Apologies for the radio (web) silence for some time. I took a little break from the online realm to focus on the real world – both professionally and personally, but you were never far from my mind I can assure you. I hope you are all well and enjoying 2019 so far.
I wanted to bring our focus and attention to a topic very close to my heart – the condition that is Obsessive Compulsive Disorder (OCD) and particularly OCD that presents in the perinatal period, often described as “Perinatal OCD” or “Maternal OCD”
Some of you may know that I have done some work and research on Maternal OCD – I founded the (hashtag) OCDBFING movement on Twitter and collaborated with charities Maternal OCD and OCD Action in doing a live twitter Q&A a few years ago. I am also work voluntarily as a scientific advisor for the Maternal OCD charity, and my specialism looks at diagnosing and treating OCD in the perinatal period, particularly looking at the effects of medication use in pregnancy and breastfeeding (something I know is a worry for many).
A question I get often about Maternal OCD, and OCD in general, is that isn’t it “normal” to be “a bit OCD anyway” ?
Its something we hear often people speak of in jest – though for me I find it personally as offensive as when people refer to (- minimise – ) individuals suffering with mental illness as “nuts, crackers, mad, or crazy” – words that are neither accurate nor helpful. OCD isn’t just about cleaning or liking a tidy decluttered home that “sparks joy” (don’t we all…)
Obsessive Compulsive Disorder falls under the umbrella of anxiety spectrum disorder; it is cousins with other conditions such as panic attacks, phobias, and health anxiety. It can be quite difficult to diagnose, particularly in the perinatal period – a time in a womans life where she faces the most change she is likely to ever encounter (biological, emotional and relational). Should a woman present to health services seeking help (often something very difficult to do) it is often confused with post natal anxiety, depression, or even Psychosis in extreme cases. It is characterised by two phases, an “Obsessional phase” – thoughts, fears or beliefs that increase ones anxiety, followed by a “Compulsive phase” routines, rituals, or behaviours with the aim to reduce the feelings of anxiety – even (and commonly) temporarily.
In the perinatal period – we are faced with a different challenge. At the end of the pregnancy, there is a new beginning – a tiny new life one is now responsible for 24 hours of the day, 7 days a week (and these intesne, almost obsessive feelings of care and responsibility doesn’t magically “disappear” when they leave home later in life).
With the influx of oxytocin (the “falling in love” hormone) as well as other biological changes in the blood and brain, mothers will often develop this “maternal instinct” – this feeling of the need to protect their child at all costs. This is why I tell my mothers in clinic that a “little bit of maternal anxiety is normal and natural” – it would be strange for a mother to not care about their childs safety – whether it be ensuring the hot cup of tea is a safe distance away from the table edge, or making sure the car seat is clicked in securely before a road trip.
So, if this protective “mama bear” instinct is normal and natural, where does OCD – a condition rooted in anxiety (often presenting in clinical practice as fear of harm occurring to the child) fit ?
From our clinical experience, the important factor is to consider how much these worries (natural or otherwise) are affecting your quality of life, your relationship with your child, your family and wider social circle. There is a massive difference in someone whom is worried about their child catching the seasonal cough of cold in the playground, to someone that will avoid interactions with others at all costs – housebound with their child as a result, afraid to send their child to school all term or have anyone (even their partner) hold their child without disinfecting themselves head to toe. It also may start to interfere with the mothers own well being – from the way she thinks about herself, to her mood and her sleep (which is often disturbed by “googling online until the early hours of the morning”…)
Often, with Perinatal OCD – no amount of “cleaning” or “checking” or “avoiding” the fear will make it go away – in fact, it serves the opposite purpose by reinforcing the inner fear, which will grow and require constant thought and attention – thus becoming an “obsessive rumination”.
Maternal OCD can present in a number of ways, from obsessive thoughts about fear of illness, harm or contamination (cue constant disinfecting of babys bottles and laundry on loop) to other examples of constant obsessive worrying (for example unwanted sexual thoughts – particularly problematic in breastfeeding). Uniquely, women may often experience disturbing visual images along with the anxious thoughts, sometimes numerous times a day – something which does not present typically postnatal depression.
Often partners and family members (and even professionals) can get caught in the vicious cycle of reassurance – they may be asked to check/double and triple check that everything is “safe” – whether it be the doors are locked, the hob is turned off, or constantly stating that they are not a “Terrible mother”. The important thing to realise is that however horrific the thoughts are – OCD is egodystonic – aka the thoughts are “alien to them” they are aknowledged as conflicting, incorrect, illogical, repulsive and distressing to the mothers sense of self or beliefs system, and there is no actual real harm or intent of harm o the child, ever.
So what happens next? firstly – if any of this is ringing any bells (for you or someone else you might know) please do not hesitate to ask for help. Speak to your GP, midwife or health visitor and ask for a referral to your local Perinatal Mental Health specialist, because of all the conditions we come across – Perinatal OCD is one of the most treatable conditions once it is correctly diagnosed. Treatment comes in all shapes and sizes, often utilising talking therapy combined with “practical” therapy of putting those fears to the test (in baby steps). In some cases, medication can also be extremely helpful – and it is important to note that the medication needed to treat OCD is often at a higher dosage to that prescribed in postnatal depression and anxiety (thus I have seen many women on medication stuck “half cured”).
If you want to learn more about this condition – including some phenomenal success stories spoken by the mothers whom have been through it all and come out the other side stronger than ever – please check out the Maternal OCD charity website http://www.maternalocd.org
I also did a podcast with Maternal OCD summarising Perinatal OCD and the use of medication specifically in breastfeeding – which is still available online via the website or on youtube here.
[Side note: Podcasts have become my new favourite thing – and actually (spoiler alert) I’m planning on adding a few more here on the blog, so please let me know if this is something you are interested in and if so what you would like me to discuss!]
Dr Chrissy Jayarajah