Managing Intrusive Thoughts

What if I drop her? 

What if I just walked away from the bath for a minute? 

What if I go into the nursery and he isn’t breathing? 

What if my kitchen knife flies out of my hand and lands in her bassinet? 

These innermost, under-lock-and-key thoughts can make us feel like we’re going totally out of our minds. But there’s a name for all these ugly, scary ideas and images. And you’re not alone in having them.

Intrusive Thoughts

Intrusive thoughts are unwanted, often extremely stressful thoughts and images that arrive completely out of the blue. They often include ideas of illness, physical injury, or sexual harm.

Most people, as much as 80-99% of the general population, have an intrusive thought at some point in their lives. Thoughts like, “What if I drove my car off this bridge?” or fleeting images of hurting our loved ones aren’t totally out of the ordinary. They’re often dismissed as irrelevant and meaningless, albeit disturbing.

For parents and parents-to-be, intrusive thoughts often revolve around accidentally or even intentionally harming our babies. They most often begin in the first few weeks to six months postpartum, but they can happen any time after bringing our new additions into the world.

And when these uninvited thoughts pop into our heads, we’re horrified. We’re so horrified, in fact, that we keep them a secret. While we hope this secrecy will help us avoid the judgment of others, it makes us feel incredibly alone. But we’re not. 

Research projects that between 70% and 100% of new moms experience intrusive thoughts, with nearly half thinking of harming their infant on purpose. Those previously diagnosed with depression, anxiety, or obsessive-compulsive disorder (OCD), have an even greater chance of developing postpartum intrusive thoughts.

The Origins of Intrusive Thoughts

We’re hardwired to protect our kids, right? So why in the world do we have intrusive thoughts about hurting them—especially on purpose?

Karen Kleiman, psychotherapist and founder of The Postpartum Stress Center, explains that all the hormonal, psychological, and environmental changes surrounding postpartum cause our body’s stress response to kick into high gear. Since we’re naturally inclined to protect our offspring, this increased stress response causes us to imagine all the ways they could get hurt. Even if it’s by our own doing.

In that way, intrusive thoughts might be adaptive. For example, if you picture your stroller rolling into traffic, you’re going to grip the handle more tightly. The more we can anticipate danger to our kids, the more we can avoid it.

This avoidance, though, can also trigger larger mental health concerns.

Intrusive Thoughts and Perinatal Mood and Anxiety Disorders

Intrusive thoughts are both symptoms of and can cause other perinatal mood and anxiety disorders (PMADs). If you have depression or anxiety, particularly after you have a baby, you’re probably not a stranger to this symptom.

But as intrusive thoughts begin or continue to impact day-to-day functioning, the more troublesome depressive or anxiety-related symptoms can become. You may begin to experience more:

• Appetite and sleep changes.

• Physical discomfort, like headaches, joint pain, or shortness of breath.

• Excessive guilt or sadness.

• Thoughts of self-harm or suicide.

If you’re experiencing thoughts of suicide or self-harm, call 911 or go to your nearest emergency room.

Intrusive Thoughts and Perinatal Obsessive-Compulsive Disorder (OCD)

OCD is marked by recurring, unwanted thoughts, ideas, or sensations (obsessions) that drive someone to do something repetitively (compulsions). 

Approximately 2-3% of the general population will develop OCD at some point in their lives. This jumps significantly after having a baby, with about 17% of new moms experiencing the disorder.

Symptoms of perinatal OCD include:

• Intrusive thoughts (obsessions).

• Guilt, shame, and alarm about having these thoughts.

• Hypervigilance, or over-alertness to your surroundings.

• Desire for another person to be around you and your baby at all times.

• Repetitious acts (compulsions) to avoid harm or decrease triggers.

Here’s an example of how intrusive thoughts can snowball into OCD:

Let’s say you had an intrusive thought that a kitchen knife would somehow end up in your baby’s crib. Over time, no matter how hard you try, you keep obsessing over the image day and night. 

To help control your anxiety, you start counting your knives every time you walk into the kitchen to make sure none are missing. Checking and counting the knife drawer now takes up more than an hour of your day. 

Suddenly, a single intrusive thought has turned into the makings of perinatal obsessive- compulsive disorder.

6 Tips to Help Manage Intrusive Thoughts

Whether part of a larger diagnosis or just a common part of parenthood, intrusive thoughts are scary. These tips will help you manage them.

#1 Separate fact from fear.

Intrusive thoughts aren’t associated with an increased risk of harm to your baby. Just because you have the thought doesn’t mean you’re going to act on it. You might fear you’re going to do X, Y, or Z to your baby. But the fact is, it’s highly unlikely you will.

When experiencing intrusive thoughts, one parent reminds herself, “Thoughts are thoughts, not threats. Feelings are feelings, not facts. Sensations are sensations, not mandates to act” (Ojeda Melchor, 2020).

#2 Leave moral judgments at the door.

Immediately after having an intrusive thought, you probably follow it up with, “What kind of parent thinks about hurting their child? What’s wrong with me? I must be a bad parent!” 

Remember, 70-100% of new parents experience this. This either means we’re all bad parents, or these thoughts have nothing to do with our ability to care for and love our kiddos.

Intrusive thoughts are just thoughts. They’re not good or bad, and you’re not bad for thinking them. Judging and dwelling on these thoughts gives them even more power, so it’s best to leave moral judgments at the door. 

#3 Try mindfulness meditation.

Speaking of leaving judgment out of it, mindfulness meditation—which is rooted in noticing and acknowledging, but not judging, thoughts—has proven itself as a worthy opponent against intrusive thoughts. By staying present in the moment and not assigning importance or meaning to these scary thoughts, we can decrease our anxiety.

 #4 Distract yourself!

When we entertain our intrusive thoughts—continuing to obsess, engage in compulsions, or actively attempt to avoid triggers—we give these thoughts the power to invade our minds even more. Instead, try these distractions as you wait for the thoughts to pass:

• Puzzles, crosswords, or games

• Outdoor exercise

• Music

• Dancing

#5 Get good sleep.

Insomnia—and poor sleep in general—raises our risk for PMADs, including OCD. One study found that in women with mid-pregnancy insomnia, the postpartum risk of OCD-related symptoms jumped from 2.2% to 8.5%.

As parents, good sleep is hard to come by even without intrusive thoughts to keep us up at night. Use these practical tips to get the best sleep possible:

• Be consistent with bedtimes and wake-ups every day.

• Create a sleep-worthy environment, making it a quiet, dark, and a comfy temperature.

• Avoid screen time before bed, including TVs, computers, and phones.

• Avoid large meals, caffeine, and alcohol before bedtime.

• Add a short, outdoor walk every day to increase your physical activity. 

#6 Share your experience.

When we share with safe people who will hear our struggles without judgment—partners, friends, family, therapists—the emotional validation we receive breeds acceptance and decreases anxiety. Sharing, and the vulnerability it requires, also decreases our shame and embarrassment. Here are some ways to find support:

• Read books about intrusive thoughts in motherhood. Good Moms Have Scary Thoughts and Dropping the Baby and Other Scary Thoughts are particularly great resources!

• Talk with another mom, who will probably tell you, “OMG! I’ve thought the same thing!”

• Call your OBGYN for recommendations.

• Visit Postpartum Support International’s (PSI) online directory to find a perinatal mental health professional.

You’re a great mom.

Intrusive thoughts don’t rob you of that title, and they certainly shouldn’t steal your confidence. Not convinced? I created Keeping Mommy in Mind, my online course,  just for you! Here you can learn more about perinatal mood and anxiety disorders, cognitive behavioral therapy skills, and relaxation techniques to manage and improve your mood. Start today!

Sources

Centers for Disease Control and Prevention. (2016, July 15). Sleep Hygiene Tips. Centers for Disease Control and Prevention. https://www.cdc.gov/sleep/about_sleep/sleep_hygiene.html.  

Collardeau, F., Corbyn, B., Abramowitz, J., Janssen, P. A., Woody, S., & Fairbrother, N. (2019). Maternal unwanted and intrusive thoughts of infant-related harm, obsessive-compulsive disorder and depression in the perinatal period: study protocol. BMC Psychiatry, 19(1), 94. https://doi.org/10.1186/s12888-019-2067-x 

Fraga, J. (2019). Why New Moms Have Intrusive Thoughts. Parents. https://www.parents.com/parenting/moms/healthy-mom/why-new-moms-have-intrusive-thoughts/. 

Fraga, J., & Kleiman, K. (2020, July 5). Having Disturbing Thoughts as a New Parent? Here's How to Cope. The New York Times. https://www.nytimes.com/2020/07/02/parenting/intrusive-thoughts-scary-images-child-dying.html. 

Lawrence, P. J., Craske, M. G., Kempton, C., Stewart, A., & Stein, A. (2017). Intrusive thoughts and images of intentional harm to infants in the context of maternal postnatal depression, anxiety, and OCD. British Journal of General Practice, 67(661), 376–377. https://doi.org/10.3399/bjgp17x692105 

Nonacs, R. (2021, May 6). High Prevalence of OCD in Pregnant and Postpartum Women. MGH Center for Women's Mental Health. https://womensmentalhealth.org/posts/high-prevalence-of-ocd-in-pregnant-and-postpartum-women/. 

Nonacs, R. (2020, March 11). Poor Sleep During Pregnancy Associated with Perinatal Anxiety, OCD. MGH Center for Women's Mental Health. https://womensmentalhealth.org/posts/pregnancy-poor-sleep/. 

Ojeda Melchor, L. (2020, November 10). I'm a Mom With Violent, Intrusive Thoughts, The Lesser-Known Symptom of OCD. Parents. https://www.parents.com/health/mental/harm-ocd-journey/.