Last week the inspiring Dr Carrie Ladd (RCGP fellow and developer of the Perinatal Mental Health Toolkit – read more here) invited Sarah and I to speak to a large group of local GPs about our perinatal mental health experiences. As you may be aware, I’ve had several less-than-adequate experiences with GPs in the past and reaching them in terms of perinatal mental health advocacy is a big priority of ours so we leapt at the chance.
Although in some ways I was relieved at some of their knowledge (especially when you consider the anecdotal evidence we have of poor practice), there appeared to be a big training gap established by the session – Perinatal OCD. Many appeared to have very little knowledge of this condition and, worse, a few carried opinions that dangerously conflict with respected medical advice. Afterwards it dawned on me that Perinatal OCD is perhaps an illness that many are unaware of or who misunderstand and, therefore, it needs some explanation.
In my earlier post – Should Perinatal Mental Illnesses Be Treated Individually? – I touched on the fact that the term Postnatal Depression simply no longer covers the full breadth of mental health issues that can be faced by parents during pregnancy or after the birth of a child. I briefly touched on Perinatal OCD (sometimes referred to as Maternal OCD) but I wanted to share a bit more today about what is it, my experience of it and how it can be treated.
I’ve found good definitions in a couple of sources. The first is the fantastic symptoms list on the Postpartum Progress website, who’s ‘plain mama English’ style is so relatable. Postpartum Progress have combined OCD with Anxiety which does make a lot of sense because they are deeply connected, although it should be noted that Anxiety can occur without OCD I believe.
Another great source is MaternalOCD.org which gives a more clinical definition.
My interpretation is that, essentially, Perinatal OCD is made up of two parts. Firstly, obsessions which are often based on something happening to your child or feeling like you might hurt or harm your child yourself, and usually characterised by distressing and frequently recurring intrusive thoughts. This is followed by compulsions, which are coping behaviours that bring temporary relief to the anxiety brought on by the obsessive thoughts. The key words here are temporary relief. Because, although at the time you feel you have to do these things and they will make you feel better, all they really do is feed the anxiety and interfere with your every day life.
I should add here that not all OCD revolves around you hurting your child. For many women it’s about becoming obsessed with the health and safety of your baby from external influences. However, my own intrusive thoughts did all revolve around harming Caterpillar and/or myself. As you can imagine, sharing these obsessions is incredibly difficult given how I truly feel as my well self but I think it’s so important to share these experiences so that other parents may find some comfort.
I’ve explained my intrusive thoughts in more depth in this post but to give an unpleasant summary the common ones for me were: suffocating my baby, dropping or throwing my baby down the stairs and cutting or stabbing myself. Since my recovery I’ve heard that a fear of knives, in relation to that last one, is especially common. I love to cook but at one point even walking past the drawer that held the knives was enough to spark an anxiety attack. Similarly, every time I walked past the bottom of my stairs I’d be consumed with terror as I could see the aftermath of dropping Caterpillar so vividly in my mind.
The most important thing I want to get across here is that I was never going to harm my son. The very definition of intrusive thoughts is that they are the absolute opposite of what the person truly desires to do. I was terrified of these thoughts. They were sick, disgusting, abhorrent and any other unpleasant adjective you can think of. Every time they entered my head I was so disturbed by them I would have a panic attack!
But, sadly, an apparent misconception is that if a mother is having these thoughts she must be a danger to her child. And who is the person who most strongly believes this? The mother herself.
The compulsions I experienced to counter these obsessive thoughts were:
- not being able to be alone with my son
- needing to be out of the house all day every day so I wasn’t alone
- not wanting to hold my son
- not being able to cook dinner or take a paracetamol or be near anything else that I could use to harm myself.
I would also have things I would need to do; mantras I had to say in the mirror or items I had to touch in order to keep myself and my son safe.
I believe CBT is generally considered the best treatment for Perinatal OCD and that certainly made a huge difference to me. But it was actually one simple concept that had the biggest impact on my recovery: they are just thoughts. That’s it, just thoughts not reality and what’s the point of being afraid of an errant thought?
My therapist helped me to see that I’ve always experienced intrusive thoughts, that everyone does. Whenever we have an unpleasant or unwanted, or sometimes simply comically bizarre thought that we’d never act on in a million years, we’re having an intrusive thought. But when we are well and strong we ignore it and it goes away but when we are mentally or emotionally vulnerable (for example after the birth of a child!) we can fixate on the thought. Our brain then thinks “Oh, she gave that a lot of attention it must be important, let me show it to her again” and so on. It is that simple. Unfortunately, it can take a lot of time and practice to learn how to let go of the thoughts but it’s very possible and I’m living proof.
My message to parents, as always, is please seek help and please know that you will get better and these thoughts and compulsions will not have a hold on you forever.
My message to GPs, or at least to the ones who don’t feel confident handling a Perinatal OCD case or who are labouring under stigmatised beliefs – educate yourselves. Do some research, read some papers, seek advice from your psychiatric colleagues, make use of The RCGP’s toolkit – whatever it takes. Just make sure when a parent comes into your office and finds the courage to speak of these appalling thoughts and unhelpful coping mechanisms you know exactly what to say to help them. And, vitally, what not to say.