As much as we would like to think that information and understanding about OCD have improved over the years, the following two stories will indicate that we have much further to go. They involve a type of OCD commonly referred to as “Post-partum OCD.” This refers specifically to OCD that is worsened or brought on by the delivery of a baby and is most likely linked to post-partum depression. I would actually see this as part of a larger category, where O-C symptoms can be touched off or worsened by pregnancy as well. Some adult women who have previously had low level OCD or even no prior symptoms will suddenly, following delivery, find themselves faced with either strongly increased OC symptoms, or the sudden onset of symptoms where they previously had none.
The form of OCD seen in these post-partum cases is not limited to any particular type. However, there is one form that I have personally witnessed, that seems to cause some fairly serious problems for new mothers. I am referring to what are known as morbid obsessive thoughts. These thoughts generally center on the theme that the thinker will deliberately cause harm to themselves or others. This harm can include violence, sexual abuse, poisoning, murder, mutilation, etc. Why OCD picks up on these particular themes in certain people remains unknown, but it always seems to have an uncanny knack for picking on whatever will bother a person most. Perhaps people obsess about many different subjects, and only those that seem most threatening actually get noticed and then persist.
It should be mentioned here that OCD sufferers never act on morbid thoughts, and are as horrified by and startled at their presence as are some of the people they reveal them to. Those with OCD, in fact, tend to be a lot more risk-avoidant than the average person, and would seem the least likely to ever do anything that would endanger themselves or others. This is all well known to those who have expertise in diagnosing and treating OCD. For an experienced clinician, hearing people’s revelations that they are thinking about doing grievous harm to themselves or others is generally all in a day’s work, and nothing to get terribly excited about. Patients are often relieved and surprised when the clinician isn’t shocked or upset, and when they are informed that such thoughts are common to many OCD sufferers.
Unfortunately, things do not play out this way when a sufferer falls into the hands of someone who is not familiar with the disorder or the different forms it can take. Here are two examples of this type of sad situation.
The first, involves a woman, Sharon (whose name and facts have been changed to protect her identity), a 32 year-old fashion designer who had been previously treated by me for problems with obsessive guilt and scrupulosity. She had done well in treatment via a combination of Exposure & Response Prevention and medication and had reached the point of recovery. At the point where she phoned me, I had not seen her for about a year, during which time she had become pregnant with her first child. She had just given birth to a healthy baby boy in a large Manhattan hospital the day before, and was on the phone in tears. As she related it to me, her second day after delivering, she began to have intrusive and repetitive thoughts about harming her new infant. These were a type of thought she had not experienced in the past, and even though she had had experience in dealing with OCD, was caught off-guard. Not knowing what to do, she discussed her thoughts with one of the ward nurses. This was where things started to go wrong. The nurse, out of a sense of diligence and protectiveness toward the infant, immediately informed the head nurse, as well as my patient’s obstetrician. Apparently, not knowing my patient’s history of OCD (which even if they did, probably wouldn’t have made any difference), they then took the thoughts at face value and informed her that they would absolutely not allow her to have any contact with her baby in order to protect it from her, and in addition, were ordering an immediate psychiatric consult. Nothing Sharon could tell them seemed to make any difference.
She tearfully called me in a state of panic. “I can’t believe what is happening,” she said. “I tried to tell them that I would never hurt my baby, but they just wouldn’t listen to me. No one believes it when I tell them I would never hurt him. I think these thoughts could be a part of my OCD, but then I get more doubts about whether they are or not. Is there anything you can do?” Sharon couldn’t be certain about the nature of her thoughts, because on of the chief hallmarks of OCD is doubt, and so she even doubted that obvious obsessive thoughts were O-C symptoms. One further irony in this whole situation was that the hospital actually had a large OCD treatment and research unit as part of the same complex, but whatever they were learning there had not been communicated to any of its other units.
Fortunately, the story had a happy ending. I was able to phone someone I knew at the hospital’s OCD center and asked if one of their more senior people would drop by the obstetrics unit to visit Sharon. They soon did this, and after talking with her, were satisfied that the thoughts were, in fact, just thoughts, and that Sharon had no bad intentions toward her child. They then explained things to the staff there, and the situation was then resolved. I wonder, however, what would have happened had there been no one at this hospital with the knowledge or authority to set things right.
The second story is somewhat less happy. One evening I received a phone call at my office from a distraught young woman I will call Joanne. She was calling me from a state in the Midwest. What she had to relate was a genuine O-C parent’s nightmare. Having given birth not long before, she had, as had Sharon, begun to experience thoughts about hurting her new son. “I didn’t know why I was having these constant thoughts,” she told me. “I would never want to hurt my son, no matter what.” Prior to this time, Joanne had never had any symptoms of OCD or any other disorder, and so had no real idea of what was happening to her. She then did what any concerned parent would do. She got the name of a local psychiatrist (there weren’t too many to choose from in her area) and set up an appointment to find out if there was anything she could do about the thoughts. As Joanne related, “The doctor was nice enough at first, but I began to feel that I had made a mistake as soon as I started to tell him about my thoughts. He sat up in his chair and looked at me with his eyes very wide, shaking his head.” She went on to say, “He told me that this was a very dangerous situation that could not be ignored, and that he intended to immediately report me to the state’s office of child protective services. He said they would take custody of my baby and make sure that nothing happened to him. He wanted to know where my baby was, and who was watching him.” At this point, Joanne got up to leave, with the doctor now angrily demanding that she give him the information. She quickly ran to her car in a state of fright and bewilderment, and went straight home. Once there, she hastily packed a bag, grabbed her infant son, and drove to the home of relatives in a neighboring state. While at their home, she had gone on the internet and done a bit of research about people who had thoughts of harming their children, and come across an article I had posted there, concerning morbid thoughts. She saw herself in this article and had decided to call me.
There wasn’t much I could do about the situation in her home state at that point, as she had already decided to relocate to the state she had moved to. I was able to tell her more about her post-partum OCD and about morbid thoughts in general. I was also able to give her the name of a psychologist in her new location that had a lot of experience in the treatment of OCD, who I believed would be able to help her. After I got off the phone, I wondered how many other new mothers had found themselves in such a predicament.
What bothers me the most about both of these stories is that they each involved professionals who were responsible for the well-being of others, but who lacked crucial information about OCD and were completely unequipped to recognize or deal with it. One was even a mental health professional who really should have known better. Rather than try to fix the blame on anyone or any institution in particular (although there is plenty of blame to go around) I think that the point of all this is that it highlights how much more work needs to be done in terms of getting the word out on OCD to the public and health professionals alike. In Sharon’s case, if she had simply begun to show signs of severe depression after giving birth, the hospital staff would most likely have recognized what was happening and would have treated her with understanding. The same would probably have been true in Joanne’s case.
I think that those of us who treat OCD need to continue to teach the public, the school systems, and other professionals to the utmost of our abilities via websites, publications, lectures, media appearances, etc. I also think that those of you out there who suffer with OCD and the members of your families need to put your support behind the OC Foundation in their quest to educate society about this serious and often puzzling disorder. It really isn’t all that hard to diagnose, and once diagnosed, there is much that can be done to help sufferers to recover.
Fred Penzel, Ph.D., is a licensed psychologist who has specialized in the treatment of OCD and related disorders since 1982. He is the executive director of Western Suffolk Psychological Services in Huntington, Long Island, New York, a private treatment group specializing in OCD and related disorders. He has written numerous articles that have been featured in many issues of the International OCD Foundation Newsletter.
If you would like to read more about what Dr. Penzel has to say about OCD, take a look at his self-help book, "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well (2nd edition)," (Oxford University Press, 2016).