I was as prepared as you can be for the baby blues, and even for postpartum depression (PPD). Our birth class had covered warning signs of PPD and what to do if it hit. I had the information in a folder, ready in case we needed it, because I knew that perinatal mood and anxiety disorders (PMADs) could happen to anyone.
But none of that prepared me for intrusive thoughts (IT). Had I known what IT were, perhaps they wouldn’t have been so disturbing. But I didn’t know.
I was sitting on the couch, a peaceful, sleeping baby in my arms, delighting in her perfection. Her birth and the three days following had been idyllic, a far cry from the discomfort, fatigue, and baby blues I had expected.
That all changed when one brief, gruesome image flashed through my mind. Trembling and nauseous, I put the baby down and called my husband. When the IT continued, we called my midwives. In the days that followed, we received help, counsel, and support that lessened the thoughts, but I was still terrified about being left alone with the baby. I knew I didn’t want anything to do with what happened in those fleeting, violent images, but they were so freakish that I felt I couldn’t trust myself. If postpartum could make me have thoughts that weren’t my own, even psychosis seemed possible.
But IT are not psychotic. Instead, IT are best understood as the “obsessions” of OCD. Obsessions “are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety.”[1] They can exist with or without compulsive behavior. Intrusive “thoughts” can also be experienced as images, urges, bodily sensations and/or doubts.[2]
In the perinatal period, IT often center around harm coming to the baby and thus are deeply disturbing.[3] In the strangest, most sickening forms of IT, mothers see images in which they are the ones who have done the harm.
Everyone has sporadic IT, but most of us just brush them off because we know they’re not who we are and what we want. Two common examples of IT are the urge to shout something in the middle of a prayer at church and the thought of stomping on the accelerator at a stop light. We might find a thought like this weird, but know it isn’t real. It doesn’t bother us. We don’t sit around and wonder where it came from, what it says about us, or if it was sinful. Thus, “the difference between those with OCD and those without is the way the thoughts are interpreted, NOT the fact they happened in the first place.”[4]
Also called “scary thoughts” or “sticky thoughts,” IT become a problem when they are repeated, persistent, or can’t be shaken. One of the difficulties in understanding IT is that we don’t really have a category for thoughts that aren’t “ours.” If a mother hasn’t been aware of her IT in the past, it can be hard for her to comprehend how this phenomenon is even possible. It’s difficult to describe the experience with precision, but I can tell you that I am certain that the images I had postpartum were not “mine” any more than you want to hit the accelerator sitting at a stop light.
Intrusive Thoughts are Related to Fear, Not Intention
As Christians, understanding IT is even more complex, because we believe that everything we do is rooted in the desires of our hearts. We may be tempted to conclude that our IT about harm coming to our babies are something we want to do, deep down inside our sinful souls. Now not only do we have a horrifying image in our mind, but also think that the thing we are so repulsed by must be what we want. This is compounded postpartum when mothers are told to watch out for thoughts of harming yourself or the baby. We think IT about the baby may be just that. We think our IT imply intention.[5]
But this is not true.[6]
IT can be completely unrelated to our fears and desires. But if anything, IT are what we do not want. This is why they bother you so much. They are related to what we are most afraid of.[7] The tender, fragile infant in your arms is vulnerable, and you want more than anything to protect her.
(Side note: This is what differentiates IT from suicidal or infanticidal ideations, though a mom can have both. IT are also not psychotic, though again, a mom who has psychosis may also have intrusive thoughts. If you are unsure, get help right away. Some have suggested that as long as a mom is bothered by her unwanted thoughts, she doesn’t have psychosis, but this is not true. The key determiner of psychosis are psychotic symptoms such as hallucinations and delusions, which a mom may or may not be disturbed by.)
IT play on fears of what could threaten your baby, and the darkest, deepest terror of those thoughts is when you imagine yourself as the biggest threat.
But studies actually show that intrusive thoughts contain no increased risk of violence.[8]As the Postpartum Stress Center states, “Your brain is playing a trick on you.”[9] [9] IT are more likely to produce overprotective, compulsive behavior that requires a different sort of support. Our hearts are more sinful than we can imagine, but IT are not a straightforward example of this. IT connect to the desires of our hearts, not because we want to harm, but because we fear harm.
This completely changes how we address them.
Responding Wisely to Intrusive Thoughts
On the one hand, we do need to search our fears and entrust what we love to the Lord. Anxiety is a long, multi-faceted battle. It’s not the topic of this article, though, and places like CCEF have many good resources regarding anxiety.
On the other hand, IT are different than general anxiety. To deal with them well, you need know several things.
First, the more weight we give our IT, the stronger they grow, especially when countered with compulsive behavior (avoiding certain things, checking the baby’s breathing excessively, etc). This behavior feels impossible to escape in the midst of OCD, because OCD convinces you that you must do something about the IT to keep your baby safe. She has to sleep a certain way. You have to check her car seat again. You have to avoid knives, balconies, and stairwells. Compulsive behavior not only makes IT worse, it also builds habits that last beyond OCD. My postpartum OCD only lasted three weeks (by God’s grace, counseling, sleep, and nutrition were effective immediately). But I’ve recently realized that some of the things I can be anxious about now are related to intrusive thoughts I had 6 years ago.
Second, in time and with support, pushing back on these compulsions is a good and necessary thing. It’s helpful to ask your husband or others around you if your fears are rational. “I just had an intrusive thought about dropping the baby. Do I need to always wear the baby in a carrier when I go down stairs, or is that overreacting?” It’s still hard to accept what they say, because IT feel real and make the danger feel intense. Have people you love and trust come alongside you as you resist compulsions.
My husband reassured me that who I was in Christ and as a mother were not the person in my IT. He knew I was not a threat to our baby, largely because of how disturbed I was by the IT. This reassurance from him as well as my parents helped me push back the IT with truth.
Finally, it’s important to understand the physical component of OCD.
While OCD is more than just intrusive thoughts, they are related.
“Those who struggle with OCD appear to have a difference in brain function that makes it harder, but not impossible, to move on from bothersome thoughts. The current medical opinion is that it is due to a difference in brain circuitry. This appears to have been demonstrated with functional brain scanning, as the individual who is struggling with OCD has a distinctive picture in their scan. While it is unproven whether these differences are the cause or effect of obsessive-compulsive tendencies, brain scans of those who have experienced changed thinking and behaviors through counseling also indicate a change in brain functioning. The belief that the problems they face are affected by a physical problem that can be changed by counseling from the Scripture offers them hope.”[10]
As with all PMADs, medication can be a helpful component of healing. Christians have freedom to consider whether or not medication is wise for them.[11] The more frequent, intense, and debilitating your IT are, the more likely it is that medication would be helpful. Sometimes it’s necessary to address OCD with medication before anything else, in order to alleviate your suffering enough that you can effectively grow through counseling.
Knowing what IT are and where they come from doesn’t make them less disturbing, but it frees them of their weight. There is effective help for them. Although your sin is deep and dark, your IT do not happen because you are a violent person. Your IT reveal what you love and desire to protect, and these fears can be entrusted to the Good Shepherd who is watching over both you and your precious baby.
[1] https://www.mayoclinic.org/diseases-conditions/obsessive-compulsive-disorder/symptoms-causes/syc-20354432
[2] https://www.postpartum.net/perinatal-ocd-part-i/
[3] If you want more concrete examples, read the ones at this link. Scroll down to “What are Common Obsessions and Compulsions in Perinatal OCD?” These are still pretty general, but if you are currently experiencing IT or are not at a place yet after healing from OCD that you can handle reading about specific IT, do be careful. I am also happy to share some of my specific IT in private. https://www.madeofmillions.com/articles/what-you-didn-t-expect-when-expecting-intrusive-thoughts-in-new-and-soon-to-be-parents
[4] https://www.postpartum.net/perinatal-ocd-part-i/
[5] https://www.postpartum.net/perinatal-ocd-part-i/
[6] Intrusive thoughts are not the same as suicidal or infanticidal ideation. If you have intrusive thoughts, you should seek help, but it is not a medical emergency. If you have actual thoughts of harming yourself or your baby and are thinking about how to do so, it is a medical emergency and you need to seek help immediately by dialing 911. If you aren’t sure which you are having, you should get help now. The Postpartum Support helpline is a good place to start (1-800-944-4773).
[7] OCD is closely linked with anxiety disorders, so this makes sense. https://www.psychiatrictimes.com/view/it-ocd-or-anxiety-disorder-considerations-differential-diagnosis-and-treatment
[8] https://repository.ubn.ru.nl/handle/2066/181926
[9] https://postpartumstress.com/get-help-2/are-you-having-scary-thoughts/
[10] https://www.biblicalcounselingcoalition.org/2020/04/20/four-important-thoughts-about-ocd/#_ftn1 ; https://www.biblicalcounselingcoalition.org/2018/03/09/biblical-counseling-and-ocd/
[11] https://www.biblicalcounselingcoalition.org/2014/08/11/6-steps-to-wise-decision-making-about-psychotropic-medications/
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