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Help! My Brain is Betraying Me!: Intrusive Thoughts in Motherhood

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Woman holding newborn
 

Mandy nuzzled her 3 month old baby happily as she warmed his bottle. It felt so good to breathe in his sweet baby smell and touch his soft delicate skin, his little body curled in a warm embrace into the curve of her neck. Mandy was starting to feel like she had her “sea-legs’ as a new mom and was particularly enamored of the fact that her new baby was sleeping through the night. The rough night-time awakenings were beginning to subside as baby Noah matured and slept for longer periods. She was looking forward to meeting a new mom friend in the park with their babies after she gave Noah a bottle.

Suddenly, in the wink of an eye, the tender moment vanished. Mandy watched the water warm Noah’s bottle on the stove. She  was blind-sided by a  horrific thought, flashing through her mind of the  water morphing into hot lava and scalding her baby boy. Mandy flinched, gasping and clenching tightly onto Noah, quickly backing away from the oven. The thought terrified her, and she could not believe such an image threatened to envelop her mind. Mandy’s entire body tensed as she began to pant, shallow breaths. She didn’t know it at the time, but, she was well on her way to her first panic attack after experiencing an intrusive thought…a hallmark symptom of perinatal depression and/or perinatal OCD.

Experiences like Mandy’s are common in some 20% of all child-bearing women who develop perinatal mood/anxiety disorders (the clinical term for depression/anxiety during pregnancy and up through the first year after having a baby). Some women develop symptoms of anxiety with intrusive thoughts while others may not experience these often debilitating and traumatic images. Others may have more depression symptoms with a smattering of anxiety, panic attacks, and sometimes intrusive thoughts.

PMADs (perinatal mood/anxiety disorders) are the clinical term for a myriad of symptoms under the umbrella of depression and anxiety from conception through the first year following childbirth.  In layman’s terms, perinatal challenges/neurobiochemical imbalances while pregnant and after having a baby often leave women completely stunned, horrified, and traumatized…because  women don’t know what hit them. And no one talks about it.

The reality is that PMADs are very common, and most likely under-reported due to the stigma connected to them. Mothers can be wracked with so much guilt about any of the symptoms, particularly if she has intrusive thoughts, that they are loathe to talk to a specialist to get help or to a family member. Many women report they feel like they are “going crazy” or afraid to be “like that woman on TV who killed her kids.”

I want to underscore the importance of supporting a woman who is experiencing intrusive thoughts to not delay in seeking help, to get help immediately with a trained specialist in perinatal challenges. The differential amongst these particular perinatal struggles is quite delicate. Furthermore, to receive the best care, she must have help from a skilled perinatal psychotherapist who can provide a comprehensive bio-psycho-social assessment and steer her in the appropriate direction for what is ideally a multidisciplinary approach to treatment.

This article is not intended to be a primer on the difference between perinatal intrusive thoughts and hallucinations since such is the subject of a workshop or conference. And, each set of circumstances requires a different course of treatment (both medically and in psychotherapy). Generally speaking, however, when a woman experiences intrusive thoughts, she is grounded in reality and horrified of the images that are occurring, feeling that her body is betraying her. She will often respond with disgust at the images and in turn demonstrate behaviors that lessen her anxiety and protect her baby (for example, Mandy avoided ovens for a time because such objects were a trigger for her). Intrusive thoughts can be part of perinatal depression and will remit with psychotherapy and in many cases, medication management (typically an SSRI), along with a good self-care plan and social supports in place.  Hallucinations, on the other hand, are considered a medical emergency and potentially part of a more rare PMAD, perinatal bipolar disorder or psychosis. In such a case, the woman is not grounded in reality, and hallucinations can cause her to do or say things that she would not normally do and have the potential to be life-threatening to her or the baby. If you suspect that you or a loved one are experiencing hallucinations, call 911 or go to your nearest emergency room immediately. Do not attempt to diagnose.

Fortunately for Mandy, she realized something was amiss in her brain biochemistry and immediately sought help with a trained perinatal psychotherapist. Upon consulting with a psychiatrist specializing in reproductive mental health, she agreed to try an antidepressant (Zoloft) to help her biochemistry restore itself. Mandy’s recovery was swift because she sought help immediately, she received support, non-judgment, validation, psycho-education, as well as cognitive behavioral strategies in psychotherapy to help her diminish the anxiety and intrusive thoughts. She worked with her therapist on a solid self-care plan and put in place the help of a doula (hired caregiver specifically for new parents). Mandy feels empowered now as a new mom, free of intrusive thoughts and filled with pride at the arrival of Noah in her life. She is now on to a full recovery, enjoying her 7 month old son. (Please note: swiftness of recovery times vary with each individual’s unique circumstances).

If you or someone you love appears to have intrusive thoughts after having a baby (or even while pregnant), do not attempt to diagnose her. Do find a trained perinatal specialist to help the woman you care about to get treatment. The good news is that PMADs are treatable and temporary, and with help, women recover fully.

Other useful resources:

  • Postpartum Support International—www.postpartum.net – largest non-profit dedicated to PMAD awareness; vast clearinghouse of information on PMADs, down-loadable fact sheets, online support groups for moms and dads, chat with an expert, stellar bibliography of recommended books, latest research findings and trainings in the perinatal world; current legislation in support of PMAD awareness, destigmatization, and treatment; coordinator/volunteers link callers/e-mailers with trained professionals; warmline in English/Spanish
  • Postpartum Progress—www.postpartumprogress.com – most widely read blog on perinatal challenges, by Katherine Stone; the reader can subscribe to a daily news feed and a daily affirmation of hope.
  • Real Mom Experts - www.realmomexperts.com – website dedicated to supporting women with PMADs, written by perinatal psychotherapists; self-care techniques for moms

Great book on intrusive thoughts:
Dropping the Baby and Other Scary Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood by Karen Kleiman and Amy Wenzel (2010). –excellent book for new moms dealing with PMADs, also for perinatal professionals

© Copyright 2011 by Andrea Schneider, LCSW, therapist in San Dimas, CA. All Rights Reserved.

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Comments
  • paul August 26th, 2011 at 6:21 PM #1

    As a male I do not understand this at all. Anyone who could harm their own child or even dream of doing this needs serious help.

  • Sophia August 26th, 2011 at 7:05 PM #2

    Although I know a bit of what can happen during the post-natal period I never thought it would be anything as described here and also about the hallucinating. Sounds like a serious thing indeed.

    I’m interested in knowing about what actually happens inthe treatment. Any resource for that would be much appreciated :)

  • Suze August 27th, 2011 at 6:33 AM #3

    The key to not giving in to this kidn of thinking is to have a strong and supportive family and friend system around you to help through this tough time. Having a new baby is exciting but can also be quite stressful! It is no wonder with your hormones and sleep schedule all crazy out of whack that there are people who have these kinds of intrusive thoughts. Most of us know that we would never act on it, but it can be repulsive and scary to even think them.

  • Enchanting Flower August 28th, 2011 at 3:34 AM #4

    There’s just so much happening inside a woman’s body while she is pregnant n even after having the baby. These things although not 2 common are normal. Just try 2 remain calm n find some help from a professional there’s nothing to worry about. You’re gonna be fine.

  • Hans August 28th, 2011 at 5:28 AM #5

    We obviously have seen that this can be a problem for many women and that some of them cannot stop themselves when it comes to inflicting harm on their children. Sad really that a new mom would have to struggle with these feelings but we all know that for some that it is indeed the reality. The trick is knowing when this is normal and when it is going to the extreme and being able to step in and do something when the time is right, and before things go terribly wrong.

  • kim August 28th, 2011 at 7:23 PM #6

    imagine a woman gets these kind f intrusive thoughts and almost ‘sees’ things.she proceeds to get help and she is fine but a little shaken nevertheless.

    now imagine another scenario where she has been advised about something like this by a doctor beforehand.she gets an intrusive though,jumps back to reality and realizes what just happened.she remembers her doctor having spoken to her about this and has the coping tips available with her right at that moment.

    which of these scenarios sounds better? pretty sure all of you agree it is the latter one. any knowledge of such things beforehand goes a long way and is much better than getting help later on.we should try and get this to happen.

  • conseils sante August 29th, 2011 at 1:58 AM #7

    Having a new baby is exciting but can also be quite stressful! It is no wonder with your hormones and sleep schedule all crazy out of whack that there are people who have these kinds of intrusive thoughts.

  • DW.M August 29th, 2011 at 11:00 AM #8

    Passing this on to a friend who recently became a mother. People may not come out with things like this but having some information ready at their fingertips may help.So I request the other viewers to please pass this on too.

  • Cathy September 3rd, 2011 at 9:24 PM #9

    Excellent blog Andrea. Thank you.

  • Andrea Schneider, LCSW September 4th, 2011 at 12:56 AM #10

    Thanks for the feedback, everyone…yes, this is truly a difficult topic…it’s hard for an individual to imagine having this kind of psychological/physical pain–and it’s not the mother’s fault…intrusive thoughts are definitely a sign a mother needs support immediately by a trained professional who can then determine the comprehensive plan of action/treatment strategy with the client’s team of providers — I will be talking more about this in a webinar in Oct…feel free to attend and ask more questions then for those of you who are clinicians/helping professionals/individuals who are or know someone dealing with PMADs…Best, Andrea :)

  • A September 11th, 2011 at 1:34 PM #11

    First I would like to note that this is common but being a more “naturalist” person I don’t think we should be telling moms they need to Run out to Doctor and get on medication.
    I had no family with my first child and my husband was gone four weeks at a time for work and home for two.I had more then just a small thought of my son being burnt.
    I appreciate this article and the honesty of mother.On other hand I don’t appreciate getting young/soon to be mothers freaked out about this.

  • Diana C. September 18th, 2011 at 9:04 AM #12

    Just reading that gave me the jitters. I get thoughts like that from time to time but I think they’re reasonable. It’s hard not to have thoughts like this when you are holding your baby above a pot of boiling water! Yet, I don’t think that I have perinatal depression. Isn’t this simply acknowledging that you’re putting your child in danger and reacting to it?

    Maybe I am missing the point but why would this be considered a panic attack caused by perinatal depression? Don’t all mothers have thoughts like these. If not then I guess I need to be getting help from a therapist for this.

  • Andrea Schneider, LCSW September 20th, 2011 at 10:06 PM #13

    Replying to the last two comments: As relates to medication, med management is one facet of treatment that is proven scientifically beneficial for sufferers of postpartum OCD. It can be part of a comprehensive treatment plan, which also includes more holistic interventions. I am not implying an individual should just run to the doctor and pop a pill…I am sharing what works for those who wish to recover swiftly. Also, knowledge is power. If people don’t have the information about the number one complication of childbirth (perinatal mood/anxiety disorders), then they are handicapped from getting help or knowing what they are going through. It is preposterous not to share this information with the general public, and is, in fact, medical neglect, to not inform people of potential childbirth complications about how they can get help.To the last commenter, I can’t be sure specifically what you are experiencing…and I certainly would not be able to differentially diagnose someone over the web. However, there are many subcategories of perinatal challenges, many of which include OCD type thinking, intrusive thoughts, and panic attacks. There can be some overlap, but the picture looks different with each woman. Please don’t hesitate to contact me directly so I can help answer your questons. Best, Andrea

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