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Why Screen for Postpartum OCD?

Posted on March 02, 2026
Mother with postpartum OCD

Postpartum Obsessive Compulsive Disorder (OCD): Why Providers Should Screen

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Postpartum obsessive-compulsive disorder (ppOCD) is underrecognized but highly treatable. It commonly presents with unwanted intrusive thoughts or images of accidental or intentional harm coming to the infant. It's accompanied by intense distress and often compulsive behaviors such as checking, avoidance, reassurance seeking, or mental rituals that temporarily reduce distress. Unlike postpartum psychosis, individuals with ppOCD retain insight, are horrified by the thoughts, and take steps to prevent harm (low risk). Many parents fear disclosing symptoms due to shame or fear of being perceived as a danger to their child. When a provider misinterprets these symptoms as dangerous, it can worsen shame and delay care.¹,²

Prevalence estimates suggest that new-onset or exacerbation of OCD symptoms occur in 2–9% of postpartum patients, with even higher rates of intrusive thoughts without full OCD.¹ Sleep deprivation, hormonal shifts, and heightened responsibility for infant safety are contributing factors.

Possible parental behaviors
  • Checking if the baby is breathing over and over
  • Avoiding being alone with the baby
  • Hiding or avoiding knives, cords, bath or other “dangerous” objects
  • Excessive washing/bathing or sanitizing bottles repeatedly.
  • Repeatedly seeking reassurance via researching or asking partner or doctor: Ie, “You don’t think I’d hurt the baby, right?”

Screening Pearls for Primary Care Providers

  • Ask directly and nonjudgmentally about intrusive thoughts
  • Assess insight (“Do these thoughts feel unwanted and cause distress?”)
  • Ask about behaviors, especially avoidance or checking (e.g., not bathing baby, avoiding being alone with infant)
  • Differentiate from psychosis (delusions, hallucinations and lack of insight are concerns that require emergency psychiatry evaluation)
First-line treatment
  • Cognitive Behavioral Therapy with Exposure and Response Prevention (ERP)
  • SSRIs (e.g., sertraline, fluoxetine) are effective and generally compatible with breastfeeding; dosing may require the higher end of the OCD range.³,⁴
  • Combined therapy and medication is often most effective for moderate–severe cases.
Illinois DocAssist Perinatal Psychiatric Consultants are available to walk you through each step in evaluating, treating, and referring for OCD or other perinatal mental health concerns. Get started by registering and requesting a consultation or referral assistance with a specialist.
Early identification reduces maternal suffering, improves bonding, and prevents functional impairment. Normalizing the experience (“Many new parents have scary thoughts of harm coming to their child…”) can be a powerful first step toward engagement in care.

Author: Dr. Ashley Mulvihill- Illinois DocAssist Psychiatric Consultant

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Do you have a consultation question?

Consultation Corner: A pregnant woman with concerns for bipolar disorder

A Nurse Practitioner working in a Community Health Center called the Illinois DocAssist consultation line and spoke with a Psychiatric Consultant about the following case.*

Consultation question 

A 31-year-old female with unspecified mood disorder but concern for bipolar disorder just learned she is 8 weeks pregnant. She is taking escitalopram 10 mg and was started on Lamictal at her last visit for mood swings. The patient experienced improvement in her symptoms and is now up to 100 mg of

Lamictal daily. How should the NP approach the rest of her pregnancy?

Consultation response 

The consultant discussed that if there is concern for bipolar disorder, it’s recommended to continue escitalopram 10mg and Lamictal, but at split dosing (to avoid peaks in plasma levels). The perinatal period is a very high-risk time for women with bipolar disorder, so they need to consider the risks of medications vs risk of maternal mental illness to the mother-fetal dyad.
Most pregnant women need a 200% increase in Lamictal dosing during pregnancy to maintain plasma levels (due to estrogen increasing clearance). Ideally, the patient would be seen monthly in clinic and consider increasing Lamictal higher if the plasma level dropped by 25% or mood symptoms worsen. If a large dose increase is needed during pregnancy, consider a 2-week postpartum taper to avoid toxicity.

*All identifying information has been changed or removed

Modified on March 12, 2026