Dr. Marlene Freeman, Associate Director of the Center for Women’s Mental Health at Massachusetts General Hospital and Editor-in-Chief of The Journal of Clinical Psychiatry (JCP), recently shared an expert commentary on postpartum OCD and intrusive thoughts, highlighting several important studies published in JCP.
What Are Postpartum Obsessions and Intrusive Thoughts?
Dr. Freeman explained that obsessions are “intrusive, distressing thoughts that one can’t stop having.” Some individuals may develop compulsions or rituals in an attempt to neutralize them. She emphasized that intrusive thoughts are quite common, especially in the perinatal period, but can cause significant distress. She also noted that postpartum depression’s “clinical picture” often includes these types of obsessions.
Key Research Findings
In a recent prospective study, Fairbrother et al. (2024) examined the timing of perinatal OCD and found that more than two-thirds of participants who met criteria for perinatal OCD had no history of OCD prior to pregnancy, indicating that people without any previous OCD history can still develop symptoms during pregnancy or after delivery. Additionally, 83% of those individuals developed OCD in the postpartum period, highlighting that postpartum carries a higher risk of new-onset or worsening OCD symptoms compared to pregnancy. Dr. Freeman emphasized the importance of screening and early identification during this particularly vulnerable time.
In another study, Fairbrother et al. (2022) examined intrusive thoughts related to infant harm, which are both common and highly distressing to new parents. Importantly, the researchers investigated whether these thoughts were associated with actual infant harm or abuse.
The findings were reassuring: unwanted intrusive thoughts of intentional infant harm were not associated with an increased risk of harming the baby. In fact, rates of harm among participants who experienced these thoughts were lower than those observed in the general population.
Dr. Freeman also discussed a prospective cohort study (Beck et al. 2026) examining unwanted intrusive thoughts of intentional infant-related sexual harm at 7 weeks and 4 months postpartum. About 9% of participants reported these thoughts, again demonstrating that they are not uncommon. Importantly, the study found no association between these intrusive thoughts and actual harm.
Major Clinical Takeaways
- Intrusive thoughts and obsessions are common, including those involving infant harm.
- These thoughts can be deeply distressing, but they are not associated with harmful behavior.
- Open discussion can help to promote understanding of unwanted intrusive thoughts as a common experience during the perinatal period, while also recognizing that these thoughts can sometimes signal underlying depression or anxiety.
- Asking directly about intrusive thoughts allows for the identification of individuals who may be suffering in silence. Because these symptoms are highly treatable, early detection is essential.
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—Skye Scoggins, BS
