Postpartum OCD – Podcast

By LifeStance Health on October 19, 2021

Stephanie Phillips joins Nicholette Leanza in discussing the important topic of Postpartum OCD, the most misunderstood and misdiagnosed of the perinatal disorders. 

Postpartum OCD

[00:00:00] Welcome to Convos from the Couch from LifeStance Health. Where each episode you’ll hear engaging and informative conversations with leading mental health professionals that will help guide you on your journey to leading a healthier, more fulfilling life.

Today’s episode features the important topic of postpartum OCD. With our amazing guest Stephanie Phillips. So it’s very, very common and, and in a lot of ways, unfortunately, still, still really misunderstood. So, you know, and when someone comes and says I’m experiencing these symptoms sometimes just in and of itself hearing. This is this is something that a lot of people experience. This is, this does not mean you want to harm your baby. This does not make you a bad parent. This, you know, it means none of [00:01:00] that. It’s so reassuring in and of itself named and identified and to be told no, like it doesn’t mean any of that.

Hello, everyone. I’m Nicolette Leanza. I’m so excited to have my colleague, Stephanie Phillips joining us today to talk about postpartum OCD. So Stephanie, it’s always great to see you. You too. Thank you. Let’s jump in. Tell me a little bit about yourself and what some of your specialties are.

Okay. So I am a licensed clinical social worker in the Commonwealth of Kentucky. I’m a licensed, independent social worker in the state of Ohio. I started my career down in Kentucky. I’ve been doing this for about 10 years. I moved up to Cleveland about three years ago. And I specialize I guess I would say a specialize in trauma and perinatal mood and anxiety disorders, which are often known as postpartum mental health issues. Which [00:02:00] of course we’re going to be talking about today. And so my one of my primary treatment modalities is eye movement, desensitization and reprocessing EMDR. So I’m fully trained in EMDR and that’s what I enjoy using the majority of the time. So. Great. Great. And so jumping into our topic here, you know, looking at postpartum OCD, I’ve come to understand that it’s very much misunderstood about postpartum in general, that people just assume that it’s postpartum depression.

And so that racking, and we think that it can also encompass OCD and other things. But yeah, I guess to get our conversation started, let’s just talk about just some common postpartum issues. Sure. Yeah, you’re absolutely right. We’ve done a really good job, I think in the relatively recent past about raising awareness for postpartum depression, which is amazing, the only drawback for that. Often people don’t realize that it’s not just depression. So in the postpartum period, oftentimes we’re looking at anxiety and [00:03:00] panic disorders, even bipolar disorder PTSD, Post Traumatic Stress Disorder is also something that can come up during the postpartum period. Obsessive compulsive disorder, of course, which we’re going to focus on today and Postpartum Psychosis.

It can also occur during the postpartum period. So there’s definitely a lot. Yeah. I, again, I don’t think it’s common knowledge that all that can happen postpartum, for sure. Yeah. And so jumping into just picking one of those aspects is compulsive disorder within post partum. So, you know, I think the biggest question is, can we just, have you tell us a little bit more of what that is and how it’s diagnosed?

Yeah, absolutely. So obsessive compulsive disorder is it can, it actually can be either or sometimes it can be both together. So obsessions, which are thoughts that essentially get stuck in our head. You know, it can be thoughts, it can be images, it can be ideas that pop up in our, in our brain [00:04:00] and just feel like they kind of go around and around just get stuck.

And it’s very, very hard. Often feels impossible to get rid of them, to stop them. And yeah, they just get stuck there. Compulsions on the other hand actually compulsions can be internal. They can be in our head, they can be things that we are doing kind of. Examples would be counting repeating phrases, things like that.

They can also be external. It can be checking things. It can be kind of kind of a classic idea of what OCD looks like is say hand-washing. If I’ve decided that my hands are contaminated or unclean, so I’m washing them repeatedly sometimes to the extent that my hands get raw and, and very dry.

 So we sometimes see those two things together with OCD. Sometimes we see just kind of one or the other. It can be an either or proposition the way we diagnose those, as of course, you know, we have a diagnostic interview where a therapist or a psychiatrist asks you a series of questions. Figures out if that’s something that you’re [00:05:00] experiencing, there are also scales.

I think the most well-known scale would be the Y–BOCS which is the Yale Brown Obsessive Compulsive scale. And so that’s something that a therapist or a psychiatrist might, or a medical doctor for that, you know, doesn’t have to be a psychiatrist specifically. A doctor can administer that and kind of look at your score and see if maybe OCD is something that you’re doing.

I would think that clients coming to you, having no idea that’s what it is, you know, they might be coming to you to saying these certain things and have no idea is the response, as you’re telling them, Hey, I think this might be postpartum OCD. Are they shocked? Yeah, usually what’s a response for them.

Yeah, very often. I mean, and, and certainly specifically in the postpartum period, cause like, yeah, like we already talked about, a lot of people are like, whoa, I’ve heard of postpartum depression. You’re telling me that OCD is something that, you know, can develop in the postpartum period. So a lot of times it is very surprising and shocking.[00:06:00] 

A lot of times. I mean, I I’d even venture to say most of the time it’s a huge relief because these thoughts and these images can often be very, very scary. Extremely upsetting specifically in the postpartum period. A lot of times they center around, you know, really awful things happening to the baby.

Even, even this fear sometimes, oh my goodness. I’m going to do something to cause harm to my baby. And so there’s, there’s often that’s, that’s part of the reason that it can be really challenging to diagnosis because there’s such a huge stigma and they’re so afraid, you know, God, if I talk to somebody about this, if I reveal that.

They’re going to think I’m dangerous. They’re going to think I’m crazy. You know, they’re, they’re gonna like lock me up. They’re going to do all these things. And it prevents people from being open and honest about what they’re experiencing and being able to be helped. Being able to be told, no, this is extremely common because [00:07:00] anywhere from two to 9 percent of new parents who have just given birth experience this, you know? Wow. Yeah. So it’s very, very common and, and in a lot of ways, unfortunately, still, still really misunderstood. So, you know, and when someone comes and says I’m experiencing these symptoms sometimes just in and of itself hearing. This is, this is something that a lot of people experience.

This is, this does not mean you want to harm your baby. This does not make you a bad parent. This, you know, it means none of that. It’s so reassuring in and of itself had that named and identified and to be told no, like it doesn’t mean any of it. This is what it is and, you know, yeah. I would think that would just, again, that reassurance would just bring down the level of anxiety so much of, okay there’s nothing, this isn’t, this is a common thing that happens. It’s not just me. And so [00:08:00] I can also see the other end. People would avoid getting help because they think it’s just them. And they maybe just not. It’s funny. I keep saying people, is this something? And I think when we think postpartum, we’re just thinking women, is there a counter?

If the partner is identified a male identified or a male. Do males go through a postpartum period? Some yes. Yeah, they definitely can. It’s definitely something that affects, you know, not just the parent who has given birth, you know, it’s, it’s definitely something that can affect a partner. And, and they can experience the same kinds of symptoms.

As the person who gave birth did. Yeah, absolutely interesting. Cause I, I think the circle just closes around the, the mom yes. Or maybe sometimes excludes those around. Yeah. Yeah, definitely. Yeah. Yeah. And, and when we know, you know, and, and sometimes of course, you know, a risk factor for developing OCD or any of these other mental [00:09:00] health concerns during this period is having pre-existing.

You know, as far as mental health is concerned. The stressor of adding a baby to the family is experienced by both the person who gave birth and, you know, the, the, the non birthing partner, essentially. So if we look at it from that perspective, it’s like, yeah, this, this is a stressor that, you know, there’s a new person coming into the house.

Often, you know, especially if we’re talking about a first child, We kind of don’t know what we’re doing. There’s no real roadmap. And so it can be a hugely, even though it’s often welcomed, even though it’s often very, it can be a hugely stressful situation. And I mean, oftentimes just because of that perception of this is a joyful time, this is a happy time, you know, that’s, that’s another thing that really contributes to the stigma.

All of these concerns and then OCD [00:10:00] specifically, because it kind of interferes with that belief and that narrative of I’m supposed to be happy. I’m supposed to be super excited about everything that’s happening right now. What’s going on with me? Why am I, why am I having these feelings? And again, It often kind of become turns into, I must be having these feelings because I’m a bad person.

Yeah. Right, right. Right. So if, if someone struggled with OCD, Previous to giving birth or around, you know, even if it’s a loved one around the partner who gave birth at that, does that increase the chances of having OCD afterwards? Yeah, definitely. I think, I think the positive thing maybe is if you’ve had preexisting issues with OCD, then it might be a little easier to identify.

Oh, you know, maybe this is kind of flaring up and maybe this is the reason that I’m experiencing this. And then of course, if you’re already in [00:11:00] therapy then you might already be able to, while you might be able, you would be taught, be able to talk to your existing therapist about that. But even if the therapy had existed had happened in the past, you know, you might be able to say, I think I know what this might be.

I think I know what it is. I know that these tools helped me in the past and maybe I can implement them and if necessary. Get back into therapy, you know, if it’s something that you’re not currently doing. Right. So how, how is it treated? Well, there are a few different options for how it’s treated. With OCD in general a specific form of CBT called ERP, which stands for exposure and response or ritual prevention can often be very helpful.

A lot of times that’s done That’s kind of as a rule done in conjunction with mindfulness practices and a lot of kind of acceptance and commitment therapy, where there’s this focus on recognizing that you can tolerate [00:12:00] the anxiety. Because a lot of times what happens is we have an obsessive that kind of gets stuck in our head.

Then we do something, you know, and that’s kind of where the compulsion often comes in is we do something to alleviate that anxiety. And oftentimes that what we are doing is unpleasant. It’s very, time-consuming, it’s not something we want to be doing. So a lot of times it’s about recognizing, okay, I can have this anxious thought I can sit here.

I can tolerate it. I can let this thought pass. I can work on letting it go without responding to it. You know, in the way my OCD is telling me I need to respond to it. Got you. Another, another thing and a thing that I like to use with OCD is EMDR. And what we do with EMDR is. we target those beliefs that emerge as a result of those OCD thoughts of, you know, like we mentioned, I must be a bad parent if I’m thinking this, you know, all of those [00:13:00] kinds of things, all of the thoughts in that realm, we target those with EMDR and are able to, you know, kind of help nudge, nudge the thoughts in the right direction of, so that component of education with, you know, okay, this is OCD. This is not me. This is not me telling me to do these things or really wanting to do these things, creating that separation, and then being able to target those beliefs that arise as a result of those symptoms. And then we can, we can kind of replace those thoughts, so to speak with not I’m a bad parent, but I’m a kind loving parent.

I’m a caring parent. Yeah. Are there other tips that people can do outside of therapy within themselves to navigate this, or for those who have partners who are struggling with this what they can do to help support someone who struggled with those be well, I mean, yeah, I think, I think the single biggest thing is just that awareness, like being able to [00:14:00] identify, you know, okay it, it sounds like here are the thoughts that are, that are happening. You know, here are the thoughts that you’re experiencing and here’s what we. Got kind of do about them. So in terms of those just basic coping skills, you know, breathing, meditation, mindfulness, all of those kinds of things. I think in the name of that kind of education and, and normalizing these symptoms or these thoughts that we often have there’s a great book called good moms have scary thoughts by Karen Kleiman and it’s, it’s set up in a cartoon.

So it’s very cute and accessible, but it really normalizes because there are so many, there are so many new parents that have these thoughts that it just normalizes. You know, this is something that a lot of people deal with and it doesn’t mean that there’s anything wrong with you. And it doesn’t mean that you’re a bad parent.

It just means that, you know, maybe you have OCD. Maybe you need a little help. Maybe you need a little extra support. So just being able to [00:15:00] notice those thoughts and name them and say, Hey. Yeah, this isn’t what that means. That doesn’t mean this about you. And then, you know, of course being able to say, okay, is this something that it feels like this is getting manageable?

Or is it this something that it feels like we could use a little outside intervention for?

So Stephanie, how long can people expect for these symptoms to last during post. Well, it, it really varies pretty widely. I think it’s important too, to keep in mind that all of these all of these mental health concerns can pop up during pregnancy and the onset can be anywhere from, you know, like during pregnancy all the way up to 12 months, post birth is kind of considered to be the classic cutoff.

Now, of course, if somebody starts having symptoms, you know, let’s say three months, Post-birth that’s not to say that if they don’t show up for therapy until their [00:16:00] child is 18 months old, that doesn’t mean that it’s not, you know, something that’s postpartum because it has that kind of specified onset.

So prognosis varies. Pretty widely, of course, depending on things like, you know, your social support system, because the better your social support system is, especially in a time when you’ve added a trial to your family. The better it’s the easier it’s going to be to, you know, get the support you need in terms of professionally and due to take care of yourself.

So yeah, it’s, it’s, it varies pretty widely in terms of how, how long a person can kind of like expect to have the symptoms subside a little bit and, and feel better, but definitely, you know, up to 12 months postpartum or post-birth is, you know, when we notice that. Coming up. I have another question for you being a clinician myself.

I know how some disorders symptoms can sometimes mimic [00:17:00] others and insight. So in my experience, I know that sometimes it can look similar of, of symptoms of OCD can look similar to symptoms of psychosis. Can you give us some clarity on that? Yeah, and I mean, that’s, that’s a really important concern because postpartum psychosis, it’s very rare.

But it’s very scary, you know, it’s, it’s definitely a medical emergency that requires immediate intervention going to the emergency room is, is key. So with OCD, as we’ve talked about, it’s, it can be these like really intrusive, scary images. Sometimes of me, you know, in the baby, sometimes myself, I’m seeing something happen.

I’m seeing myself harm the baby. So the biggest way to differentiate between OCD symptoms versus psychosis symptoms is in OCD. That’s very, very upsetting to me. It’s not something that I want to do. It’s not something that I want to follow through on. It doesn’t make sense. It makes me feel [00:18:00] like there’s something wrong.

That’s, that’s the biggest thing with psychosis. Unfortunately, you often have the new parent has thoughts about needing to harm the baby, needing to harm themselves. And those thoughts make. Those thoughts seem like this is what needs to happen. This is the right thing to do. And so, so if somebody is expressing those things and they don’t seem to think that it’s a problem or there’s something like if it’s not just stressing to them, then that’s when it’s time to get to the closest to yeah.

It’s a medical emergency. It needs immediate intervention. People recover. It’s important to, it’s important to emphasize this people make full recoveries from psychosis. It’s a very time limited medical emergency that requires immediate intervention, but it, when you get the intervention. You know, often people make that full recovery and everything is fine, but it does require immediate intervention.[00:19:00] 

That’s actually a really big relief that someone can recover from it. And also thank you for helping us understand the difference between postpartum OCD and postpartum psychosis. My gosh, Stephanie, you’re such a wealth of knowledge on this topic, so thank you again for joining us today. And also we can have you on against them.

Thank you.

Thank you everyone for listening to Convos from the Couch by LifeStance Health, where we are re-imagining mental health. Please take care.