Intrusive thoughts in the perinatal period

Intrusive thoughts

• Are negative, unwanted and distressing thoughts, ideas, images, or impulses, experienced as frightening, shameful, and unacceptable
• Are not consistent with one’s views and beliefs of oneself
• Are not a prediction of harmful behaviours toward the infant
• Occur in 91% of new mothers and 88% of new fathers  
• Range from mild to unbearable; intermittent to constant; fleeting and manageable, to life interfering
• Usually settle with time, reassurance, and extra sleep
• Tend to peak in the initial postpartum weeks, especially for first-time mothers  
• Tend to decline by the third month

Types of negative thoughts, ideas, images or impulses

There are a range of themes that new or expectant parents commonly struggle with, including:

• Ideas of suffocation to the baby
• Accidents, such as dropping the baby or crashing the car
• Contamination fears such as poisoning baby
• Intentional harm such as stabbing the baby
• Sexual themes; fears around arousal when feeding or fears of molestation of the infant

Types of behaviours

There are certain behaviours that might occur in response to intrusive thoughts, including:

• Excessive checking, for example constantly checking on the healthy, sleeping infant
• Over-attachment to the infant by constantly being there or not sharing caregiving
• Excessive cleaning and washing
• Avoidance of the infant if the parent does not trust themselves
• Seeking repeated reassurance regarding the infant’s well-being and their own parenting capacity

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Am I losing my mind?

When anxiety levels become elevated and cause uncomfortable symptoms like scary thoughts, they are NOT usually an indicator of psychosis. These thoughts can make expectant and new parents feel like they are going crazy, but they are not. It is important to remember that the distress comes from thoughts that are outside the person's values and beliefs.

Postpartum psychosis is a more serious mental health condition than intrusive thoughts. Those with Postpartum Psychosis (PPP) may experience hallucinations and delusions and are unable to differentiate between those thoughts and reality. PPP is a diagnosable condition which can respond well to appropriate treatment. Read more about PPP.

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Why do people have intrusive thoughts?

Health professionals who understand perinatal related intrusive thoughts know they are just thoughts, and that they are usually a sign of overwhelm and increased anxiety.

Although unwanted thoughts can occur at any time throughout someone’s life, those in the perinatal period are especially vulnerable because they have the added worries of keeping an infant alive.

Risk factors for intrusive thoughts include:

• Personality characteristics such as being overly analytical, perfectionistic, controlling, and mothers who are more empathic
• Stress, particularly those who are more reactive to stress
• Having low perceived social support
• A history of anxiety (including worrying) and depression
• Rapid hormonal changes, including oxytocin and serotonin
• Maternal sleep deprivation and fatigue

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Treatment for intrusive thoughts

There is significant evidence-based treatment, including medication, psycho- education, and therapeutic techniques to manage intrusive thoughts and behaviours. If intrusive thoughts persist for more than two weeks or become a concern for the parent or those around them, a GP can help or refer to a perinatal mental health specialist.