Perinatal OCD: Intrusive Thoughts, Treatment Options, and How It Differs from Anxiety

Written By Amber Penn

Understanding Perinatal OCD: What It Is and How to Get Help

Becoming a parent is often described as joyful, but for some, it also brings intrusive thoughts, intense anxiety, and obsessive behaviors. If this sounds familiar, you may be experiencing Perinatal OCD.

In this blog post, we’ll explore what perinatal obsessive-compulsive disorder (OCD) is, how often it occurs, the most common symptoms, evidence-based treatment options including Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), and Inference-Based Cognitive Behavioral Therapy (I-CBT), and how to tell the difference between perinatal OCD and other conditions like perinatal anxiety or postpartum psychosis.

What Is Perinatal OCD?

Perinatal OCD is a subtype of obsessive-compulsive disorder that occurs during pregnancy or after childbirth (the perinatal period). While OCD can emerge at any point in life, the hormonal, emotional, and identity shifts of early parenthood can trigger or intensify symptoms in some individuals.

Perinatal OCD is not rare. Research suggests that:

  • Around 7.8% of women experience OCD during pregnancy.

  • Approximately 16.9% of women experience OCD during the postpartum period.

  • Perinatal OCD may be more common than previously thought, especially when intrusive thoughts are assessed directly rather than self-reported.

These statistics underscore the importance of increasing awareness, reducing stigma, and offering specialized care.

Common Symptoms of Perinatal OCD

Perinatal OCD involves two main components: obsessions (distressing intrusive thoughts or mental images) and compulsions (mental or physical rituals done to neutralize the distress).

Here are some common presentations:

Intrusive Thoughts (Obsessions)

  • Fear of accidentally or intentionally harming the baby (e.g., dropping, smothering, or stabbing)

  • Worries about contamination or germs

  • Obsessive concern about making a mistake that will harm the child

  • Unwanted sexual thoughts involving the baby (deeply distressing but not reflective of desire)

  • Fear of developing a serious mental illness and harming the child

Compulsions (Responses)

  • Repeatedly checking the baby’s breathing, temperature, or surroundings

  • Avoiding sharp objects, certain rooms, or being alone with the baby

  • Excessive cleaning or sterilizing

  • Mentally reviewing or praying to "undo" thoughts

  • Seeking constant reassurance from partners, family, or providers

These behaviors may look like hypervigilance, but they are driven by intense fear, shame, and the urge to prevent a catastrophic event that the parent deeply does not want to occur.

Intrusive Thoughts After Birth

Intrusive thoughts are actually very common in the perinatal period. Research shows that up to 70-100% of new parents experience unwanted, distressing thoughts such as imagining harm coming to their baby or accidentally making a mistake. These thoughts can be graphic, bizarre, or frightening, and they often provoke guilt or fear. The presence of intrusive thoughts alone doesn’t mean someone has perinatal OCD. What distinguishes perinatal OCD is how a person responds to those thoughts - typically with intense distress, compulsive behaviors (like checking, avoiding, or seeking reassurance), and difficulty moving on. If intrusive thoughts feel consuming, interfere with daily life, or lead to rituals meant to "cancel out" or prevent harm, it may be time to seek professional support.

Is It Perinatal OCD or Just Anxiety?

It’s completely normal to feel anxious as a new parent, but when does it cross the line into a clinical issue?

Many people confuse perinatal anxiety with perinatal OCD, because they share features like worry and restlessness. However, there are important differences:

Perinatal Anxiety

  • Persistent worry or fear about real-life concerns (e.g., baby’s health, finances, sleep)

  • Physical symptoms like racing heart, tension, insomnia

  • Worries feel proportional or based in reality

Perinatal OCD

  • Distressing, unwanted intrusive thoughts or images, often about things the parent would never do

  • Rituals (mental or physical) to reduce fear caused by the obsessions

  • Obsessions feel irrational, shameful, and deeply unwanted

Read more about perinatal anxiety here to understand when worry becomes more than just a passing phase.

Postpartum OCD vs. Postpartum Psychosis

It’s also important to distinguish postpartum OCD from postpartum psychosis, as the two are often confused but they are very different conditions. In postpartum OCD, intrusive thoughts are ego-dystonic, meaning they are unwanted, distressing, and completely out of alignment with the person’s values. Parents with OCD are typically horrified by these thoughts and go to great lengths to avoid any risk of acting on them. In contrast, postpartum psychosis involves a loss of touch with reality (such as delusions, hallucinations, or disorganized thinking) and may include a lack of insight into one’s condition. Postpartum psychosis is rare (affecting about 1–2 per 1,000 births), and it is a psychiatric emergency requiring immediate medical attention. While both conditions can be frightening, the presence of intrusive thoughts does not mean a parent is experiencing psychosis.

What Causes Perinatal OCD?

There’s no single cause of perinatal OCD, but research suggests it results from a complex interplay of biological vulnerability, psychological risk factors, and environmental stressors.

Biologically, the perinatal period is marked by rapid hormonal fluctuations, including changes in estrogen, progesterone, oxytocin, and cortisol - all of which influence the brain’s regulation of mood, fear, and anxiety. Some individuals may also have a genetic or neurobiological predisposition to OCD or other anxiety-related disorders, making them more susceptible during times of heightened stress or transition.

Psychologically, new parents often experience increased responsibility, fear of harm, perfectionism, and a sense of identity upheaval. For some, becoming a parent activates long-standing patterns of catastrophic thinking, excessive doubt, or the need for certainty - all of which can feed obsessive-compulsive symptoms.

Environmental factors such as sleep deprivation, lack of support, difficult pregnancies or births, NICU stays, or previous trauma can increase vulnerability. Even positive stress, like the immense desire to protect and care for a new baby, can heighten sensitivity to perceived danger.

🧾 A 2021 review by Challacombe et al. highlighted that intrusive thoughts and compulsive behaviors in the perinatal period are influenced by “evolutionary drives to protect the infant, heightened personal responsibility, and maternal cognitive distortions,” particularly among those with prior mental health histories.¹

It’s important to emphasize that perinatal OCD is not caused by anything a parent has done wrong. It’s a mental health condition that can arise in even the most loving, attentive, and capable parents - and it is highly treatable with the right support.

Treatment for Perinatal OCD

Perinatal OCD is highly treatable, and recovery is possible with the right support. The gold standard treatments include:

1. Exposure and Response Prevention (ERP)

ERP is a well known evidence-based treatment for OCD. It involves:

  • Gradually exposing the parent to feared thoughts, images, or situations

  • Learning to tolerate the anxiety without performing compulsions

Example: A parent might hold a kitchen knife while near their baby (with guidance and support), and not engage in safety rituals like avoidance or excessive checking. Over time, anxiety decreases as the brain learns the feared outcome does not occur.

2. Acceptance and Commitment Therapy (ACT)

ACT focuses on:

  • Accepting difficult thoughts without trying to eliminate them

  • Learning to defuse from obsessive thinking

  • Taking action in alignment with core values, like showing up fully as a parent despite fear

ACT is especially helpful for perinatal clients who feel overwhelmed by guilt, shame, or identity shifts.

3. Inference-Based Cognitive Behavioral Therapy (I-CBT)

I-CBT offers a newer, meta-cognitive approach to OCD. Rather than focusing on the content of obsessions, it explores:

  • How the person comes to believe the intrusive thought is true

  • How doubt and imagined scenarios override real evidence

  • Rebuilding trust in perception and intuition

This approach can be powerful for perinatal OCD when clients feel consumed by “what if” thoughts and struggle to access their internal sense of safety or certainty.

You’re Not Alone: Support for Perinatal OCD

If you’re experiencing perinatal OCD, you are not a bad parent, and you are not dangerous. Intrusive thoughts do not reflect your intentions or desires, they are symptoms of a very treatable condition.

Seeking help from a therapist trained in perinatal mental health and OCD is a courageous first step. Treatment can provide tools to reduce suffering, reconnect with your baby, and reclaim your sense of self.

Final Thoughts

Perinatal OCD can feel terrifying, isolating, and misunderstood - but with the right care, healing is possible. Whether you're pregnant, newly postpartum, or supporting a new parent, it’s essential to know what to look for and how to access evidence-based treatment.

FAQs About Perinatal OCD

What is the difference between perinatal OCD and postpartum depression?

While both can occur after birth, perinatal OCD involves intrusive thoughts and compulsive behaviors, while postpartum depression centers more on sadness, hopelessness, and disconnection. Some people experience both.

Are intrusive thoughts about harming my baby normal?

Yes, many new parents experience these thoughts. In perinatal OCD, they are persistent, unwanted, and cause distress. These thoughts do not mean you will act on them.

Will I always feel this way?

No. With proper therapy most people experience significant relief and regain trust in themselves.

What kind of therapist should I look for?

Look for a therapist trained in OCD and perinatal mental health. Ask about ERP, ACT, or I-CBT as part of their treatment approach.

Amber Penn
Next

Surviving the NICU: Mental Health Effects on Parents and the Best Therapy Approaches for Healing