Postpartum OCD: One Therapist’s Reflections

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

One of my colleagues, a well-known expert in OCD, recently made a brave public announcement.  Before I share it, I want to explain one aspect that makes her so effective as an OCD therapist.  She herself suffered with debilitating OCD for many years and overcame it to live a full, productive life – and to help countless others do the same.  Open about her past, she is a role model to her both her patients and her colleagues. However, the joyous occasion of childbirth one year ago brought with it the surprising and unexpected return of her OCD. In this beautiful and personal article, Dr. Jenny C. Yip (PsyD, ABPP) describes her own experience with postpartum OCD and the work it took to triumph over it once again.

About Postpartum OCD

Pregnancy and childbirth can be times when Obsessive-Compulsive Disorder first occurs or reappears. OCD researcher and expert, Jonathan Abramowitz, Ph.D., ABPP, notes thatamong female OCD patients who have given birth, pregnancy and childbirth are the most commonly cited “triggers” of OCD onset.” In addition, “a greater than expected percentage of women with OCD attribute the onset or worsening of their symptoms to pregnancy or the postpartum.”

Women with postpartum OCD may have intrusive thoughts (obsessions) that the child may die or that harm might come to him/her, she may fear harming the baby in some way, or she may fear that she doesn’t love the child enough. Rituals a postpartum woman with OCD might have include checking on the baby to be sure it is still alive, avoiding contact with the baby to avoid harming it, taking extra steps in caring for the child to “prove” she loves it enough, or praying or doing superstitious behaviors to avoid harm befalling the infant. While there are both biological and psychological theories about the causes of postpartum OCD, there currently is not a definitive explanation for it.

While we may not completely understand what causes postpartum OCD, we do know that the same treatments used for OCD that is not related to childbirth can be very effective. Those treatments may include Cognitive Behavior Therapy (CBT) with Exposure and Response Prevention (ERP) and medication. In CBT, a therapist works with the patient to identify the specific thoughts, images, or urges the patient is experiencing, as well as the behaviors (compulsions) the patient engages in to decrease their anxiety and discomfort. Then, the therapist works with the patient to develop a plan to confront the distressing thoughts and to gradually eliminate the compulsive behaviors. In Dr. Yip’s article, she describes some of the steps she took to overcome her OCD.

If you, or someone you know, is struggling with postpartum OCD, there is help. A therapist trained in CBT and ERP may be a good place to begin. There are also excellent resources and information available through organizations, such as the International OCD Foundation and the Anxiety and Depression Association of America.

Anxiety and Depression Association of America: https://adaa.org/

International OCD Foundation: https://iocdf.org/

 

A Very Informative Interview About OCD

There are so many misconceptions about Obsessive-Compulsive Disorder. In particular, people frequently think it is about being neat, tidy, and organized. They often think it doesn’t affect children. Very importantly, people do not realize that OCD requires specialized treatment by someone trained to do a particular kind of Cognitive Behavior Therapy (CBT) know as Exposure with Response Prevention (ERP). In this interview by Alison Dotson, Nathalie Maragoni (who both has OCD and is training to be a therapist) beautifully describes what OCD can look like in a child, ways to educate the school, and resources for adults with OCD and for parents.

Click here to read.

Get Comfortable Being Uncomfortable: Achieving Your Goal

Image courtesy of duron123 at FreeDigitalPhotos.net
Image courtesy of duron123 at FreeDigitalPhotos.net

The music is pumping, the class is full, and the energy is palpable in the room. Fitness trainer and indoor cycling instructor Wendell Mitchell moves through the rows of students.

“Get comfortable being uncomfortable!” he calls over the music, and the students respond, each giving a little more than they thought they could a moment ago.

The anxiety therapist in me delights in what is happening here. He directs students to do what’s difficult – what’s outside their comfort zone – and they do it. Each knows on some level that the only way to get to where they want to be (weight loss, endurance, energized, etc.) means having to push themselves through some level of discomfort.  They know that it won’t be given; it has to be earned.  “No pain, no gain” is the familiar gym mantra.

“This is just like anxiety treatment,” I think to myself.

In anxiety treatment, the therapist instructs and encourages the patient to act outside of

Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net
Image courtesy of David Castillo Dominici at FreeDigitalPhotos.net

their comfort zone, to do something different than they might already be choosing to do. By taking these steps forward, anxiety is something that one can learn to manage and to thrive with. Yet many people fear what treatment for anxiety will be like. Just the mention of standing up to your fears is enough to keep many away from the treatment that could open the door to a much better life.

What Does He Know?

I’m intrigued by how Wendell is able to get so much out of his students, and I wonder what it is that he knows that benefits his fitness students, and applies so well to anxiety sufferers. I sit down with him to talk one sunny day. It’s clear from the start that, in the nearly twenty years he has been in the fitness industry, he has developed a passion for changing lives.  I wonder with him how he is able to inspire motivation in his students – and what nuggets I might take from this into my treatment of anxiety sufferers.

He is quick to point out that the motivation must come from each individual themselves, and not from any goal he might have for them.

“They need to find what their motivation is for being here,” he says, noting that he encourages students to think about why they are in class.

I quickly draw a parallel to anxiety treatment. A person seeking treatment must know their “Why?” Why are they in treatment? It is the job of therapist to instruct the patient in successful techniques and to nurture that inner motivation – that “Why?” – and keep it in sight throughout treatment. Without a “why,” there is no compelling reason to get better. In fitness, the motivation might be to live a healthier life.  With anxiety, the motivation might be to be able to do things a person has been wanting to do, but has felt too afraid to try.

“It’s Empowerment”

Wendell also explains to me that something happens when a person decides to push themselves, even just a little. There’s a recognition that they did something that they previously thought they could not – and that tends to trigger even more motivation.

“It’s empowerment,” he says. “Most people walk away feeling unstoppable.”

Again, I draw a parallel to anxiety treatment. When a patient does something that they previously thought they couldn’t, there is an incredible feeling of empowerment. And this empowerment tends to help propel a person forward. The  memory of that success can be a great motivator.

Baby Steps

With anxiety treatment, just as with fitness training, finding your “baby steps” is key. Rarely does a fitness student or anxiety patient start with the most difficult task.  If you’ve never taken a 45 minute indoor cycling class before, you probably wouldn’t expect to be a top performer in class on your first day. And if you’ve never stood up to a particular fear before, you most likely wouldn’t expect to stand up to the scariest thing right off the bat.

“You need to figure out where their baby steps are,” says Wendell, when discussing taking the trip up the fitness ladder. Then you can “celebrate the little small victories.”

When it comes to anxiety treatment, the same is true. A person chooses the steps that feel manageable to them as they work their way toward conquering a fear. Each step is a cause for celebration.

Be Willing

Most people begin a fitness routine knowing it will be tough work. As Wendell likes to say, “this is a workout, not a cookout, folks.” Any patient I ask about getting fit or getting good at something that involves fitness (from cycling to hiking) can tell me that it is more than just showing up and going through the motions. It takes hard work, and if one does the work, they will see improvement, and what seemed difficult at first gets easier. The same is true for anxiety treatment. It takes hard work facing your fears, learning new ways of coping, and pushing through challenging exposures. Yet the payoff is seeing what seemed insurmountable before become more manageable – maybe even easy. And just like in fitness, you get to do it at your own pace. Pushing yourself harder means more progress; going a little slower means more measured progress.

Image courtesy of stockimages at FreeDigitalPhotos.net
Image courtesy of stockimages at FreeDigitalPhotos.net

The key is “being willing,” says Wendell when he talks of progress in fitness. A person has to be willing to push themselves toward a goal. If they do, they may find themselves somewhere unexpected.

“I didn’t think I could do it, but here I am. I’m not gonna like it, but I’m gonna do it again.”

With anxiety as it is with fitness, if you push yourself, practice, and repeat – willingly – you may find yourself soaring to places you never imagined. Get comfortable being uncomfortable.