Therapy for OCD

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Obssessive compulsive disorder is an often misunderstood, but debilitating disorder that wreaks havoc on someone’s life. Therapy can be a path to liberation for many people.

Common OCD themes include:

Sexual Orientation OCD: This type of OCD involves obsessive thoughts about one's sexual orientation, causing distress and anxiety.

Harm OCD: This type of OCD involves obsessive thoughts about causing harm to oneself or others, leading to compulsive behaviors to prevent the harm from occurring.

Existential OCD: This type of OCD involves obsessive thoughts about the meaning of life, death, and one's existence, leading to extreme anxiety and compulsive behaviors to try and find answers.

Relationship OCD: This type of OCD involves obsessive doubts and fears about one's romantic relationship, causing distress and leading to compulsive behaviors to seek reassurance or avoid triggers.

Scrupulosity OCD: This type of OCD involves obsessive thoughts about religious or moral beliefs, leading to extreme guilt and compulsive behaviors to try and alleviate the guilt.

Just Right OCD: This type of OCD involves an obsession with symmetry, exactness, and perfection, leading to compulsive behaviors to achieve a sense of "rightness."

Contamination OCD: This type of OCD involves obsessive fears of being contaminated by germs, toxins, or other substances, leading to compulsive cleaning or avoidance behaviors.

Sensory OCD: This type of OCD involves obsessive thoughts about sensory experiences, such as a fear of choking or being unable to breathe, leading to compulsive behaviors to avoid triggers.

Magical Thinking OCD: This type of OCD involves obsessive thoughts about causing harm to oneself or others through one's thoughts or actions, leading to compulsive behaviors to prevent the harm from occurring.

Health Anxiety OCD: This type of OCD involves obsessive fears and preoccupations with one's health, leading to compulsive behaviors such as excessive checking, reassurance seeking, or avoidance of triggers.

“I’m afraid I might hurt my baby”

Thoughts like these torment mothers who suffer from OCD in the pregnancy or postpartum period. The obsessions during this time often revolve around purposely harming the baby or being responsible for accidental harm to the newborn and can be quite bizarre. Violent or disturbing images may also accompany these thoughts. Women may have a variety of other obsessions as well. Women who have these thoughts or images are horrified and are terrified that they may act on them. They will engage in behaviors to reduce their anxiety or ward off the possibility of harm.

OCD in Pregnancy and Postpartum

OCD in the pregnancy and postpartum period is often confused with postpartum psychosis by both nonprofessionals and professionals. Women suffering from pregnancy and postpartum OCD fear that they could actually act on the thoughts of harming their baby. Often, these women feel that they are not fit to parent their baby. Many women do not tell anyone about these disturbing thoughts out of fear of being diagnosed “as crazy or dangerous,” being hospitalized, or having their baby taken from them. However, women suffering from perinatal OCD are NOT a danger to their baby and do not act on their scary thoughts.

Because of the lack of understanding between postpartum OCD and postpartum psychosis, women are at risk of being misdiagnosed. Careful assessment by a therapist or psychiatrist who has experience with OCD is critical. Women with postpartum psychosis experience a break from reality and often cannot tell that they are delusional and that their judgment is impaired. They do not have the experience of being horrified by thoughts of harming the baby and may actually feel like they are trying to protect the newborn. Postpartum psychosis is a medical emergency and requires immediate medical attention. OCD is a mental health condition that is treatable with outpatient therapy and possibly medication.

I have worked with many women who suffered from perinatal OCD. Most of them had never heard of perinatal OCD and many of them delayed seeking help for years due to shame and fear. Perinatal OCD is a disorder that affects between 2% and 5% of pregnant or postpartum women. Many women who suffer from perinatal OCD have never experienced OCD symptoms prior to pregnancy. The effects of perinatal OCD can be devastating. Depression, hopelessness, lack of self-care and suicidal thinking are common, as are problems caring for and bonding with the infant due to fear and avoidance. A mother’s sense of self can be seriously damaged if left untreated.

Fortunately, there is help available. Postpartum OCD, like other sub-types of OCD is treatable with an empirically-validated form of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP) or Inferential Cognitive Behavioral Therapy (ICBT). With these methods, people learn to and overcome their obsessive fears and the compulsive and avoidant behaviors they use to manage their fears. When seeking treatment for perinatal OCD, it is important to find someone who has had specialized training and experience in OCD due to the pervasive lack of adequate education around OCD for mental health providers.

Common obsessions in perinatal OCD include:

  • Images or thoughts of throwing the baby from a bridge, balcony or stairs

  • Thoughts of putting the baby in the microwave

  • Thoughts of stabbing or suffocating the baby

  • Disturbing thoughts of sexually abusing the baby

  • Fear of harming the baby because of carelessness and irresponsibility

  • Thoughts of accidentally harming the baby by exposing it to chemicals, germs, pollutants, etc.

  • Fear of giving the baby a disease such as AIDS, cancer or herpes

  • Fear of making the wrong decision about the baby’s welfare (vaccines, certain foods, medications, etc.)

Common compulsions in perinatal OCD include:

  • Hiding or throwing away knives or other sharp objects

  • Avoiding changing the baby’s diaper for fear of sexually abusing the baby or touching it in an inappropriate way

  • Avoiding feeding the baby for fear of poisoning the baby

  • Excessive washing and sterilizing of baby’s bottles, clothing, food prep, etc.

  • Keeping the baby away from other people for fear they might contaminate the baby

  • Rigidly sticking to a baby schedule to the point of disruption of relationships and other life activities

  • Avoiding being alone with the baby or caring for the baby

  • Repeatedly asking family members for reassurance that no harm or abuse has been done to the baby

  • Repeatedly checking on the baby