Does having an intrusive thought mean I have OCD?

No. Intrusive thoughts are extremely common for new parents and usually fade. They point toward perinatal OCD when they become frequent, you start checking or avoiding because of them, or you need constant reassurance. Only a clinician can assess that, and it is very treatable.

Does having scary thoughts about my baby mean I am dangerous?

An intrusive thought is something that happens to you and horrifies you; an intention is something you want. The horror is the tell. An article cannot assess anyone’s safety, but these thoughts are the opposite of what you want, and telling a therapist about them gets you help, not trouble.

Should I try exposure exercises on my own?

No. Exposure and response prevention works well for perinatal OCD in trained hands, but it is never about forcing yourself near a hazard with your baby to prove something. Work with a clinician experienced in perinatal OCD.

How common are intrusive thoughts about harming your baby?

Very common. In a study of 100 new mothers, every mother reported unwanted thoughts of accidental harm to her baby, and close to half reported unwanted thoughts of harming the baby on purpose. Research on groups can't assess any one person, though.

What is the difference between intrusive thoughts and postpartum psychosis?

Intrusive thoughts clash with your values: you know you don't want them, and they horrify you. In postpartum psychosis, a mom's contact with reality changes; she may hear or see things that aren't there, hold beliefs that can't be true, or be severely confused, often without realizing anything is wrong. Psychosis is rare and a medical emergency: call 911 or go to the nearest emergency room.

Postpartum Intrusive Thoughts of Harm: What They Mean

Q: What therapy helps with postpartum intrusive thoughts?

When intrusive thoughts point to perinatal OCD, the main therapy is exposure and response prevention (ERP), a form of cognitive behavioral therapy, done with a trained clinician. For some people, medication is part of the plan too; that's a decision to make with a physician or psychiatric provider, and it can happen alongside therapy. Ask any therapist about their experience with perinatal OCD specifically, and don't try exposure exercises on your own.

The short answer: Unwanted, upsetting thoughts about your baby being harmed, even by you, are very common after birth. Having one isn't the same as wanting it. They become something to get treatment for when they take over your day or you start checking, avoiding, or seeking constant reassurance, which can point to perinatal OCD. If you think you might act on a thought, can't keep yourself or your baby safe, or are seeing or hearing things others don't, call 911 or go to the nearest emergency room.

You're carrying her down the stairs and the thought arrives out of nowhere: what if I dropped her. You grip the railing. Your stomach turns. And then the worse thought, right behind it: what kind of mother thinks that?

If this is you, I want you to know two things before you read another word. You are not the only one, not even close. And having a thought is not the same as wanting it.

I'm a psychologist who specializes in this, and I'm a mom who has had the stair thought, the bathwater thought, the knife-on-the-counter thought. Most moms have. Almost none of them say it out loud, because the thought feels like evidence. It isn't.

What these thoughts are

They're called intrusive thoughts: unwanted, often violent or disturbing images that pop in uninvited. New parents get them in huge numbers, usually about the baby being hurt, and often with the parent as the one doing it. The content is upsetting precisely because it's the opposite of what you want. Your brain, newly wired to protect a fragile person, is scanning for every possible danger, including you.

I spend a lot of my week explaining this distinction. An intrusive thought is something that happens to you and horrifies you. An intention is something you want. The horror you feel is the tell. People who are actually a danger to their children don't lie awake sick about a thought on the stairs.

An article can't assess your safety. What I can tell you is what the thoughts usually mean, and exactly how to get a real answer.

How common are intrusive thoughts after having a baby?

Much more common than anyone tells you. In a study of 100 new mothers, psychologists Nichole Fairbrother and Sheila Woody, working in Vancouver, found that unwanted, intrusive thoughts of accidental harm to the baby were universal: every mother in the study reported them. Close to half reported unwanted thoughts of intentionally harming their baby. The researchers concluded that these thoughts are a relatively normal experience in the early postpartum period, and found that thoughts of intentional harm were more likely when parenting stress was high and social support was low (Fairbrother & Woody, 2008).

That's research about groups of mothers, and it can't speak to any one person's situation. It doesn't replace an assessment. What it does tell you is that you're far from alone, and that these thoughts are something perinatal clinicians expect to hear about.

Intrusive thoughts vs. postpartum psychosis

This is the comparison that keeps a lot of moms up at night, so let's be precise about it. Clinicians sometimes describe intrusive thoughts as ego-dystonic: they clash with your values and sense of self, which is why they feel so alien and upsetting. That's very different from psychosis, where a person's contact with reality changes.

With intrusive thoughts, you know the thought isn't something you want. You're horrified by it, you may avoid things because of it, and you'd give anything to make it stop.
With postpartum psychosis, a mom may hear or see things that aren't there, hold beliefs that can't be true, or be severely confused, and often doesn't recognize that anything is wrong (NHS). Postpartum psychosis is rare, and it is a medical emergency.

Only a clinician can assess any individual situation. If you want the fuller picture, including the warning signs families should know, read postpartum psychosis warning signs.

When it tips into something that needs treatment

For many moms, intrusive thoughts are occasional, awful, and fade on their own. For some, they become the center of the day. That's when I start thinking about perinatal OCD:

The thoughts are frequent and you can't shake them
You've started checking: the baby's breathing, the locks, the stove, over and over
You're avoiding things because of the thoughts: the stairs, bath time, being alone with her, knives
You're asking your partner for reassurance constantly, and it only helps for a minute
You feel like you have to "neutralize" the thought somehow before you can move on

None of that makes you dangerous. It makes you someone with an anxiety disorder that responds well to treatment. The International OCD Foundation describes perinatal OCD in more detail if you want to read on.

Postpartum OCD and generalized postpartum anxiety can look alike from the outside, and they're treated a little differently. This explainer on postpartum OCD vs. anxiety walks through the differences, and if your fear is less about a thought and more about constant dread that something will happen to her, new mom hypervigilance may sound more familiar.

How to say it to someone

The hardest part is the first sentence. Try this, word for word if you want: "I'm having thoughts that scare me, and I'm afraid of what they mean. Can we talk through them?" If you can't say it, write it down and hand it over.

A good clinician will want to know: what the thought is, in your words; whether you want it to happen (you'll say no, and they'll believe you); what you've started checking or avoiding; how you're sleeping and functioning; and whether anything has felt unreal or confusing. You can also ask up front how confidentiality works and when a therapist is required to act. Knowing the rules makes it easier to be honest.

Moms worry about this, so I'll say it plainly. Having intrusive thoughts and telling your therapist about them does not get your baby taken away. What it gets you is help.

If you're the partner hearing this

If she tells you she's having thoughts like these, the way you respond matters. Stay calm, thank her for telling you, and know that being horrified by a thought like this is very common with intrusive thoughts. You don't have to fix it or figure out what it means. Your job is to help her get to someone who can: her OB or midwife, or a therapist who works with perinatal OCD. And if anything she describes fits the urgent signs below, call 911 or go to the nearest emergency room.

If either of you wants to talk to someone who knows perinatal mental health before booking anything, the Postpartum Support International HelpLine (call or text 1-800-944-4773) can point you to local help. It isn't a crisis line; for the urgent signs below, use 911, the ER, or 988.

What treatment looks like

The treatment for OCD is called exposure and response prevention, and in trained hands it works well for perinatal OCD. It is not something to attempt on your own from an article, and it is never a matter of forcing yourself near a hazard with your baby to "prove" something. A clinician who knows this work will help you tell the difference between a compulsion and ordinary infant safety, and build a plan that fits your house. Ask any therapist you talk to about their experience with perinatal OCD specifically.

Exposure and response prevention (ERP) is a form of cognitive behavioral therapy (CBT). The NHS describes therapy for OCD as usually a type of CBT with ERP, where you work with a therapist to break the problem into its parts (thoughts, physical feelings, and actions) and gradually learn to have the obsessive thoughts without neutralizing them with compulsions. For some people, medication is part of the plan too. That's a decision to make with a physician or psychiatric provider (I'm a psychologist and don't prescribe), and it can happen alongside therapy. Postpartum Support International lists evidence-based therapy and medication among the treatment options for perinatal OCD. Here's more on how postpartum OCD treatment works in Austin.

What therapy won't do is promise the thoughts will never show up again. What it aims for is that they lose their grip: less time spent on them, less checking and avoiding, and more room for the rest of your life.

When it's urgent

Intrusive thoughts are different from psychosis, but I want you to know the signs that mean call now, don't book a consult: you think you might act on a thought of harming yourself or your baby; you can't keep yourself or her safe; or you're seeing or hearing things others don't, or feel severely confused. In any of those, call 911 or go to the nearest emergency room. Call or text 988 for crisis support.

Talking to me

For everything short of that, a free 15-minute consultation is where to start. You don't need a polished explanation. "I'm having scary thoughts" is enough; I'll take it from there. You can also read more about how I work with postpartum anxiety and OCD.

You don't have to be "bad enough" to benefit from support. Many of the moms I work with aren't clinically depressed at all. They're dealing with the everyday stress of becoming a mom, and therapy helps with that just as much as it helps with depression or anxiety.