The Real Difference Between Postpartum OCD & Psychosis, Plus How To Recognize the Signs
If you’re a new mom, you may have experienced alarming thoughts about harming your baby, find yourself constantly checking your baby’s breathing, or even feeling like you’re losing touch with reality. And since you’re here reading this article, we’re confident in telling you that you are an incredible mother. You are doing right by your baby, and everything you’re feeling is surprisingly common for new mothers, especially since 60-80% of birthing people face postpartum mental health struggles.
As psychotherapists who specialize in postpartum mental health in the Boston, MA, area, our goal is not only to help you differentiate the difference between postpartum OCD and postpartum psychosis but also to give you all the facts so you can make quick decisions about your health and start loving motherhood.
What is Postpartum OCD?
Postpartum OCD is a form of obsessive-compulsive disorder that can affect birthing parents from shortly after birth up to a year postpartum. It often involves intrusive thoughts entering the mother’s mind, as well as compulsions in an attempt to keep the thoughts at bay. While postpartum OCD commonly centers around the baby, it can also involve other areas of a mother’s life, which is a fact that isn’t widely recognized. Despite being diagnosed in only 2.9% of birthing parents, our professional experience suggests that this number is likely higher.
Postpartum intrusive thoughts typically come as a shock to new moms when they experience anything other than happy thoughts about their new baby. But what worries or scares us the most tends to live at the forefront of our minds. And rather than ignoring it, you find yourself ruminating on that thought because the things you fear are being broadcasted too intensely.
Postpartum intrusive thoughts are experienced by 70-100% of birthing mothers and are generally ego-dystonic, which means they go against your values and who you believe yourself to be. This is precisely the reason they are so jarring and upsetting when experienced.
Postpartum OCD compulsions, on the other hand, are repetitive actions that stem from thoughts. These compulsions are designed to control and prevent these fears from coming true. It can lead to responses like checking the baby’s breathing constantly, excessive cleanliness, or even triple-checking car seats.
Here are some examples of how intrusive thoughts and compulsions can interact with a mother
with postpartum OCD:
If a mom has thoughts about drowning the baby, this leads to not wanting to bathe the baby or asking another adult to bathe the child.
If a mom has thoughts about the baby being cut or cutting the baby herself, this leads to avoiding all sharp objects around the baby or even removing knives from the home.
If a mom experiences fear of dropping the baby, this can lead to having another caregiver carry the baby downstairs or avoid walking with the child altogether.
These thoughts and compulsions can feel very sticky and uncharacteristic, which is why they are so distressing for postpartum mothers. If you’re questioning yourself after reading this part of the article, we want you to know that we’re here to help you navigate these experiences with compassion and evidence-based approaches. We aim to help you feel grounded and at peace with yourself as you move through this postpartum season.
What is Postpartum Psychosis?
Postpartum psychosis is a rare but severe condition that new mothers can experience in the first few weeks after birth. Unlike postpartum OCD, where mothers remain aware of their intrusive thoughts, mothers with postpartum psychosis experience a detachment from understanding what is and isn’t real. Knowing the difference between OCD and psychosis is critical because while both are serious, postpartum psychosis symptoms need immediate support and intervention to keep mama and baby healthy and safe.
Postpartum psychosis may feel like:
Hallucinations or delusions: You may hear or see things that aren’t there or strongly believe things that feel real to you but aren’t true. For instance, you might be convinced your baby turned blue, and you believe your baby is in danger, even if your partner confirms they’re perfectly fine.
Extreme mood changes: Mothers who experience uncharacteristic sudden shifts between deep depression and intense energy, similar to mania are a sign of postpartum psychosis.
Difficulty sleeping: Unlike the natural tiredness most parents experience in early parenthood, you may feel weirdly energized, like you hardly need any sleep or that you’re unable to sleep even when you know you must be exhausted.
Extreme thoughts: These thoughts can feel out of your control or even like commands, making it hard to stay grounded in reality.
Postpartum psychosis is rare and often misunderstood because many new mothers feel like this must just be part of the average postpartum experience and don’t want to believe something is wrong with them. It’s not caused by anything you did or didn’t do. If you feel that you are suffering from postpartum psychosis, you need to seek emergent care immediately.
What is the Difference Between Postpartum OCD & Psychosis?
Now that we understand postpartum OCD and postpartum psychosis separately, we want to talk about the differences between the two together. We’ve found a lot of confusion in the online community around this topic, and we feel it’s important that new mothers know the differences between the two so they can find the proper support quickly.
Postpartum OCD often presents as distressing and ‘sticky’ intrusive thoughts that feel scary and completely out of character - a term we call ego-dystonic in the psychotherapy world. These thoughts are upsetting and often lead to repetitive behaviors or “compulsions,” like frequently watching your baby’s stomach for breath movements or excessively cleaning for fear of germs making your baby sick. While these thoughts are hard to ignore, moms with postpartum OCD recognize these thoughts as their own and stay grounded in reality, even if the thoughts are
Scary.
Postpartum Psychosis, on the other hand, is rarer and much more severe. With psychosis, the line between reality and awareness becomes blurred. These symptoms can include hallucinations where you see or hear things that others don’t or even have intense experiences
that feel undeniably real. Unlike postpartum OCD thoughts, postpartum psychosis involves a complete detachment from what’s real and may cause behaviors or thoughts that feel entirely out of the mother’s control. These symptoms make it hard to recognize what’s happening, which is why immediate support is so critical for postpartum psychosis.
While both experiences are incredibly distressing, they are rooted in different causes and require very different forms of treatment. With postpartum OCD, the support used is exposure and response prevention, a form of cognitive behavioral therapy that focuses on managing anxiety and easing the constant feeling of guardedness. At the same time, postpartum psychosis requires emergent medical and therapeutic intervention to help mothers regain stability.
What Causes Postpartum OCD and Psychosis?
While the exact causes of postpartum OCD and psychosis aren’t fully understood, we do know that hormonal changes and the stress of caring for a new precious life can create the perfect storm for mental health struggles during postpartum. We’ve found that there are two primary triggers for new moms.
First, we have hormonal changes. After childbirth, we know that hormone levels like estrogen and progesterone drop rapidly. And for some new moms, those changes can intensify anxiety or
trigger intrusive thoughts.
Family history can also play a significant role in triggering postpartum OCD or psychosis. When we have new moms come in who have family members who have been diagnosed with OCD, anxiety, or other mental conditions, we find they can be more prone to experience postpartum
mental health struggles.
On top of this, the lifestyle changes that come with bringing a new life into the world are enough to add strain to the mix. But most importantly, we want you to know that if you’re experiencing anything we’ve mentioned thus far, it’s not your fault. These shifts are natural, and experiencing mental health symptoms doesn’t make you a “bad mom.” It signals that your mind and body may need a little extra support.
As therapists who help new mothers navigate their postpartum mental health in the Boston, MA, area, we’re here to support you with resources and therapies tailored to help you feel like yourself again. Alongside our evidence-based approach, our therapists are mothers who have had first-hand experience with postpartum anxiety and depression and have also been extensively trained by PSI (Postpartum Support International.)
In short, we hear you, see you, and are here to help support you. Motherhood is full of challenges, but it doesn’t mean you must walk through this part alone. Reaching out for help is a sign of strength, and with the proper support, you can start feeling steady, empowered, and ready to embrace all the new, exciting moments that come with being a new mom.
Contact Soultality
Are you struggling with postpartum OCD & Psychosis? Our experts at Soultality are here for you! Schedule your appointment with us today. For more information, call (617)631-8284 or email admin@soultality.com.