lord, C., Rieder, A., Hall, G. B., & Soares, C. N. (2017). Anxiety disorders in the perinatal period. Women’s Health, 11(6), 841–852. https://doi.org/10.2217/WHE.15.20
• Maina, G., Albert, U., Bogetto, F., Vaschetto, P., & Ravizza, L. (1999). Recent life events and obsessive-compulsive disorder (OCD): The role of pregnancy/delivery. Psychiatry Research, 89(1), 49–58
• Fairbrother, N., Collardeau, F., Albert, A. Y. K., Challacombe, F. L., Thordarson, D. S., Woody, S. R., & Janssen, P. A. (2021). High Prevalence and Incidence of Obsessive-Compulsive Disorder Among Women Across Pregnancy and the Postpartum. The Journal of Clinical Psychiatry, 82(2), 20m13398. https://doi.org/10.4088/JCP.20m13398
• Miller, L. J. (2008). Postpartum depression. In G. Reyes & J. D. Elhai (Eds.), The encyclopedia of psychological trauma (pp. 139–141). Wiley.