Postpartum OCD vs. Postpartum Psychosis: What Mothers Need to Know
If you’re a new mother, or you work with new mothers, you’ve probably heard of the Lindsey Clancy case. It feels like every time I pick up my phone, open my computer, sit down with a client, or run into a friend, someone is talking about the case.
Given my work with women in the perinatal period, and particularly with intrusive thoughts and OCD, this isn’t entirely unexpected. But beneath the curiosity, I’ve noticed something else coming up again and again: fear.
So many women are afraid this could be them. This is particularly true for women struggling with intrusive thoughts about harming their child. This case can feel like their worst nightmares coming true.
When Postpartum OCD Makes You Afraid of Your Own Mind
Women with postpartum OCD and intrusive thoughts about harming their baby often come to me in a state of emergency. They may fear that the thoughts they are having are dangerous. Sometimes it’s the first time a woman has ever had thoughts like this, so she is often afraid it means she is “going crazy” or could really hurt her baby.
She may feel exhausted, changed dramatically by motherhood, or traumatized by a difficult birth or complications during pregnancy or after birth. These changes, combined with terrifying intrusive thoughts, can make women feel like they are “losing control.”
Postpartum OCD can involve frightening, unwanted intrusive thoughts, images, or urges—sometimes involving harm coming to the baby. These thoughts can feel incredibly meaningful to the person experiencing them, particularly when OCD convinces her that having a thought says something about who she is or what she might do.
The more frightening the thought feels, the more urgently she may try to figure it out. She might check her feelings, ask for reassurance, avoid certain situations, repeatedly search the internet, or monitor herself for signs that she is becoming dangerous.
But Postpartum OCD and Postpartum Psychosis Are Different
Postpartum psychosis is a different clinical experience. It can involve hallucinations, delusions, severe confusion, disorganized behavior, paranoia, and significant changes in a person's perception of reality or functioning. It is a psychiatric emergency and requires immediate evaluation.
With OCD, the intrusive thoughts are typically unwanted and distressing. The person is often afraid of what the thought might mean and may begin monitoring, checking, avoiding, or seeking reassurance to make sure the feared thing won't happen.
Despite these differences, women with postpartum OCD are often afraid of becoming psychotic, losing control, or hurting their children. It can feel like a “good mom” should be able to guarantee that her children are safe—or, at the very least, guarantee that her children are safe from her.
When cases like this come up, that fear can become an obsession of its own. A woman who is already afraid of losing control may begin monitoring herself for any sign that she is becoming psychotic or dangerous. She may spend hours researching symptoms, analyzing her thoughts, or asking herself whether she can trust her own mind.
We Don't Get Perfect Certainty
The truth is, we cannot guarantee our children’s safety from everything. We can seek help, find support, and be honest about what we're experiencing. We can learn what to look for when something changes and know when more care is needed.
But safety is not certain.
When I’m working with a mom experiencing OCD, this reality can feel crushing. And when we see a brutal reality like this in the news, that uncertainty can feel even harder to tolerate.
OCD asks us to take the possibility of losing control very seriously. It can make a thought feel like a warning and a fear feel like a prediction. But a frightening thought is not the same thing as an intention, and fear of losing control is not the same thing as actually losing control.
Having intrusive harm thoughts in the context of OCD does not, by itself, mean that someone is at increased risk of acting on them. At the same time, significant changes in perception, thinking, behavior, or functioning can signal that something more serious is happening and warrant prompt psychiatric evaluation.
Part of my job is helping women understand what they’re experiencing, recognize when OCD is driving them to seek certainty, and figure out when additional care or support may be needed.
Safety is never guaranteed. But neither is this something you have to figure out or carry alone.
What We Can Do Better
We can do a better job educating mothers, partners, families, and healthcare providers about postpartum mental health.
Mothers should know that frightening intrusive thoughts do not automatically mean they are dangerous or losing touch with reality. They should also know that significant changes in perception, thinking, behavior, or functioning can be signs that something more serious is happening and deserve prompt psychiatric evaluation.
We don't need mothers to diagnose themselves. We need them to know that they can ask for help—and we need a system that is actually able to help them.
Getting Help
If your thoughts have started to scare you, or you find yourself spending hours researching this case—or other cases like it—you don't have to figure this out alone.
I'd love to connect. I know how terrifying this time can be. You don't need to spend hours trying to determine what your thoughts mean or whether you're safe. We can slow it down, make sense of what's happening, and figure out what you need from here.
If you're experiencing postpartum intrusive thoughts or are worried about postpartum OCD, Red Elm Psychotherapy offers specialized OCD and perinatal mental health therapy.
If you or someone you love is experiencing hallucinations, delusions, severe confusion, or a significant loss of contact with reality after childbirth, seek immediate psychiatric or emergency medical care.
For additional support and guidance around perinatal mental health, contact Postpartum Support International (PSI) at 1-800-944-4773 or visit Postpartum Support International.