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.

Parents as Part of the Treatment Team

Image courtesy David Castillo Dominici @freedigitalphotos.net
Image courtesy David Castillo Dominici @freedigitalphotos.net

I am preparing to head to the annual conference of the Anxiety and Depression Association of America (ADAA).  I look forward to conferences like this one because they provide inspiration for the work I do and the opportunity to interact with the latest information and the great minds that are working on treatments for anxiety and depression.  This year, I am fortunate to be able to present at the conference on a topic that is of great interest to me, since I work with a good number of children and teens:  Engaging Parents in Children’s Anxiety Treatment.  Because I think this is such an important subject, I’d like to share some of what I will share with the professionals at the conference here.

Through my practice, I’ve come to believe that parents are a very important ingredient when it comes to treating children who are struggling with anxiety disorders.  Why?  Well, first, it is generally parents who spend the greatest amount of time with their children and who are the “experts” on the child.  As a clinician, I know that I have a great resource to tap into in the form of the parent.  Who better to help me understand how this person spends their time, how they react to things,  what they are sensitive to, etc.?  Certainly I can often obtain a good deal of information from talking to the child or teen him or herself, but the outside perspective a parent provides is beyond valuable.

Next, working with anxiety requires a good deal of understanding on the part of the person with anxiety and their immediate support system.  A big part of overcoming anxiety disorders is education.  I spend a lot of time helping the people I work with to really understand how anxiety works and how to challenge it.  The better educated someone is, the better they are able to make good choices for dealing with their anxiety.  If a child or teen goes home to a parent who is well-educated in the ways of anxiety, that child stands a much better chance of finding success and support in defeating their anxiety.

Third, dealing with anxiety requires a lot of active work outside of session.  Learning to defeat an anxiety disorder means a child or teen has to go home and practice, practice, practice.  For that practice to be effective it has to be done regularly, with a good understanding of the purpose, and with a sound rationale.  If I send a young person home to do practice that makes sense to no one but him or her, then the task is much more difficult.  Without that support, a the chances the practice will happen decrease greatly, and treatment is going to progress much more slowly.  If a parent who understands the work to be done is there to provide support and direction, then the work is much more likely to be done, and treatment is much more likely to move along.

Finally, once treatment ends, if a parent has participated in treatment, the child or teen is not alone in his or her knowledge and understanding of anxiety and its ways.  Anxiety is a natural part of life and when it pops up a good plan is necessary to deal with any of the more difficult challenges it may present.  When a parent has participated in treatment with a child, that child has an ally in identifying anxiety when it tries to disguise itself in the future.  The parent might even recognize the signs and tricks of anxiety before the child or teen does.  Parent and child can form a team to use the tools learned in treatment and put anxiety back in its place.  They may even potentially prevent the need to return for treatment.

These are some of the reasons that I believe parents are an important part of the treatment team.  Because of this, I try to let both parent and child know how important a player each is in the treatment process.  In a future post, I will talk about some of the challenges parents face when they have a child who struggles with anxiety.

No, That’s Not a Normal Part of Child Development

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Sometimes, I wish my head could keep up with my conversations – that I had the right response at the right moment.   A little while ago someone who rarely asks me about my work asked how my practice was going.  I responded by mentioning how many young boys and girls with some very big fears had recently been brought by their parents for treatment.  Some, I noted, were having full blown panic attacks.

Now I was fairly certain my conversation partner would say something like, “Wow.  What do you do in situations like that?” or perhaps, “It’s good that they are getting help now.”  Instead, what I got was, “Parents can be so over-reactive.  They take a normal part of child development and turn it into a problem.  If they would just leave it alone, it would pass.”

This is where my spinning head could not keep up.  In part, my professional ego was a little bruised (“Don’t you think I can tell the difference between a child who’s going through a normal phase and one who is truly suffering?” ).  At the same time I was feeling a little defensive about the parents who had the courage and the sensitivity to bring their child for a consultation.  Frankly, I think it takes a lot of guts to admit that something is going on with your child and to reach out for help.

Yes, sometimes parents do overreact about something that is a childhood phase.  They love their kids.  They want to see them happy and healthy.  It’s part of what they do.  At the same time, too often children’s and teens’ emotional issues are overlooked or not attended to.  According to the Child Mind Institute[i], more than 15 million children in the U.S. have diagnosable mental health or learning disorders, yet less than half of them will actually get help.  In addition, the National Institute of Mental Health (NIMH)[ii] notes that the results of a large national survey indicate that approximately 8 percent of teens have an anxiety disorder.  Their symptoms appeared around age 6.  However, less than one-fifth of these teens ever received mental health care.

What’s sad and concerning about this is the loss of potential and the unnecessary suffering – for both parents and kids.  There are effective treatments available that can help get these kids back on track and the whole family functioning better.  But how does a parent know when something is normal childhood development and when it is time to seek help?

Anxiety is a normal part of life for us all.  For a child, there are certain worries and fears we can expect at different ages.  For example, very young children may be afraid of strangers, the dark, imaginary monsters, costumes, being separated from parents and getting hurt.  Older children may worry about school performance or making friends.  If we provide reassurance and are supportive as children learn to deal with these things, in most cases they will eventually resolve.  When a fear or worry persists, creates great distress for the child and interferes with the child’s functioning at home, school or with friends it has crossed over to becoming a problem.  This is when it is time to seek help.

But when you seek help aren’t you just pandering to the child’s fears and making them an unnecessary focus?  Well, the truth is that when adult anxiety sufferers are asked about the history of their symptoms, a high percentage of them actually have symptoms dating back to childhood.  Their symptoms did not go away .   So treating children for anxiety may not only help the child from spending needless time suffering, but may help prevent anxiety disorders in adults as well.

Getting back to my conversation, if my head had been working at the proper speed, I would have said something along these lines:

“At times, you are correct, we as parents do overreact, but we also frequently under-react. Actually what’s going on with these kids isn’t part of normal child development and these parents aren’t over-reactive at all.  I admire them.  They recognized that their children were suffering and that this was not going to go away on its own.  They were forward thinking enough to reach out and get help.  Hopefully we will be able to prevent a lot of suffering now and in the future.”

I can’t make time stand still and give a well-composed answer.  For now, at least I am on the record.  Children with anxiety disorders deserve their suffering to be recognized and they deserve the opportunity to get better.  Bravo to the parents who have the courage to reach out.

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[i] “Why Speak Up.”  Speak Up for Kids: Child Mind Institute.  Child Mind Institute. Web. 16 July, 2013.  <http://speakup.childmind.org/why_speak_up/&gt;.
[ii] “Anxiety Disorders in Children and Adolescents (Fact Sheet).”  National Institute of Mental Health.  National Institute of Mental Health.  Web. 16 July, 2013. http://www.nimh.nih.gov/health/publications/anxiety-disorders-in-children-and-adolescents/index.shtml.