The postpartum period is often described as a time of joy and bonding between mother and baby. However, for many women, it can also be marked by heightened stress, anxiety, and intrusive thoughts that are difficult to manage. While postpartum depression is widely recognised, postpartum obsessive-compulsive disorder (OCD) remains under-discussed and frequently misunderstood. This condition can cause immense distress to new mothers who experience persistent, unwanted thoughts or mental images often centred around their infant’s safety. Understanding these obsessions is essential for early detection, compassionate support, and effective treatment by a therapist or counsellor.
What Is Postpartum OCD?
Postpartum OCD is a type of anxiety disorder characterised by intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions) that mothers perform to reduce their distress. These obsessions typically begin within the first few weeks to months after childbirth but can also appear later. Unlike psychosis, mothers with postpartum OCD recognise that their thoughts are irrational, yet they struggle to suppress them.
According to the American Psychiatric Association (2022), OCD affects approximately 2–3% of the general population, but studies show that postpartum women are at a higher risk. Estimates suggest that up to 11% of new mothers experience postpartum OCD symptoms (Russell et al., 2013). The condition can lead to severe emotional exhaustion, guilt, and avoidance behaviours that interfere with maternal bonding and daily functioning.
Most Common Postpartum OCD Obsessions
1. Fear of Harming the Baby
The most common obsession in postpartum OCD involves an overwhelming fear of accidentally or intentionally harming the infant. Mothers may have intrusive images of dropping, smothering, stabbing, or otherwise injuring their baby. These thoughts are deeply distressing and often accompanied by feelings of guilt and shame.
Research by Abramowitz et al. (2010) revealed that up to 90% of new mothers report some intrusive thoughts about infant harm, though only a smaller percentage develop clinical OCD. What distinguishes postpartum OCD is the level of distress and preoccupation caused by these thoughts, leading to compulsive behaviours such as avoiding sharp objects or constantly checking on the baby’s breathing.
2. Fear of Contamination or Illness
Another prevalent obsession revolves around the fear of contamination. Mothers may become excessively worried that their baby will get sick due to germs, unclean surroundings, or contact with others. This often leads to compulsive cleaning, handwashing, sterilising bottles repeatedly, or refusing to let others hold the baby.
According to a study by Fairbrother and Woody (2008), contamination obsessions are among the most commonly reported symptoms in postpartum OCD, linked to heightened maternal responsibility and perceived vulnerability of the newborn. This type of anxiety is further intensified by hormonal changes and the social expectation that mothers must keep their infants safe at all costs.
3. Intrusive Sexual or Morally Unacceptable Thoughts
Some mothers experience sexually intrusive or taboo thoughts involving their baby—an obsession that often triggers profound shame and fear of being judged or misunderstood. These thoughts do not reflect the mother’s desires or intentions but rather her anxiety and distress about losing control or violating moral boundaries.
Because of the stigma surrounding these obsessions, many women avoid disclosing them even to a therapist, fearing that they might be seen as unfit parents. However, mental health professionals emphasise that having intrusive thoughts does not make a mother dangerous. Rather, it indicates intense anxiety and overactive protective instincts (Fairbrother et al., 2017).
4. Fear of Making Irreversible Mistakes
Some women develop obsessions around making mistakes that could harm their baby’s development or safety. These might include doubts about feeding schedules, sleep positions, or whether the baby is getting enough nutrition. Mothers may engage in excessive research, reassurance-seeking, or checking behaviors to reduce their anxiety.
This pattern often overlaps with perfectionistic traits, which can heighten stress and self-criticism. According to Misri and Swift (2015), such mothers may feel trapped in a cycle of self-doubt and compulsive correction, leading to chronic anxiety and emotional fatigue.
5. Fear of Losing Control
Another common obsession involves fear of losing control over one’s impulses such as shouting, throwing the baby, or acting irrationally. These thoughts are terrifying to mothers who deeply love their child and have no actual intention of causing harm. They often respond by avoiding situations that might trigger these fears, such as bathing the baby alone or being left unsupervised.
Cognitive-behavioural research suggests that this obsession is linked to misinterpretation of intrusive thoughts, where normal but distressing mental images are seen as indicators of real danger or moral failure (Abramowitz et al., 2009). Such interpretations feed the cycle of anxiety and compulsive avoidance.
Causes and Risk Factors
Postpartum OCD is multifactorial; it arises from a combination of biological, psychological, and social factors. Hormonal fluctuations after childbirth, sleep deprivation, and increased responsibility can heighten emotional sensitivity and anxiety. Personal or family history of OCD, depression, or trauma also increases risk.
Psychologically, new mothers often experience immense pressure to meet societal ideals of “perfect motherhood.” This pressure can amplify fears of failure or harm, especially when accompanied by stress and exhaustion.
Treatment and Recovery
The good news is that postpartum OCD is highly treatable with appropriate professional help. Cognitive Behavioural Therapy (CBT), particularly Exposure and Response Prevention (ERP), has strong evidence for effectiveness in reducing obsessions and compulsions (Williams et al., 2021). ERP helps mothers face their fears gradually while learning to tolerate distress without resorting to compulsive behaviours.
In some cases, medication such as selective serotonin reuptake inhibitors (SSRIs) may be prescribed alongside therapy. Support from a therapist, counsellor, and family members plays a vital role in recovery. Psychoeducation about postpartum OCD also helps mothers differentiate between intrusive thoughts and real intentions, reducing shame and isolation.
Conclusion
Postpartum OCD is a silent yet significant challenge that affects many new mothers. Its common obsessions, such as fears of harming the baby, contamination, or moral transgressions can be distressing and isolating. Understanding these symptoms fosters empathy and encourages timely intervention. Recognising that intrusive thoughts are a manifestation of anxiety, not a reflection of moral failure, is the first step toward healing and emotional freedom.
For mothers seeking professional support or searching for the best psychologist near me, the Psychowellness Center, located in Dwarka Sector-17 and Janakpuri, New Delhi (011-47039812 / 7827208707), offers individual counselling, self-esteem therapy, mindfulness-based therapy, and personal growth coaching. Their trained psychologists use evidence-based approaches such as Cognitive Behavioural Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), and Positive Psychology interventions to help new mothers manage intrusive thoughts, strengthen self-awareness, and rebuild confidence.
For flexible, confidential support from home, TalktoAngel provides online counselling with experienced therapists specialising in emotional wellness, self-compassion, and postpartum mental health, empowering mothers to embrace authenticity, restore balance, and reconnect with the joy of motherhood.
Contribution: Dr. R.K. Suri, Clinical Psychologist, and Ms. Sheetal Chauhan, Counselling Psychologist
References
Abramowitz, J. S., Schwartz, S. A., Moore, K. M., & Luenzmann, K. R. (2003). Obsessive-compulsive symptoms in pregnancy and the puerperium: A review of the literature. Journal of Anxiety Disorders, 17(4), 461–478. https://doi.org/10.1016/S0887-6185(02)00206-2
Abramowitz, J. S., Nelson, C. A., Riemann, B. C., & Whiteside, S. P. (2009). A cognitive-behavioral model of obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 23(3), 174–184. https://doi.org/10.1891/0889-8391.23.3.174
Fairbrother, N., & Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women’s Mental Health, 11(3), 221–229. https://doi.org/10.1007/s00737-008-0017-6
Fairbrother, N., Janssen, P., Antony, M. M., Tucker, E., & Young, A. H. (2017). Perinatal anxiety disorder prevalence and incidence. Journal of Affective Disorders, 200, 148–155. https://doi.org/10.1016/j.jad.2016.04.039
Misri, S., & Swift, E. (2015). Generalized anxiety disorder and obsessive-compulsive disorder in the postpartum period: Assessment and treatment. Journal of Women’s Health, 24(9), 762–770. https://doi.org/10.1089/jwh.2014.5142
Russell, E. J., Fawcett, J. M., & Mazmanian, D. (2013). Risk of obsessive-compulsive disorder in pregnant and postpartum women: A meta-analysis. The Journal of Clinical Psychiatry, 74(4), 377–385. https://doi.org/10.4088/JCP.12r07917
Williams, M. T., Powers, M. B., & Foa, E. B. (2021). Cognitive behavioral treatment for obsessive-compulsive disorder in postpartum women. Clinical Psychology Review, 87, 102037. https://doi.org/10.1016/j.cpr.2021.102037
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