Understanding Intrusive Thoughts and Anxiety Before and After Childbirth
You may hear people around you refer to "intrusive thoughts." While they may assign different meanings to this, the medical definition of an intrusive thought is an unwanted, sudden thought, image or urge that pops into the mind. The thought may or may not be related to what is actively happening at that moment. The thought may be entirely random!
Intrusive thoughts during and after pregnancy are not rare and are usually a negative experience, with parents experiencing sudden thoughts involving threats to their child's safety. For some, the thought does not trigger an emotional response, but for others, the thought may be associated with negative emotions, especially fear. Most of the time, these thoughts are called "ego-dystonic," meaning parents do not recognize the thought as something they agree with, and they are upset by having had the thought in the first place.
What Do Intrusive Thoughts Mean?
The presence of intrusive thoughts or a sense of worry does not automatically mean that someone is experiencing a mental health disorder. New parents should have some degree of worry and anxiousness. Protecting and raising a newborn baby is a hard job, and parents need to be vigilant for potential dangers to their baby. However, intrusive thoughts may be an indicator that something more is brewing.
There are a number of recognized anxiety disorders that can begin or return during and after pregnancy. Those include:
- Generalized anxiety disorder
- Panic disorder
- Obsessive-compulsive disorder
- Post-traumatic stress disorder
Intrusive thoughts are more common in generalized anxiety disorder and obsessive-compulsive disorder but can be present across multiple mental health conditions. Contrary to popular belief, these disorders can affect all new parents, not just the parent who has given birth.
When Should We Worry About Something More?
Psychological symptoms become a medical disorder when someone's life is impacted by those symptoms. New parents with intrusive thoughts or extra worry may find that they:
- Simply cannot sit still or relax
- Cannot enjoy their baby
- Feel scared to be alone with their baby, while also being afraid to let anyone else care for their child
- Need to be constantly reassured that they are doing it "right" or may spend excessive amounts of time gathering information around parenting or infant health
- Focus only on all the bad things that could happen, with fears constantly stuck in their minds, rather than the good things that are happening
- Feel a strong sense of guilt secondary to intrusive thoughts and may even express a feeling that they need to be punished for having these thoughts
People close to new parents may observe that they withdraw or isolate, are more irritable or argumentative, seem unhappy or disinterested in their new baby or are never able to rest.
What Can Be Done to Help?
The first step is to assess safety. Warning signs that should prompt urgent evaluation include:
- Suicidal thoughts including feeling like the baby would be better off without the parent
- Severe lack of sleep or restlessness
- Signs of psychosis
When intrusive thoughts stem from anxiety or obsessive-compulsive disorder, these thoughts are unwelcome, cause distress and the parent is aware that the thought may not be appropriate. In cases of psychosis, parents may not be bothered by the thought and may actually welcome it. They usually do not express any insight into how the thought may be dangerous and they may make efforts to act out the thought. Psychosis has additional symptoms and is a medical emergency.
Parents can find help by speaking with their primary care or pregnancy provider, a psychiatrist or mental health clinician who can diagnose and recommend appropriate treatments. Safe and effective treatments for anxiety disorders around pregnancy include psychotherapy, medication and lifestyle adjustments.
As knowledge around anxiety and pregnancy has grown, so has the number of resources and support groups available. You can find resources at:
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