Therapy for Pregnancy and Postpartum OCD
(Perinatal OCD)
All new moms are anxious…right?
Perinatal OCD sometimes gets minimized “that’s just anxiety, it’s normal!” and sometimes, gets villainized “you’re having what kind of thoughts?!”
Sometimes it convinces you that you're the only one having thoughts like this. Regardless, it is wildly, wildly misunderstood.
Understanding Pregnancy and Postpartum OCD:
OCD (Obsessive-Compulsive Disorder) occurring during pregnancy and postpartum (perinatal OCD) involves two components:
Obsessions: Intrusive, unwanted thoughts, images, or urges that cause significant distress. In the perinatal period, these often (but don’t always) involve harm coming to your baby, either accidentally or intentionally. These thoughts are ego-dystonic, meaning they go against your values and terrify you precisely because they're the opposite of what you want.
Compulsions: Repetitive behaviors or mental acts done to reduce anxiety or prevent the feared outcome. Common compulsions include checking (breathing, temperature, safety), seeking reassurance, avoiding situations, mental reviewing, or excessive researching.
I cannot state this part enough: having intrusive thoughts about harming your baby does NOT mean you want to harm your baby or that you will. These thoughts show up because you care so deeply about your baby's safety.
OCD is more than “bad anxiety”, and it’s about way more than washing your hands. Often called “the doubting disorder,” OCD can lead you to question your senses, your memories, your intentions, and even who you are. It starts with a doubt, a worry, an intrusive thought, or a “what if” (the obsession) that prompts some sort of action to reduce the anxiety or resolve the doubt (compulsion). Compulsions can be observable by others (checking locks, asking for reassurance, Googling, repeating actions) or can be mental (analyzing, replaying memories, trying to reassure yourself).
A real pain point with OCD is that you know your compulsions aren’t necessary - and yet, you feel compelled to do them anyway. This is because they are in response to a story your mind is telling you, and stories can be incredibly powerful. Stories rooted in imagination and possibility can prompt real-life emotions in reality. This mismatch can not only be distressing, but can cause signifiant problems in your life.
Why Does This Happen?
Perinatal OCD develops due to a combination of:
Hormonal changes during pregnancy and postpartum
Sleep deprivation that affects the nervous system
Increased responsibility and the weight of keeping a baby safe
Identity shift and adjustment to parenthood
Pre-existing anxiety or OCD that worsens during this period
Brain changes that make you hyper-focused on threat detection
This is not your fault. You didn't cause this by thinking the wrong thoughts.We practice with a whole-body approach, so we also include nutritional and lifestyle recommendations to help address OCD from all angles.
Why Specialty Treatment Matters
Only one in six Americans living with OCD are properly diagnosed. Perinatal OCD affects 2.9% of women during pregnancy and 7% postpartum (although recent studies suggest much higher- one suggesting a weighted prevalence of 16.9% across the postpartum period) with 14% experiencing subclinical symptoms (below diagnosis).
Many people spend years in therapy without realizing they have OCD, and some studies suggest it takes 7-10 years to get properly diagnosed. That’s because OCD is tricky, highly individualized, and is not adequately addressed in most therapy training programs. Traditional talk therapy is not only ineffective at treating OCD, but it even has the potential to make it worse due to therapists co-compulsing with clients, diving into possibility/probability, or arguing against the thoughts.
Our therapists are highly trained in treatments that help break the OCD cycle rather than provide short-term relief. Our primary modality for OCD is Inference-Based Cognitive Behavioral Therapy (I-CBT), an evidence-based treatment that quickly gaining in popularity due to its effectiveness at treating OCD sustainably, no whack-a-mole approach. I-CBT is a specialized treatment for OCD that addresses the reasoning processes underlying your obsessions. Instead of focusing primarily on exposures, I-CBT helps you understand why certain thoughts feel so compelling and real in the first place. You’re not crazy- there’s a reason these thoughts feel so scary, so real, and so intense. I-CBT aims to help you understand OCD’s tricks so you can respond differently.
How It Shows Up
OCD often intensifies or appears for the first time during major life transitions like trying to conceive, pregnancy, and postpartum. The high stakes, uncertainty, and responsibility of growing your family can trigger or worsen obsessions and compulsions.
As PMH-C certified specialists, we understand how OCD presents differently during these seasons:
During Fertility Treatment:
Obsessive tracking and rituals around conception
Intrusive thoughts about "deserving" to be a parent
Hypervigilance about body symptoms
Compulsive research and reassurance-seeking from doctors
Magical thinking about what will make it work
During Pregnancy:
Intrusive thoughts about harming the baby or losing the pregnancy
Contamination fears or health anxiety about what you're eating, touching, breathing
Excessive checking or avoidance behaviors
Hyperresponsibility about every decision
Constant reassurance-seeking from doctors or partners
Postpartum:
Disturbing intrusive thoughts about the baby being harmed (the most common and misunderstood presentation)
Compulsive checking (Is the baby breathing? Is the temperature right? Did I feed them correctly?)
Excessive cleaning or contamination fears
Inability to let others care for the baby
Avoidance of being alone with the baby or certain objects (knives, stairs, bathtubs)
Needing to confess every thought or action
In Motherhood:
Continued checking and reassurance-seeking as your kids grow
Intrusive thoughts about harm or safety
Hyperresponsibility about parenting decisions
Difficulty trusting others with your children
There is a significant care gap for Perinatal OCD.
Most therapists fall on one side of a gap. Many perinatal mental health therapists understand this season of life deeply, but don't specialize in treating OCD. Many OCD specialists know the disorder inside and out, but lack real training in the perinatal period.
Frequently Asked Questions:
What’s the difference between postpartum OCD, postpartum anxiety, and postpartum psychosis?
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They differ mainly in what's happening in the mind: OCD involves unwanted intrusive thoughts or obsessive doubts paired with compulsions to neutralize them, anxiety involves persistent worry and physical tension without that specific obsession-compulsion cycle, and psychosis involves a break from reality altogether.
With postpartum OCD, you recognize these thoughts as distressing and wrong, which is exactly why they're so upsetting. Postpartum psychosis involves delusions, hallucinations, or severely disorganized thinking. People experiencing postpartum psychosis often want validation that supports their thoughts- people experiencing postpartum OCD often want reassurance that the thoughts aren’t meaningful.
To be honest- while postpartum anxiety is characterized by persistent and excessive worry and physical anxiety symptoms, I often believe there is OCD disguised as “just anxiety”.
If I tell my doctor about intrusive thoughts, will my baby be taken away?
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This is one of the most common fears keeping people silent, and it's important to say clearly: having intrusive thoughts, on their own, is not a sign of danger to your baby, and disclosing them to a knowledgeable provider is not a reason for child protective involvement. That said, we understand the fear is real, which is part of why working with providers who specifically understand perinatal OCD (rather than general practitioners unfamiliar with it) matters so much.
It can make bonding harder — not because you don't love your baby, but because the compulsions (avoidance, excessive checking, distress) take up time and mental energy that would otherwise go toward being present. This is one of the clearest reasons why treatment can support you and your ability to be present as a parent.
Can perinatal OCD affect bonding with my baby?
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Yes, medication can be an effective part of treatment for some people, often in combination with therapy. I tend to say that it “turns the temperature down” so that therapy can be more accessible. We coordinate closely with OB-GYNs and reproductive psychiatry providers to help you weigh options that are safe for pregnancy or breastfeeding, if that's part of your plan.
Can medication help perinatal OCD?
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Does perinatal OCD only affect women who are postpartum?
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No, perinatal OCD can develop during pregnancy, in the immediate postpartum period, or even resurface later, well beyond the first year. "Perinatal" covers the full window from conception through the first year or more after birth, and OCD can emerge or intensify at any point along that timeline (including during fertility treatment, throughout pregnancy, in the newborn stage, and as your child grows into toddlerhood.)
You're not alone, and you're not broken. Perinatal OCD is treatable, and understanding what's actually happening is the first step back to trusting yourself.
Therapy for Pregnancy and Postpartum OCD in Maryland, Pennsylvania, South Carolina & Vermont
We offer secure, HIPAA-compliant virtual therapy for perinatal OCD throughout Maryland, Pennsylvania, South Carolina, and Vermont: including Baltimore, Columbia, Towson, Bethesda, and Philadelphia. No matter where you are in these states, you can access specialized, compassionate care from the comfort of your home.
You're not broken. You're not alone. And therapy can help.