Is this postpartum OCD? Psychosis? If so, what do I do now?

Pregnancy, birth, and postpartum brings with it many feelings, hormone, changes, and role transitions. Some women develop symptoms of anxiety and depression to the point of where it causes significant distress. Findings suggest that 1 in 7 women, have diagnosable depression and/or anxiety during the postpartum period. 

Is this postpartum OCD?

A study from the Journal of Clinical Psychiatry found that pregnancy and childbirth can produce OCD symptoms or increase symptoms of OCD if previously diagnosed. 

Symptoms of OCD in the perinatal period include:

• Contamination obsessions and washing/cleaning rituals, common during pregnancy

• Intrusive obsessional thoughts or images of harming the baby

• Avoidance behaviors or checking rituals

Other OCD symptoms include:

• Worry of accidentally causing harm to the baby

• Fear of exposing baby to toxins or chemicals

• Obsessively checking baby while he/she sleeps

• Unwanted sexual thoughts 

• Excessive washing or sterilizing baby’s clothing or bottles

Onset of OCD in the postpartum period can happen as early as 2-3 days post birth and considered “rapid onset”. Typically OCD, does not get diagnosed and then goes untreated. This can lead to negative affects in the family, the woman, and the baby. 

The literature review also suggested that pregnancy and/or birth can exacerbate symptoms of OCD if the mother already suffers from obsessive/compulsive symptoms. 

Postpartum OCD can be treated through outpatient therapy. Typically, using CBT (cognitive behavioral therapy) is an effective treatment that specifically addresses decreasing intrusive thoughts and teach healthy coping skills. Some women are treated with psychiatric medications as well to manage their OCD. Discussions with your provider or therapist will help determine what level of care and treatment approach would be best for you. Postpartum OCD is treatable and the symptoms you may be experiencing are not your fault and you can get better. 

The constant fear, overthinking, and worry lead some women to believe they may actually harm their baby. These thoughts are anxious in nature and there is a very low chance of women acting on these thoughts since these are not considered to be delusions. 

To be clear, OCD symptoms can sometimes be confused with postpartum psychosis. 

What is postpartum psychosis?

Postpartum psychosis is an emergent situation that needs immediate medical attention. The onset of postpartum psychosis typically occurs within the first 2 weeks post birth with sudden onset. Essentially the mother is having a break from reality and her delusions and hallucinations appear real to her. 

Symptoms include: 

• Strange beliefs or delusions

• Hallucinations- seeing or hearing things that are not there

• Paranoia

• Decreased need for sleep

• Difficulty communicating

• Rapid mood swings

• Extreme irritation 

• hyperactivity

Risk factors include:

    Family history

    Previous psychotic episode

    History of bipolar disorder

Postpartum psychosis is very rare, 1 or 2 out of 1000 births. .1-.2% of women postpartum. Postpartum psychosis is treatable and temporary, but professional help and monitoring is needed for stabilization. 

If you or someone you know is suffering with postpartum psychosis call for immediate help by calling your doctor, 911, or going to your closest emergency room. 

If you believe you are struggling with postpartum OCD, you can call me at 970-795-2100 or email me at alison@hartmantherapyco.com to learn more or ask any questions you may have. 

It’s hard taking that first step, you can do this. 

with care,

Alison

If you or someone you know is struggling with postpartum OCD or postpartum anxiety and reside in Colorado or Texas I offer postpartum counseling. I am a prenatal and postpartum therapist who helps women and their families from pregnancy, birth, through postpartum. If you would like to learn more about me and my work with moms click here

I provide online therapy with the ability to meet you anywhere. No need to find childcare or the extra time needed to get to and from an office. 

If you live outside Colorado and Texas you can reach out to Postpartum Support International and they can connect you to a local therapist. They also offer a wide variety of support groups for moms and dads. You can click the link here to learn more: Postpartum Support International

Treat yo self

Not sure if you were a Parks and Recreation fan, but Donna and Tom have a day dedicated to treating themselves. It’s called treat yo self.

You can watch what it’s all about here

https://youtu.be/AU0h7TlZGO4

Yes this is an exaggerated version of treating yourself, but the idea is important. To take care of yourself, not just on 1 day out of the year, but daily. Today, I am going to talk with you about ideas for a self care plan, along with a simple way to stick to your plan. 

There are 5 aspects to self care: Mind, body, spirit, reflection, and connection. 

This is definitely not an exhaustive list. This is to give you an idea and you can tailor it to meet your needs.

Mind

Take 3 deep breaths- breath in count to 4, hold for 4, breath out for 4

Read a book

Color

Paint or draw

Drink cocoa of coffee

Cozy up with a warm blanket and watch a movie or your favorite show

Paint your nails or go get a mani pedi

De-clutter a room in your home

Watch the snow or rain fall

Listen to classical or rock music

Body

Go for a walk

Yoga

10 minute stretch

Cut back on sugar

Eat more fruits and veggies 

15-30 minute cardio workout

Go for a run

Run around outside with the kids

Dance your heart out

Deep pressure- using your hands to squeeze up and down your arms and legs

Get a massage

Have your hubby give you a massage

Spirit

Prayer time

Read your Bible

10 minute meditation

A 15-20 minute nap

10 minutes of lying down resting with your eyes closed

Tell yourself positive affirmations like “I am good enough” and “you can do this”

Laugh and laugh often 

Smile

Reflection

Journal

Write down 1 thing you are thankful for daily

Use a planner to stay organized

Reflect on your daily goals

Blog or vlog

Connection

Call or text a friend

Call or text a close family member

Go out to lunch or coffee with someone special

Volunteer 

Give or donate

Be intentional about treating others with kindness

Express gratitude 

Spend quality time with your kids

Go on a date with your spouse

Goal Setting

In sticking to your plan it’s will be key to remember your why behind having a self care plan and why it's important to you. This way if you do get off track you can be reminded by why you started it in the first place. Consider the pros and cons for not taking care of yourself. A couple examples of the benefits for a self care plan for me are my mind will feel more clear and refreshed and I will have more energy. The cons could be that when I don't take care of myself I know this leads to burnout, not connecting with friends and family, and irritability. 

If you want to stay consistent with your plan start with realistic goals for yourself. For instance if you don't workout regularly I wouldn't start with a goal of working out 4-5 days out of the week. The first week in, you may not meet this goal and you might be discouraged with the results. A realistic goal could be “okay this week I am going to work out 2 times for 15 minutes each”. Then over time you can build up and work towards your ultimate goal of working out 3-4 times a week.

Choose 1 or 2 self care ideas from each category that you would like to implement into your day or life more. Write them down and check in on your goals weekly. Pay attention to how you feel before and after you do a self care activity. This will help you recognize the benefits of taking care of yourself regularly and how much better you will feel. Most of these activities can be done in 10 minutes or less.

Small steps are important in this process and it's really about what works for you, your style, and your life. 

Get started today and treat yo self!

with care,

Alison

I offer postpartum counseling to those who have experienced birth trauma. I am a prenatal and postpartum therapist who helps women and their families from pregnancy, birth, through postpartum. If you would like to learn more about me and my work with moms click here

I provide online therapy with the ability to meet you anywhere. No need to find childcare or the extra time needed to get to and from an office. 

If you live outside Colorado and Texas you can reach out to Postpartum Support International and they can connect you to a local therapist. They also offer a wide variety of support groups for moms and dads. You can click the link here to learn more: Postpartum Support International

Best Practices for Treating Postpartum Depression

Becoming a parent comes with so many emotions and changes. I remember when I first found out I was pregnant, I felt so many different emotions I couldn’t even name all the ways I felt, from excitement, relief, to fear. I remember reading so many books and watching videos of births, but nothing really prepared me for the real life experience of the birth and the experiences that came after. 

Being a parent is a significant developmental life stage and there are so many changes and transitions to make. From our bodies changing and doing different things that we didn’t know our bodies were capable of, and all the expectations we have for how life will be with baby. 

We also experience loss even if we don’t realize it, the loss of our independence and the life we once had, having all the time to ourselves to do whatever we want, when we want, possibly loss of employment, maybe you worked a long time to build your career, but now you are going to be a stay at home mom. Then there’s the limited sleep, and trying to find quality time with your partner. Finding time for dates and conversations that don’t involve poop, pee, sleep, and eating are few and far between. 

These adjustments and the emotions that follow can be distressing to the point of needing additional intervention. But typically women will not reach out for professional help and will try other informal ways first, as in finding support from family and friends, researching on the internet, or reading articles or books. 

The barriers that keep women from reaching out for professional help include: 

1. Stigma -their own thoughts on mental health or not trusting their healthcare professional enough to share what is really distressing to them.

2.  May be unsure if their symptoms are normal or not

3.  May not be able to describe how they feel, and wanting to figure it out on their own first. “I can manage this on my own”. 

4. May not want to take psychiatric medications and afraid that if they seek out professional help they will be pressures to start medications. 

5. Perceived lack of time

6. Financial reasons

7. Childcare

8. Transportation

9. Or location of services may not be convenient. 

Often times though, perinatal distress goes untreated and undiscovered. When postpartum depression goes untreated, at least 40% of these women will continue to have symptoms throughout their child’s school years even. Perinatal distress can impede the mother-infant relationship, cause developmental issues with their child, or complications during the prenatal period. 

Best practice IPT

There are specific treatment approaches that have positive outcomes in treating postpartum depression. 

Interpersonal Process Therapy(IPT) has about 35 years of effectiveness treating adults with depression. Women who receive Interpersonal Process Therapy (IPT) to treat their depression have noticed improvement in their marriage, mother-child relationship and significant decrease in depressive symptoms. 

Goals of IPT

Increasing social support network, while addressing loss, role changes, relationship conflicts, and interpersonal problems. It is noted that IPT can improve a person’s ability to cope with challenging situations and increase resiliency. IPT is considered one of the best treatments in addressing postpartum depression. If symptoms are more intense, best practices are a combination of IPT and medication management. 

Importance of reaching out for help

If you think you are struggling with postpartum depression reach out to your primary care doctor or look into starting counseling. The benefits that you can feel better and have improvement in your marriage, personal relationships, support system, and the bonding relationship you can have with your baby are invaluable. 

Learn more about the symptoms of postpartum depression here PPD

Reach out by phone 970-795-2100 or email me alison@hartmantherapyco.com

To discuss if counseling would be a good option for you. 

We can even schedule a 15 minute consultation by video for you to test the process. I would send you a link and when it is our scheduled time to meet, you click on link and the consultation begins. Hope to see you there!

Reference: Bright K, Charrols E, Mughal M, Wajid A, McNeil D, Stuart S, Hayden K, & Kingston D. Interpersonal psychotherapy for perinatal women: a systematic review and meta-analysis protocol (2019), open access, published online, doi:10.1186/s13643-019-1158-6

Online Counseling and why you should try it…

When I moved to Colorado 10 years ago, my husband and I were still dating at the time and he was living in California. We were doing the long distance relationship thing and wanted to stay more connected than what phone calls could offer. So we decided we would use Skype as another way to stay close. We planned it so every Monday evening we would connect via Skype. The first couple  times it was a little awkward talking to him through a screen, but after that it was smooth sailing and became second nature. It was cool because I was able to see his facial expressions and it felt like I was right there with him. For me, it was what made the long distance relationship that much easier to endure. It really made a difference and felt like we didn’t skip a beat. 

I share this story with you because with online counseling you are able to build and maintain a relationship with your therapist, it is possible. 

We watch and follow people on YouTube pretty regularly. By watching their videos or live streams, it feels like we have been able to get to know them in a sense and they have built the “know, like, and trust” factor with us. People even have video meetings in the workplace all the time. In this digital age, we are able to build connections with people all across the world, so it’s no wonder people can access healthcare and therapy through this route as well.

Telehealth is increasing access to care

Think about it, with the ability to access care from anywhere you are as long as you have an internet connection. Doctors and other healthcare providers are using this service more and more. This allows the patient to share their symptoms with the doctor and get their needs met without having to leave your home, especially if you don’t feel well. 

With the option of online counseling here are some of the benefits

1. No need to drive to and from an office

2. No need to worry about childcare

3. If you have a newborn, you don’t have to pack up all the things you need to get out the door or worry about the time it takes to get yourself with the baby out of the house (we all know that it takes lots of time and preparation to get out of the house with a newborn)

4. If you don’t have a car available during the day you don’t have to worry about transportation issues.

5. If the weather is bad or there is a sick child at home, you can still have your therapy session. 

6. If you live in a rural area with limited access to services or the closest therapist is an hour + away you don’t have to be concerned with the all day planning and travel to make it to an office. 

The conveniences that online therapy offers are plentiful. I also like that research shows us, clients make just as much progress in therapy as they do with face to face in person sessions. This, along with the ability to build a good working relationship with your therapist through televideo is a huge reason why this is a great option. 

Ok, ok, what are the barriers, right?

There are a few instances when telehealth is not the best option for someone. A couple reasons are if a person is persistently mentally ill, i.e. suffering from schizophrenia or schizoaffective disorder, psychosis or if they have had multiple hospitalizations for risk to self or others. 

Screening with your therapist during the first consultation or intake session will allow the therapist to determine if online therapy is a good fit or if a referral should be made. 

As I shared above, the first couple times Skyping with my husband was a little awkward and different, but I think that is to be expected because it was new to us. Meeting a therapist or new professional in any setting can bring up a little nervousness in any situation and it’s completely normal and expected. 

If you would like to learn more about the process. You can visit my web page that goes over a few more facts on telehealth: Telehealth FAQ 

You can also call me at 970-795-2100 or email me alison@hartmantherapyco.com if you would like to talk further if this is a good option for you. 

We can even schedule a 15 minute consultation by video for you to test the process. I would send you a link and when it is our scheduled time to meet, you click on link and the consultation begins. Hope to see you there!

Alison is the owner of Hartman Therapy in Colorado. She offers online counseling helping tired, overwhelmed moms, sad teens, and frustrated parents. Alison has been working with adolescents, families, and adults for the past 7 years helping to build healthy, resilient families. She specializes in perinatal mental health and teen girl depression and anxiety.

Finding a therapist that's right for you

Finding the right therapist

Whenever I ask people if they have been in therapy before and they answer yes. My follow up question is what did you think about it and did you find it helpful? A lot of times I either hear that they didn't like their therapist’s style or that they stopped going after a few sessions. The therapist never reached back out to see why they had stopped going and what changes could be made in the therapeutic relationship to help the person reach their goals and stay engaged.

This is unfortunate, if their therapist had taken the time to work collaboratively and meet the person where they are at, they may have had better outcomes. This approach is considered feedback informed treatment. Research shows that when you have a good working relationship with your therapist and find them to be a good fit the client is more likely to make progress and reach their goals.

Getting feedback on how the clients sessions are going is important to the relationship and allows the client to feel safe and speak freely when the session isn't addressing their goals, they don't like the approach, or maybe they didn't feel listened to. Checking in with the client on a regular basis is important in building a safe space.

I am sure you have heard of them before. CBT, EMDR, Gottman certified, EFT trained, and so on. These are theories the therapist is working from and determines what type of interventions they use. While yes all are important, but should not be the the determining factor in choosing your therapist. The first consideration could be do they help people with struggles like mine; relationship problems, anxiety, eating disorders, trauma, self harm etc. if your therapist provides good, quality care, using best practices, treats your struggles, and you have a good relationship with them you will make progress.

building Rapport

This is when you are building a relationship with your therapist and it can take time. You have to be able to know, like, and trust your therapist. You can't just jump right in to interventions if your therapist doesn't know you and hasn't figured out what approach is going to be a good fit for you.

working phase

Once the relationship is built you move into the intervention phase or “working phase” of therapy. Where you try different approaches and techniques in sessions and then you practice those outside of the therapy room. Then when you return to session we look at whether it did or didn't work in the “real” world. If it did work we do more of that, if it didn't work we tweak it or explore why it didn't work, or try a different intervention. Back to why the feedback informed treatment is important! Giving your therapist feedback is essential and supports the collaborative approach.

This is because this allows you and the therapist to move in a different direction if needed, maybe you feel something is missing in the sessions, maybe you don't feel like you are moving towards your goals, or you don't like the approach. Again, having a good relationship with your therapist is key. Feeling safe with your therapist to give them this feedback will not only allow you to grow but also the therapeutic relationship. Once we find out what works, you are reaching your goals, and finding relief, and making progress.

Termination

Once you have reached your goals it's time to discuss termination. This can be done a few different ways. By decreasing the frequency of sessions from weekly, to every other month, to 1 time a month. This allows you to practice your learned skills and ease out of therapy. Also during this time, you are creating plans with your therapist on how to sustain the growth you have made, and what to look for if you need to re-enter therapy, begin to struggle again, or maybe come in for a “few” booster sessions to have some support and remind you of your skills and what worked before.

how i view the role of the therapist

The role of the therapist is dependent on the therapists theoretical background and training. I see my role as supportive and a guide. I am not here to tell you what to do or give you advice. That's what parents and everyone else in our lives already do. I am here to help you consider all of your options, see situations from a new perspective, and a new way of viewing problems to find solutions.

All in all

When you are thinking about starting therapy it's important to get along with your therapist and that you feel they are a good fit for you. If over time you aren't feeling connected with your therapist have a conversation with them about it and see if that helps and if not look for another therapist. Similar with any service provider if you don't like your dentist you are probably not going to go back and find one better suited to meet your needs.

Alison is the owner of Hartman Therapy in Colorado. She offers therapy to women and teen girls helping them find relief, hope, and purpose in their lives. Alison has been working with adolescents, families, and adults for the past 7 years helping to build healthy resilient families. She specializes in perinatal mental health and teen girl depression and anxiety. Reach out today to learn more.