Postpartum Anxiety Disorders - Obsessive-Compulsive Disorder Definition

Written by Linda Sebastian

What Is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is an anxiety disorder that used to be considered rare. Now psychiatric clinicians recognize it is much more common than originally thought. Obsessive and compulsive are terms sometimes used to depict people who are perfectionistic, require a certain order, or have rigid routines. Although these characteristics may fit many people, these traits are parts of our personalities. The actual criteria for OCD diagnosis include many more serious symptoms. People with the disorder (rather than just the traits) lead disrupted lives.

This anxiety disorder has two components: thoughts and behavior. Obsessions are persistent thoughts that intrude upon the person's consciousness. These thoughts are unwelcome, but the affected person feels incapable of controlling them. Examples of obsessions are thoughts about a body part, saying a word over and over, and thoughts of hurting yourself or someone else. Among postpartum women, these obsessions are frequently about hurting the baby in some manner, like throwing it against a wall or by hitting or stabbing it. In her book, Shouldn't I Be Happy? Emotional Problems of Pregnant and Postpartum Women, Dr. Shaila Misri reports that in addition to the obsessive thought of hurting the baby, another obsession is frequent. She describes a theme of obsessing about previously having killed a baby, which may affect women who have terminated an earlier pregnancy. This theme may also be evident in women who have miscarried.

Compulsions are behaviors that are repetitive and ritualistic. Common compulsions are continuous cleaning, rearranging things such as items in kitchen cabinets, or washing hands. The urge to do these things continually is uncomfortable, but the person feels as if stopping is not possible. Common compulsive behaviors in postpartum women with OCD are frequent bathing of the baby or changing its clothes. Nola, a twenty-five-year-old mother, tells of her OCD episode:

After I was home for about two weeks, I began having fears about smothering the baby with her pillow. I could not stop the thoughts from happening.
I love my daughter so much, and I felt so ashamed of having these awful thoughts.
Finally, I called a crisis hotline. They told me I probably had an anxiety problem called OCD. I was so relieved, I cried for several hours. I was started on a medication, and the thoughts stopped. It was like a miracle!

Nola's story is very typical of persons with OCD. They recognize that their thinking and behavior is "not normal." Women describe a sense of shame and guilt about having these thoughts and behaviors. They often hide from their family and friends their ritualistic behaviors and obsessive thoughts. Nola reports:

I'd had obsessions since I was a child, but thought I could control them. I never told anyone because I was afraid they would send me to a psychiatric hospital. I realize now how much of my life I have spent hiding something that was easily treated. I wish I had gotten help earlier so I would not have had such a hard time when my daughter was born.

Just like Nola, many of these women suffer in silence because they feel so ashamed of having such thoughts. Often the new mother with OCD will go to great lengths to avoid being alone with her baby. Common strategies are to be gone from home all day to places like the library or shopping mall or out to visit friends. Developing complaints of illness to avoid taking care of the baby is also common.

Because OCD is not a psychotic illness, the mother is unlikely to act on her thoughts, so there is little risk to the infant. Nevertheless, the toll on the mother is tremendous. Some women whose children are now in their twenties with children of their own clearly remember the thoughts they had of possibly harming their babies. They still feel guilty decades later.

In order to meet the criteria for a diagnosis of obsessive-compulsive disorder, either compulsions or obsessions can be present. In addition, at some point, the person has recognized that the obsessions or compulsions are excessive or unreasonable. The obsessions or compulsions cause marked distress, are time-consuming, or significantly interfere with the person's normal routine, occupational functions, or usual social activities or relationships.

Symptoms of Obsessive-Compulsive Disorder

Obsessions are defined by:

• recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate and cause anxiety or distress
• thoughts, impulses, or images that are not simply excessive worries about real-life problems
• attempts to ignore or suppress such thoughts, impulses, or images
• awareness that the obsessional thoughts, impulses, or images are a product of his or her own mind

Compulsions are defined by:

• repetitive behaviors (hand washing, ordering, checking) or mental acts (praying, counting, repeating words silently) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
• behaviors or mental acts aimed at preventing or reducing distress or preventing some dreaded event or situation

If you recognize that you have obsessive-compulsive disorder, seek help. Far too many people live their lives hiding these problems and not getting the treatment that can make such a difference in the quality of their life.