What are intrusive thoughts?
During pregnancy and in the postpartum period mothers and sometimes fathers may experience intrusive thoughts. What do these thoughts sound like?
“What if I lose control and throw my baby out the window?”
“What if I felt aroused when changing my baby’s diaper/breastfeeding?”
“What if my baby is suffocating to death in my sheets ?”
“What if my baby falls in the washing machine?”
“Sometimes I picture myself dropping the baby down the stairs.”
These are just a few examples of what intrusive thoughts can sound like. The perinatal period (the time during pregnancy and postpartum) is often associated with feelings of joy and excitement. Realities that can co-occur or even overwhelm those anticipated emotions are often associated with great stressors and not so smooth transitions. Some of these stressors include but are not limited to:
- Lack of sleep
- Change in appetite
- Change in common routines.
- Hormonal changes.
- Less time to pursue passions and self-care.
- Changes in sexual health
- Responsibility shifts
Having a baby whether our first or fifth requires us to experience a period of change where we learn how to integrate our new family members into our lives. The perinatal period is also hallmarked by hormonal shifts that can lead to imbalances (these hormones include progesterone, serotonin, and oxytocin).
The biological, environmental, and psychological shifts that occur during the perinatal period create circumstances that make mothers more vulnerable to mental health challenges. Intrusive thoughts are symptoms of anxiety disorders that can arise during this period. These thoughts are described as scary thoughts or mental pictures of harm coming to our baby, other children, spouses, or even ourselves.
The surprising common occurrence of intrusive thoughts during the perinatal period.
Evidence suggests that Intrusive thoughts are very common for new and expecting parents. Some research suggests that up to 91% of mothers experience unwanted and disturbing thoughts related to their loved ones, especially their children. New fathers also experience intrusive thoughts. . Dr. Jonathan Abramovitz et al. found that over two-thirds of new fathers surveyed also experienced intrusive thoughts during the perinatal period.
Intrusive thoughts and perinatal OCD:
The occurrence of intrusive thoughts does not automatically equate to Perinatal OCD. In fact, for many, these thoughts can be unpleasant but are ultimately deemed just that, unpleasant thoughts that pass. Intrusive thoughts that are accompanied by a surge of anxiety or panic may be indicative of something more complex such as perinatal OCD. For those who experience accompanying panic and anxiety with intrusive thoughts, the thoughts are interpreted by the thinker as dangerous. This may cause us to treat the thoughts as a warning sign that we may act upon or carry out these thoughts.
An example of an intrusive thought linked to perinatal OCD may sound like this: A mother has thought of throwing her baby down the stairs and then immediately thinks, “I can’t believe I had that thought. I am a monster. Good mothers do not think this way about their children. I must protect them from myself, I don’t trust that I won’t act on this thought.” The ensuing behavior often involves the mother (or parent) attempting to avoid, push away, and suppress these thoughts.
Examples of this behavior can be:
avoiding spending time alone with children for fear that you will hurt them,
hiding objects that could be used as a tool to carry out harmful acts,
making lists as evidence to convince you that you love your child.
These behaviors actually exacerbate the intensity and occurrence of intrusive thoughts in addition to causing significant distress and impairing our ability to function in our relationships and daily lives.
Why am I experiencing this?
We have a number of theories as to why we may experience intrusive thoughts. Among these Dr. Nichole Fairbrother and Dr. Jonathan Abramowitz have identified various explanations for perinatal OCD. In their research, they find that the majority of people experience some kind of unwanted or intrusive thoughts throughout the lifespan. The difference between these intrusive thoughts happening to parents is linked to the increased sense of responsibility for protecting and keeping their children safe. This is especially true for parents who have a newborn as the new infant is especially dependent upon the parents for safety. Mothers have an inherent instinct to protect their children and fathers have a similar biological response. From an evolutionary lens, our cave-dwelling ancestors were constantly hyper-vigilant about keeping their young safe from life-threatening danger. This inherent protective mechanism may cause parents to be more hyper-aware of potential threats to their child(ren)’s wellbeing.
What can make the intrusive thoughts and feelings worse?
Hyper-awareness can cause parents to adopt behaviors like: avoidance, reassurance-seeking and checking compulsions. These behaviors send a message to the brain that the intrusive thought is not meaningless but relevant and helpful in promoting safety (which is a false interpretation). The behavior actually increases the intensity and recurrence of the intrusive thought.
For example, if a mother experiences the thought “what if I lose control and throw my baby down the stairs?” and then she responds by avoiding going near the stairs, making someone else hold the baby by the stairs, or exercising less than normal caution when going up and down the stairs, this sends the message to her brain that her thought was actually a legitimate threat and reinforces the idea that avoiding the stairs is actually protecting the baby. Therefore, the brain may become extra sensitive and identify other of other possible ways harm could come to the baby. This may cause the brain to send more “suggestions” for how to avoid such harm. The new threat will evoke a new set of compulsive behaviors which will create a new cycle of intrusive thoughts, panic, and neutralizing behaviors.
Does having intrusive thoughts mean I am more likely to act on the thoughts?
The most distressing part about intrusive thoughts is that they are distressing to the person having them. Many mothers who meet the criteria for perinatal OCD feel shame, scared, and confused about the thoughts they are having. Many mothers question their ability to trust themselves as the thoughts make them feel as if they may lose control at any moment. Some mothers even go as far as to believe that the mere occurrence of having intrusive thoughts makes them an unfit parent. The heightened distress surrounding intrusive thoughts often arises because the nature of the thoughts are completely outside of the value system of the mother having them as their children’s safety is often the most important thing to them.
In fact, mothers who have this distress associated with intrusive thoughts often resort to dire lengths to avoid any danger that may come to their children even if it means separating themselves from their children. In addition, they may feel a sense of desperation to get rid of, condemn, and even shame themselves as a form of reassurance that they will not actually act upon them. Which only serves to heighten and promote the recurrence of the thoughts themselves.
Oddly research suggests that the occurrence and persistence of intrusive thoughts is a maladaptive way of keeping mothers from acting on them (read this sentence slowly again). The French actually have a term that encompasses this phenomenon. L’appel du vide or the “The call of the void,” describes the impulse we have to hurl ourselves into danger sometimes (think jerking the steering wheel to turn into oncoming traffic, jumping off a high story building, harming yourself when holding a sharp object, etc..). When you are on the edge looking down from a high place or in another situation with potential danger your brain sends a warning sign, “back up! Don’t touch that! Stay glued to your lane!” The signal happens so quickly that your instincts kick in and you do what the signal requests without realizing it. Then when you have a moment to process you may misinterpret the safety message as an “out of nowhere,” desire to hurt yourself. In short, these thoughts are the brain’s way of alerting us to dangerous situations to get us to protect ourselves against potential threats. To re-emphasize our point, these thoughts are very common during the perinatal period and their presence alone is not an indication that your child(ren) is in any danger.
How can I cope with intrusive thoughts in a healthy way?
- Seek help from a professional that can help you identify your specific patterns of thinking and behaviors. For some mothers, intrusive thoughts can feel like a tidal wave that constantly returns and takes our breath away throughout the day. This can interfere with our ability to take care of ourselves and our children in healthy ways. Therapy and medication are evidence-based measures that can help mothers successfully feel well again and cope in addition to feeling less alone.
- Notice the thought or feeling, name it to tame it, and then let it pass without judgment. Remember avoiding the thought and trying to make it go away will only exacerbate the intensity and frequency. Try using statements like, “there’s that thought again. I know this worry, I’ve had it before. I wonder if this thought is a sign that I might need to attend to one of my needs. Am I hungry, how am I sleeping? Do I need some time alone to decompress? Do I need the company of a good friend?” Getting curious about our thoughts and feelings rather than fearing them or judging them steals their power and intensity.
- Talk about the thought with someone you trust. It can be really difficult to bring up thoughts and mental images that are particularly disturbing in nature to what other people may think of us. This is the function of shame. Being vulnerable with someone we trust about our thoughts and feelings allows us to feel validation and empathy, both of which dispel the shame and lead to feelings of safety and support.
- Depersonalize the thoughts and feelings.Remember that thoughts are just thoughts and feelings are just data. Neither are facts and neither makes our behavior more prominent. Try using this visual: Picture yourself on a moving walkway going through an airport and watching your thought come into view as you stand on the walkway and then letting it slip out of view as you continue down the terminal.
- Notice and validate the thought and then distract by doing something else that brings you joy in the moment. Some examples may be watching a funny television show, listening to a song that makes you feel comfort and peace, putting on your favorite lotion, or lighting your favorite scented candle.
