This information can also be viewed as a PDF by clicking here.
The information provided is taken from various reference sources. It is provided as a guideline. No responsibility can be taken by the author or the Breastfeeding Network for the way in which the information is used. Clinical decisions remain the responsibility of medical and breastfeeding practitioners. The data presented here is intended to provide some immediate information but cannot replace input from professionals.
Sadly it is not uncommon for people to joke that they have OCD when they are being particular about some activity and feel a bit quirky. OCD is an anxiety related condition where there are recurrent unwelcome, intrusive thoughts and ideas. These thoughts lead to excessive behaviours often around cleanliness or recurrent checking, possibly a predetermined number of times. Those who have symptoms have insight and know that the thoughts and behaviours are irrational but are unable to stop them. In fact attempts to stop the thoughts and behaviours may lead to increased anxiety if attempted without professional support.
For most people OCD follows on from anxiety and is often associated with depression. It has a prevalence of 0.5% of the general population but is often more common in the post-natal period with the obsessive thoughts focussing on risk to the baby. It can interfere with family relationships, social life and personal care.
Cognitive Behavioural Treatment (CBT) is very effective and should be sought as soon as is possible. As far as medication is concerned first-line treatment is by the use of an SSRI antidepressant (sertraline, citalopram, paroxetine or fluoxetine). If at least one of these drugs has been tried but not helped clomipramine is an alternative.
Information is available from LACTMED in PDF format (the source of information recommended by NICE PH11 Guideline) (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACTMED).
Sources of support
OCD-UK : www.ocduk.org/
MIND : www.mind.org.uk
Anxiety UK: www.anxietyuk.org.uk
Mental Health UK : www.mentalhealth.org.uk
For further information on anxiety and breastfeeding bfn.local/anxiety
Below is the experience of a mother, shared with her permission, so that others may recognise symptoms and not be affected for as long as she was. We thank her very sincerely for this.
“I had pre and postnatal OCD with my first child. I think it was brought on by the overwhelming feeling of responsibility I felt to protect my little one. I don’t think I really knew how to deal with those feelings and therefore my reaction was fairly extreme.
I first became anxious when I was pregnant. Anything from what I ate to general substances in the environment that I was exposed to (and everything in between) would cause me anxiety. At the time I put this down to just normal pregnancy hormones but now I know it was the start of Obsessive Compulsive Disorder.
This got worse when baby was born. To keep the anxiety in check, I developed rules and rituals that I had to carry out, I won’t go into specifics but they generally centred around cleaning. If something that could go in the baby’s mouth had touched something that I deemed to be unclean I would probably end up throwing it away. I had to know everything that was near the baby had been washed or wiped, (normal maybe but I even got nervous about things which were clean). I washed my hands a minimum of 50 times a day, sometimes a lot more. I breastfed and this was my saviour as I didn’t trust myself to sterilise bottles properly but I even had to have showers throughout the day because I didn’t trust that I was clean enough to feed the baby.
If someone gave the baby something I thought was ‘unclean’ my anxiety would rocket.
Obviously when you have a baby you don’t always (or ever, really) have time to thoroughly clean every day and so finding the time to keep everything clean and carry out all these rituals was very tricky. When I couldn’t keep on top of cleaning, or carry out the rituals, my anxiety hit a new level. I started to feel that places in the house were almost contaminated and couldn’t touch them even to clean them as I didn’t want to get myself dirty and consequently get the baby dirty, so there were places in the house I was actually too anxious to clean, My anxiety was made worse by the fact that it was difficult to get out of the house. My hands were red raw and sometimes bled from all the washing. Other people being round or doing things for me was also a problem as I didn’t know what they had touched in the house that could have made them dirty. My house wasn’t dirty. It was messy, as I didn’t have the time or energy to tidy it, but it certainly wasn’t contaminated, or a danger to the baby. It was all in my mind. In my mind everything was covered in dirt or germs. My anxiety had escalated to a point where there were some days that I literally had no idea what to do or how to deal with it. It all seems completely irrational now I am writing it down, but at the time it was very real.
It affected my relationships. I stopped wanting to go to peoples’ houses, I didn’t want people round mine. My marriage suffered. My husband couldn’t understand my OCD (which I thoroughly understand as it seems completely illogical). People kept telling me I was irrational but that didn’t help at all. I felt very isolated, I knew I needed to talk to someone but I was embarrassed and felt like people would think I had gone mad. It felt like other people thought I could just switch it off, but I couldn’t.
I felt pressure to be a perfect mum, I was worried that I would pass my anxiety on to my baby, I was worried that people would think I was unhappy since becoming a mum, which couldn’t be further from the truth, I was so happy to be a mummy and I love my children more than anything. I compared myself to other mums who seemed to have it all ‘together’ and knew what they were doing and I just didn’t feel confident or trust myself enough to do a good job. I loved this little one so much I was so scared I would mess up.
When baby was 16 months I finally accepted I needed help. I went to the GP. I told him I thought I had OCD and he referred me to the mental health clinic. I cried all the way home, I felt like a failure. It started to feel real, like I really had a mental health issue. I was assessed and referred for face to face counselling sessions with iTalk. It took 6 months to get an appointment. It was hard to wait as by this time I really needed some strategies in place to manage the anxiety. I didn’t want to take drugs as I was worried about taking anything while I was breastfeeding and I thought this would make me more anxious, even though there probably is medication that is safe to take, no one could have convinced me of that at the time.
I had 20 counselling sessions in total, over 5 months, and during this time I fell pregnant with my second child. I was worried that all the anxiety would come back due to the pregnancy but the counselling had done the trick. I have been so much more relaxed with this baby. There is no fog. It feels easier. I am now pretty sure that I had Post Natal Depression with my first, as well as the anxiety. Now, although I still have anxious or down days, they are very few and far between, and I know how to deal with them and I know where to go if I need help. I don’t feel the need to wash my hands as much any more and I don’t get as anxious about cleaning. I am happier and generally more relaxed. I don’t know what my experience would have been if I hadn’t have had counselling.”
©Dr Wendy Jones MBE, MRPharmS and the Breastfeeding Network Sept 2019