Perinatal Obsessive Compulsive
About this leaflet
This leaflet is for anyone who wants to know about Perinatal
Obsessive Compulsive Disorder (Perinatal OCD). We hope it will be
- Women who have, or think they may have, perinatal OCD
- Partners, family and friends who want to find out more.
The leaflet describes:
- What Perinatal OCD is
- How it affects women in pregnancy and after birth
- How to help yourself
- When to seek help from your GP or mental health services
- Treatment options
- Further sources of help and support
What is Perinatal OCD?
Disorder (OCD) is a relatively common mental illness.
It can affect men and women at any time of life. If women have OCD
during pregnancy or after birth (known as the perinatal period) it
is called Perinatal OCD.
You may have had OCD before getting pregnant. For some women,
pregnancy or birth can be the trigger for the disorder.
OCD has three main parts
- Thought or images that keep coming into your mind. These are
- Anxiety - usually as a result of the thoughts
- Thoughts or actions you keep repeating to try to reduce your
anxiety. These are called compulsions.
What does it feel like to have 'Perinatal OCD'?
Having a baby brings many changes and this can be stressful.
Many pregnant women and new mothers have a normal (and probably
helpful) rise in obsessive or compulsive-like symptoms. Most
mothers feel that having a baby is a huge responsibility. It is
normal to worry about your child's wellbeing and to want to protect
your baby. You may be more careful about avoiding risks in
pregnancy or after birth.
You may worry if you have normal, but unexpected, thoughts about
your baby being harmed. For most women these thoughts are not a
For some women these normal worries can trigger or worsen
symptoms of OCD. The symptoms can interfere with life and usually
bother people for at least an hour a day, and often much more than
The main symptoms of Perinatal OCD are:
These are unwanted thoughts, images, urges or doubts. These
happen repeatedly and can make you very distressed. Common examples
- Intense fear that something is contaminated by
germs or dirt. Women with Perinatal OCD often worry
that their baby will be harmed due to contamination.
- An image (a picture in your mind), or a thought, of
harming someone. You may worry that you will
accidentally or deliberately harm your baby, including sexual and
violent thoughts. We know that people with OCD don't become violent
or act on these thoughts.
- Perfectionism. You may worry that you have left your doors or
windows unlocked, or not sterilised your baby's bottle
Anxiety and other
- You may feel anxious, fearful, guilty, disgusted or
- You feel better if you carry out your compulsive behaviour.
This doesn't help for long.
These are the things you do to reduce your anxiety or prevent
what you fear from happening. They include:
- Rituals - e.g. washing, cleaning or
sterilising repetitively and excessively. This can take up so much
time that it stops you doing other things you need to do.
- Checking - e.g. repeatedly checking your baby
throughout the night to ensure he/she is breathing.
- Seeking reassurance - repeatedly asking others
to tell you that everything is alright.
- Correcting obsessional thoughts by counting,
praying or saying a special word over and over again. This may feel
as though it prevents bad things from happening. It can also be a
way of trying to get rid of unpleasant thoughts or pictures in your
- Avoidance of feared situations or activities
is common. People with OCD often avoid things that may trigger
obsessions or compulsions. If you have perinatal OCD, you may avoid
nappy changing, hide all your knives. You may not attend mother and
baby groups. Some women avoid spending time alone with their
In Perinatal OCD, symptoms are often focussed on the baby.
However, obsessions and compulsions can focus on many different
Although mothers with OCD may fear harming their baby, they are
not a risk to their babies. There are no recorded cases of people
with OCD acting on their obsessional thoughts. However, OCD can
cause problems if people are avoiding lots of things or excessively
using cleaning products for example. In rare cases, people can
become suicidal or have difficulties bonding with their baby due to
other problems which they may also have, such as severe
OCD varies in severity. Perinatal OCD can affect a range of
experiences and care-giving tasks. Most women can care for their
baby and other children well, despite their symptoms.
For others, Perinatal OCD can be very disabling and have a major
impact on women and their families. If this happens, you may need a
lot of practical help and support. Perinatal OCD may also mean that
you don't enjoy pregnancy and being a mother as you as you would
otherwise have done. Fortunately Perinatal OCD is a very treatable
condition. You should see your GP as soon as possible if you think
you have OCD, and are not already having treatment.
Recognising Perinatal OCD
Women with Perinatal OCD often realise their symptoms are
unreasonable or excessive. This may be less clear when you are
acutely anxious. Some women worry that their symptoms mean that are
made mother or that they are "going mad". You may also feel
embarrassed or ashamed. You shouldn't worry about this. Perinatal
OCD is an illness and can be treated. It's not your fault!
Sometime Perinatal OCD is not well understood. This means women
may not always get the right diagnosis. It is important that your
GP or psychiatrist identifies the symptoms of OCD. They can
distinguish Perinatal OCD from other disorders. These may include
depression or postpartum psychosis. It
can be a huge relief to get the right diagnosis. Having a name for
the problem means it's not just you who is affected. Also, once
your Perinatal OCD is recognised, you can get the right
Other mental health problems before and after birth
Women can have many different mental disorders in pregnancy and
the postpartum period, just like at other times.
Depression and anxiety are the most common mental health
problems in pregnancy. They affect 10-15 in every 100 women. For
further information, see our leaflet on 'Mental health in
Many women experience mild mood changes after having a baby. It
is common to feel many different emotions. Over half of new mothers
will have the 'Baby Blues'. This usually starts 3 to 4 days after
birth. You may have mood swings. You may burst into tears easily.
You can feel irritable, low and anxious at times. You may also
over-react to things. It usually stops by the time your baby is
about 10 days old. You don't need treatment for Baby Blues.
This affects 10 to 15 in every 100 women after childbirth. The
symptoms are similar to those in depression at other times. These
include low mood and other symptoms lasting at least two weeks.
Women with depression can experience obsessional thoughts.
Perinatal OCD is a distinct disorder from depression. Many women
have a sense that if the OCD improves the depression will also
lift. Some women with Perinatal OCD may also have depression, which
requires treatment in its own right. For further information, see
our leaflet on 'Postnatal
This is the most severe type of mental illness that happens
after having a baby. It affects around 1 in 1000 women and starts
within days or weeks of childbirth. It can develop in a few hours
and can be life-threatening, so needs urgent treatment.
There are many symptoms that may occur. Your mood may be high or
low and there are often rapid mood swings. Women often experience
psychotic symptoms. They may believe things that are not true
(delusions) or see or hear things that are not there
The illness always needs medical help and support. You may have
to go into hospital. Ideally, this should be to a specialist mother
and baby unit where you can go with you.
Although puerperal psychosis is a serious condition, the vast
majority of women make a full recovery. For further information,
see our leaflet on 'Postpartum
How common is Perinatal OCD?
About 1 in every 50 has OCD at some time in their lives. At
any one time about 1 in every 100 people has OCD.
There is not enough research to say exactly how common Perinatal
OCD is. In pregnancy, it affects about 1 in every 100 women, which
is similar to the rates in the general population. Research suggest
that Perinatal OCD is more common after having a baby. We think
that about 2 to 3 in every 100 women are affected in the year after
Who is most likely to get Perinatal OCD?
Perinatal OCD may be more likely in first time mothers but you
can have it during or after any pregnancy. If you have had OCD
before, you are more likely to get Perinatal OCD.
There may be many factors which cause you to have Perinatal OCD.
Hormones may be a factor for some women. OCD can also run in
Perinatal OCD has also been reported in fathers.
What is the prognosis?
For about a third of women who already have OCD, pregnancy and
childbirth can make this worse. For some women, pregnancy and birth
have no impact or can even improve symptoms.
If you have OCD for the first time in pregnancy, it may get
better soon after birth. For most women this is not the case
and OCD continues after birth.
If perinatal OCD starts after your baby is born, it can happen
very suddenly days or weeks after giving birth. For some women, the
onset is more gradual.
OCD can be a persistent and recurring disorder if left
untreated. Pregnancy and birth can be a trigger for long-standing
OCD. It can continue or come back later in life if you don't have
Where to get help
The help and treatment you need depends on how severe your
perinatal OCD is. Your GP, midwife and health visitor can help you
decide what kind of help you need.
Everyone can try the self-help suggestions below. If this is not
enough, you may benefit from a talking therapy or medication (see
below). Your GP can advise you about these treatments.
Some women with perinatal OCD will need help from mental health
services. In some areas, there are perinatal mental health
services. These are specialist services for women who are pregnancy
or in the first postnatal year. Your GP, midwife or health visitor
can refer you. This is usually only needed for women with more
If you cannot look after yourself or your baby, or if you have
plans to harm yourself, you should be seen urgently by:
- your GP
- a mental health service
- your local Accident & Emergency Department
Rarely women may need admission to hospital. In that case, you
should usually be admitted to a specialist Mother and Baby Unit
with your baby.
Tell someone how you feel. It can be a huge
relief to talk to someone understanding. This may be your partner,
a relative or friend. If you can't talk to your family and friends,
talk to your GP, health visitor or midwife. They will know what
help is available in your area.
Learn about OCD. Become an expert on the
disorder and how it makes you feel. You can learn to recognise the
physical and mental symptoms common in OCD. This will help when you
are in the moment and feeling challenged with an OCD fear.
Self-help workbooks. You can use these on your
own or with professional guidance. Homework will aid your
Maintain energy levels and general wellbeing.
Recovery requires a lot of energy. Take every opportunity to get
some sleep and rest. Think about what really needs doing now and
what can wait. Accept offers of help from family and friends. This
will mean you focus on getting better.
Self-help groups. Attend a group with other
mothers who have perinatal OCD, run by someone who is an expert on
OCD. This will help you to realise you are not alone. The group can
become a support group during your recovery.
Don't blame yourself. It's not your fault.
Don't use alcohol or drugs to control your
Which treatments are available?
The two main treatments are Cognitive Behavioural
Therapy and Medication. These can be used alone or in
Cognitive Behavioural Therapy (CBT)
This is a talking therapy. CBT helps you examine patterns of
thoughts and behaviour that are causing distress. This usually
involves seeing a therapist on a weekly basis. Sometimes you can
attend a full course of sessions over a shorter period. For further
information, see our leaflet
on OCD with further details of CBT for
Antidepressants are used to treat OCD. There are several
antidepressants you can try. The most commonly used antidepressants
for OCD are called Selective Serotonin Reuptake Inhibitors (SSRIs).
Sometimes other medications are added. For further information, see
our leaflet on Antidepressants.
How do I decide which treatment is best for me?
- Is medication safe in pregnancy and
Decisions about whether or not to take medication in pregnancy,
or when breastfeeding, are not straightforward. You need to decide
what is best in your individual case. It is important to discuss
medication with your GP or psychiatrist. They will give you
information to help you decide what is best for you and your
If you have OCD and are planning a pregnancy, you should talk to
your doctor before you become pregnant. However, many pregnancies
are unplanned. In that case, you should see your doctor as soon as
you know you are pregnant. It is very important that you don't stop
medication suddenly, unless your doctor tells you to. Stopping
treatment suddenly can cause people to relapse for quickly. It can
also cause side-effects.
Many women need to take medication in pregnancy and when
breastfeeding. This can be for mental or physical health problems.
Many women take antidepressants in pregnancy and when
Your doctor can help you to think carefully about the advantages
and disadvantages of medications in pregnancy or when
breastfeeding. Some medications have been used in pregnancy for
many years. In many cases, we simply do not have enough information
to be absolutely sure that a treatment is safe. In order to decide
what is right for you, you should think about:
- How unwell have you been in the past?
- How quickly do you become unwell when you stop medication?
- Medications you have taken before:
- which medication has helped you most?
- have some medicines caused side-effects?
- Up-to-date information about the safety of medications in
pregnancy and breastfeeding. Discuss this with your doctor.
- How easy or difficult is it to access CBT in your area? Discuss
with your doctor.
- What might happen if you are unwell during pregnancy or after
birth? This may include:
- Not taking good care of yourself.
- Not attending antenatal appointments. This means you may not
get the care you need.
- Using more alcohol or drugs. This can be harmful to your unborn
- Needing a higher dose medication if you become ill. Sometimes
you may need two or more medications to treat a relapse. This might
be more risky for your unborn baby than if you take a standard dose
of medication throughout pregnancy.
- Needing in-patient treatment.
- Finding it more difficult to care for your baby.
- If your illness is not treated, this may be more harmful for
your baby than the effect of medication. For example, some research
studies have found babies are more likely to have low birth-weight
if their mother has depression in pregnancy. Untreated mental
illness can also affect a baby's development later on. There is no
information available about how untreated OCD affects your unborn
Can CBT cause any problems?
CBT has no reported side-effects. However, it is an 'active'
treatment involving tasks in, and between, sessions. This helps you
to put what is learnt into practice. It does require effort and
commitment. It can help with the specific and individual ways that
OCD affects life with a small baby.
Which is best for me - talking therapy or medication?
The best treatment for you will depend on the type and severity
of illness you have experienced. Both SSRI antidepressants and CBT
have been shown to be effective in treating OCD. Research shows
their effectiveness is similar.
Evidence for the treatment of Perinatal OCD comes from
small-scale research studies and so is limited. Both medication and
CBT have been shown to be very effective in reducing Perinatal OCD
After seeing your doctor, you may find it helpful to discuss
treatment options with your family and friends. Consider the impact
of the treatment on yourself and your family. Think about the
side-effects that you may find hard to cope with. Also think about
lifestyle changes you may need to make during the treatment.
Consider how long each treatment may take to make a difference
to your recovery and how accessible treatment is locally. You may
have to be referred out of your area. Advocacy services (such as
those offered by OCD charities) can help mothers get treatment
outside their local area, or from specialist centres.
Understand that overcoming Perinatal OCD does take dedication
and hard work. Any support will really help your recovery.
How partners, family and friends can help
Understand OCD. Read about the disorder and
learn about the symptoms. A mother suffering from Perinatal OCD may
appear to be very rigid. However, she is just trying to get through
Be supportive. Sometimes a
mother may feel ashamed to admit she is unwell. She may worry about
the stigma of having a mental illness. Support her to find out more
information about perinatal OCD. This will help to normalise the
Make time for yourself. Being
around a mother with Perinatal OCD, and a baby or child too, can be
exhausting. Ensure you are also looking after yourself.
Be reassured: mothers with Perinatal OCD are
not at risk of acting on their thoughts.
Level of involvement. Families often get
involved in the compulsions of OCD. Having a good understanding of
what is driving these can really help mother and partner to limit
this. If the mother has therapy, it may be useful to become
involved in the homework tasks. Suggest attending one session so
you can understand what you can do at home. This may include
encouraging exposure to something the mother fears. It may mean
saying ‘no’ to assisting compulsive rituals.
Obsessive Compulsive Disorder. NICE clinical
guideline 31 (2005). National Institute for Health and Clinical
Care Excellence: London
Antenatal and postnatal mental
health: clinical management and service guidance. NICE Clinical
Guideline192 (2014) National Institute for Health and
Care Excellence: London
Sources of further help
OCD: A charity set up by mothers recovered from
perinatal OCD, who can provide support via email, twitter and
skype. For further details please contact: firstname.lastname@example.org
OCD Action: A
charity providing a dedicated OCD helpline, email support and
advocacy service. Contact details: 0845 3906232; email: email@example.com
Netmums: A website
offering support and information on all aspects of parenting, to
pregnancy and beyond. There is a specific section of the website
support with details of where to find local and national
support in person and online, including local resources and support
- Break Free From OCD -
Dr Fiona Challacombe, Dr Victoria Bream Oldfield and Prof Paul
Salkovskis ISBN 978-0-09-193969-4
- Cognitive Behavioural
Therapy for Dummies – Rob Willson and Rhena Branch ISBN
- Overcoming Obsessive
Compulsive Disorder – David Veale & Rob Willson ISBN
Leaflet was produced by the
RCPsych Faculty of Perinatal Psychiatry and Public
Education Engagement Board.
Series Editor: Dr Philip Timms
Original Authors: Fiona Challacombe, Maria
Bavetta and Lucinda Green
This leaflet reflects the best available evidence available at
the time of writing.
© June 2015. Due for review: June 2018.
Royal College of Psychiatrists.
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