Postpartum OCD may be as common as Postpartum Depression. So why isn't it discussed?

Bringing home a new baby is imbued with excitement, but it can be fraught with fear, worry and sadness, too. And while sensitivity towards, and awareness of postpartum depression has increased in recent years, a lesser known condition, Postpartum Obsessive Compulsive Disorder, or Postpartum OCD, may increasingly on the rise.

Postpartum Depression effects to to 20 per cent of new mothers, and Postpartum Anxiety isn’t far behind, with some estimates showing 17 percent of mothers experience it. Studies also show that Postpartum Anxiety may be as common, if not more common, than Postpartum Depression.

One study revealed that as many as 57 percent of new mothers who suffer from Postpartum Depression also had symptoms of Postpartum OCD, making the condition vastly more widespread among new mums than realised. So why don’t we talk about it?

The DSM-5 Diagnostic Criteria for Obsessive-Compulsive Disorder can include a range of distressing symptoms, including presence of obsessions and compulsions, repetitive behaviours, and recurrent, persistent and intrusive thoughts.

For new mothers experiencing Postpartum OCD, these symptoms will usually centre around the health and safety of their child. Some mothers become overcome with obsessive worries about their child dying, becoming sick or being injured. Some become acutely germ-phobic.

Others have intrusive thoughts and fears that they may accidentally harm their baby: dropping, smothering or leaving the baby in a hot car. Some even have horrifying dark thoughts of hurting their babies, killing or abusing them – thoughts they would never act upon but cannot stop themselves from thinking.

For Rebecca, 30, the obsession with her baby’s safety started the day her son was born. For eight months she’d had a dream pregnancy – no morning sickness, no complications, no pain, and she “barely felt pregnant”. But when her baby remained in breech position and she had to have an emergency C-section, something inside her changed.

From the moment her son was handed to her after the surgery, Rebeccca was irrationally scared that the baby would die, and that anxiety only grew and grew.

“I was meant to be recovering from a C-section wound, but I couldn’t sleep at all that first night. I watched my son every moment, afraid that he’d stop breathing. Everyone told me I was being silly, but I was convinced if I took my eyes off him something horrible would happen”.

Lily Bailey explains what it’s like living with OCD. (Post continues below.)

Rebecca was confined to her bed because of her surgical wound, and constantly feared the baby’s crib was “too far” away from her. She couldn’t sleep, she had to keep watch. Over the next week, as Rebecca remained in hospital, and slept no more than a handful of hours, resting only when relatives visited and promised to watch the baby like hawks.

When she was alone, she’d nod off for a handful of seconds and wake panicked. Occasionally, she wouldn’t trust her own observations and would buzz the nurse to check if her baby was okay. The lack of sleep slowed down Rebecca’s healing process and she spent almost two weeks in hospital.

Once home, the obsession didn’t let up. Rebecca spent rarely more than a minute or two away from her son, holding him all day long until her arms and neck ached dreadfully from the strain. She panicked over every cry and sign of discomfort the baby exhibited. Her anxiety was so severe she could not eat and lost an alarming amount of weight.

Eventually, her husband stepped in, forcibly removing the infant from her care each night and sleeping with the baby in a spare room so Rebecca could get some much needed rest. Rebecca, who had suffered from depression in the past, returned to therapy and slowly got a grip on her obsessions. She describes those first few months of her firstborn’s life as a “waking nightmare”.

For some mothers, the OCD behaviours can remain long-lasting. Their fears may turn to themselves - anxious thoughts they they become terminally ill, or have an accident and perish, leaving their child motherless. They may experience hypochondria, worrying themselves sick that minor ailments are fatal illnesses.

Postpartum OCD is difficult to treat, and because it often goes hand in hand with PPD, it's often misdiagnosed as being depression. Mothers often feel shame over their symptoms, and may be convinced they're bad mothers, "going crazy" or fear having their child taken away, which makes them reluctant to seek treatment.

But help is available. Much like "traditional" OCD, Cognitive Behavioral Therapy (CBT), can be effective in breaking the cycle of obsessive behaviour in Postpartum OCD. Anti-depressant and anti-anxiety medications may be prescribed.

The Centre for Perinatal Psychology offers a range of services, including support groups, mindfulness courses, suggested reading and help finding a perinatal psychologist. The first step is opening up about your symptoms and seeking medical help.

While Rebecca continues to suffer from the symptoms of OCD, thanks to therapy, she's regained her sense of control and is relaxed around her son, who is now two years old. She's noticed the change in her son too. "He was a very unsettled baby, and I think my anxiety was affecting him too," Rebecca says.

With a second child on the way, Rebecca will do things differently next time. "I still have good days and bad days," she says. "I just wish I had reached out for help sooner, for both me and my child's sake".

If you’re suffering from depression or anxiety and need help or just someone to chat to, you can call Lifeline on 13 11 14 or BeyondBlue on 1300 22 4636. You can also reach PANDA, a National Postnatal Depression Helpline, Mon to Fri, 9am - 7.30pm AEST, on 1300 726 306.