Postnatal depression (PND) and obsessive-compulsive disorder (OCD) are two common conditions which affect parents within the first year after the birth of a child.
PND refers to symptoms such as sadness, lack of interest in previously attractive activities, loss or gain of appetite, sleep disturbances, and even violence or substance abuse in men. Parents may also find themselves thinking about harming their child, with or without meaning to, or having violent thoughts about the baby. Though these thoughts are never realized practically by these parents, the patients do not understand this simple fact. Instead, the presence of such thoughts is interpreted as signs that they are ‘bad’ or unfit parents.
OCD, on the other hand, results from another psychiatric condition characterized by three components. These comprise:
- Intrusive negative thoughts which are highly distressing to the parent, called obsessions
- High levels of anxiety induced by the obsessions
- Rituals or actions undertaken to relieve the anxiety, which are called compulsions
By way of illustration, a mother or father may worry repeatedly about contamination of the baby’s things or the baby, by careless handling. This leads to intense anxiety about harming the child. To compensate for this, a ritual or action is developed, which is repeated over and over again to defuse the worry.
Examples of rituals may include a ten-step procedure to sterilize all feeding equipment before and after each feed. This eventually takes up so much time and effort that other necessary housework and responsibilities are neglected. In other cases, a particular prayer may be repeated a specific number of times, endlessly, to avert anxiety.
How to help parents with OCD or PND cope
First of all, it is good to know that almost all parents do have thoughts of harm coming to their baby through their means, both inadvertently or deliberately. While these do cause anxiety and self-reproach, normally these thoughts are dismissed quickly and no action is taken on them. On the other hand, parents with OCD keep worrying about the thoughts, which they experience much more often than other parents. The high frequency and intensity of the thoughts distinguish OCD from random disturbing thoughts in parents without OCD.
It is interesting that such thoughts also occur more frequently in parents with depression. However, the development of severe anxiety and compulsive avoidance or performance rituals to deal with the anxiety set OCD apart from PND.
Supporting parents with OCD or PND is essential to helping them achieve a satisfying parental experience, which will facilitate the normal development of their children. The following steps may help:
- They must be specifically counseled about the possibility of such thoughts and reassured that this does not mean they are not good or adequate parents, and also that it does not mean they will actually harm their babies
- Parents who drop out of support groups must be contacted to find out if they are unwilling to return because they feel they are the only ones with such thoughts or problems, which would, they feel, label them as unfit to care for their children
- Rather than suffering in silence, it is important to make it clear that new parenthood has its intense anxieties as well as its joys. It should be explained that feeling sadness or loss at times does not make one a bad parent, but may be the normal result of stress, sleep deprivation, fatigue, and dramatic hormonal changes
- Rather than threaten parents with the threat of having their children taken away, they should be reassured that they will soon learn with help to enjoy and take care of their new babies, while recovering from their psychiatric conditions. Postpartum support groups with experienced and trained moderators may be very useful in such situations
Psychotherapy should be offered to those parents who need it. Practical help from family, friends, or doulas, will help parents catch up on their sleep, enjoy renewing and building their relationship with each other, and come back to normal parenting attitudes.
Education as to the signs of PND and perinatal OCD will also help in reaching out to parents, and will assist them to ask for help early in the course of the condition. This will be of great use in avoiding the onset of severe depression in many parents.
Reviewed by Susha Cheriyedath, MSc