New Perinatal OCD Infographic launched!
Working with the Perinatal Research Anxiety Lab including Director Dr. Nichole Fairbrother and Cora Keeney and their team, along with Dr Jon Abramowitz and Dr Fiona Challacombe – Maternal OCD has co-produced the following infographic to help support women and their families to further understand perinatal OCD.
Click here to view the Perinatal OCD infographic
To view infographic on slides please click here
Maternal OCD hints and tips during the Covid-19 pandemic
There has been much discussion and guidance for how to cope with Covid-19 when you also have a diagnosis / suffering with Obsessive Compulsive Disorder (OCD). This is a difficult time for us all, so please see below a summary of the general guidance and some thoughts (both from a clinical and expert by experience perspective) for pregnant women and mums with perinatal OCD when it can be very challenging.
Current guidance for the general population with OCD
The current suggestions on how to deal with OCD during this time are below and do also apply during the perinatal period:
- Don’t do anything above and beyond what the Government advises re keeping safe and don’t listen to the OCD bully who creates new rules in your brain
- Observe what you’re doing and whether it’s changing over time i.e. if it increases then stick to the 20 seconds rule for washing hands
- Less frequent checks of reliable information updates on COVID-19 will help to quieten your mind as well as muting notifications
- Look out for why you are washing for example, is the washing being carried out as per the Government guidelines to reduce the risk of spreading the virus, or is it being done fuelled by OCD to feel “just right”?
The above was sourced from the following articles, please do read them for fuller details:
https://ocdaction.org.uk/articles/covid-19
https://www.bbc.co.uk/news/health-51873799
Clinical perspective of how to manage perinatal OCD during the Covid-19 pandemic
We are living through what for most of us is an unsettling time, and we are all in the process of adjusting to this. A level of anxiety and elevated stress is to be expected for everyone and we all need to take our reactions day by day to some extent. OCD of course loves uncertainty and unpredictability and it likes to fill the gap with the illusion that it can help us, so it is understandably a time that many people could experience a worsening of symptoms. However, it is important to recognise that this might be the case, and think about what is excessive relative to the specific context. At the time of writing, the emerging evidence seems to say that pregnant women are not at any more risk than others, and children seem generally to have less severe symptoms. Therefore, pregnant women and those with young children need to take only the same precautions as others. ‘Now’ is always a good time to confront your OCD and act as though you don’t have the problem, even if you feel more anxious than usual. Help is still available via NHS psychological therapies services and online support and these treatments can be as effective as face to face therapy.
Expert by experience thoughts for coping during this challenging time:
We have captured a list of hints and tips to support women and please do let us know if there is anything else we can add.
- The new era of ‘personal responsibility’ may be very difficult for some to navigate, try to speak to a valued family member, friend or healthcare provider for support
- We acknowledge how hard it has been for perinatal women during this time and that vaccines have created difficult decisions for some so, please do discuss with a healthcare provider if you are unsure
- Try and focus on the job at hand, brushing the children’s teeth, giving them a bath, preparing meals
- Know it is going to be difficult but not impossible – give yourself permission to get frustrated and know this is a new normal for a little while
- Use this time to carry out Exposure and Response Prevention work, we know what is in our control and what isn’t
- Not to romanticise this time but, is there anything you can now do that previously you couldn’t? Try and catch the good moments
- Create time in the day / evening for yourself, be kind to yourself whatever that looks like for you
- Reach out to online groups to help manage your anxiety (see here for OCD Action Perinatal OCD support online group)
- Whenever OCD starts knocking, fill that time with what we could call ‘positive distraction’ which could be anything that fills your soul
- Surround yourself (virtually) with people who understand the disorder, see here for a leaflet you can share with them
- Remind yourself that recovery is possible from OCD, read here for some personal stories
- Become an expert in perinatal OCD, see the Resources page for further details
- Eat well, include movement/exercise in your routine (even if self -isolating) and keep hydrated
- Keep a diary to help identify what works well for you and schedule those activities / rest ideas into your day.
Please see below OCD Action support contact details:
OCD Action helpline and Skype/phone support groups remain open during this challenging period.
Helpline: 0845 390 6232
Email: support@ocdaction.org.uk
Access skype groups by calling 0303 040 1112
Website: https://www.ocdaction.org.uk/
OCD Action also suggest that if you are currently in therapy for OCD, try contacting your therapist or service provider and ask if they offer skype/phone sessions instead of face-to-face appointments.
Please share your concerns with a clinician you trust e.g. GP, midwife, health visitor – and again call them to see if they can speak over the phone / skype etc.
Thank you to our patron Dr Fiona Challacombe for her support with this article.
During recovery there are various resources that can be useful tools to support mums, please see below some suggestions:
The Royal College of Psychiatrists perinatal OCD leaflets
Maternal OCD patron Dr Fiona Challacombe and Maternal OCD co-founder Maria Bavetta co-authored a leaflet with Dr Lucinda Green outlining various aspects of perinatal OCD including:
• How perinatal OCD affects women in pregnancy and after birth
• How to help yourself
• When to seek help from your GP or mental health services
• Treatment options
Click here to read the leaflet.
New leaflet for carers: there is also another leaflet called Perinatal OCD for Carers which we were involved with, please click here to read.
Pregnancy and Post Birth Well-being Plan
The Boots Family Trust has created an easy to use plan for mums to help think about the mental health and wellbeing support they might need during pregnancy and post birth. Click here to view.
Department of Health films Maternal OCD co-founder Maria Bavetta
Click image below to watch Maria describe her journey to recovery and explain the need for specialist perinatal mental health services for mothers.
Podcast with Dr Chrissy Jayarajah
Maternal OCD interviews Dr Chrissy Jayarajah about the “#OCDbfing” OCD and breastfeeding twitter chat campaign. Dr Jayarajah is a Consultant Perinatal Psychiatrist for a new Perinatal Mental Health Service in London and a member of the Maternal OCD scientific advisory panel.
Please click image below for Part 1 of the #OCDbfing podcast:
Please click image below for Part 2 of the #OCDbfing podcast:
Click here to read the twitter chat #OCDbfing
Maternal OCD Facebook Live session
Maternal OCD supported the Perinatal Mental Health Partnership #maternalmhmatters week with a Facebook Live session.
Please click on the link below to watch Maternal OCD patron Dr Fiona Challacombe and co-founder Maria Bavetta discuss their insights into perinatal OCD both from a clinical and lived experience.
https://m.facebook.com/story.php?story_fbid=762568750601030&id=587696788088228
Q & A from Perinatal Mental Health Partnership (PMHP) Maternal OCD Facebook live session, authored by Dr Fiona Challacombe
Q1. How can we reassure mums that’s it is ok to open up about intrusive thoughts to their doctor? There is a fear of being open about intrusive thoughts and having baby taken away.
A1. We can’t, as with anything they will need to get a feel for whether the person has knowledge and understanding of this and proceed accordingly. As we said, if unsure simply say something generic eg ‘I have horrible unwanted thoughts that I think are part of ocd as they horrify me’ please refer me for an assessment.
Q2. ERP has been the most effective form of treatment for me. I know the ultimate exposure is to one day father my own child but I am still nervous. Do you have advise for potential fathers?
A2. Same as for any person, it’s a big and often complex decision, even with OCD out of the equation. Try and get help for your ocd asap. Think if I didn’t have this problem how would I make this decision?
Q3. Just curious if anyone else noticed that the psychosis / OCD started after hyperemesis gravidarum? I wonder if, for some women, their mental health spirals out of control after being deprived of essential minerals during early pregnancy? My OCD still troubles me but it was at its worst for the 7 years during / after birth. I developed a form of eczema which I was told could be down to a lack of iron / B12. I was tested and shown to be severely deficient – probably since pregnancy. I was given incredibly strong supplementation and, within about a fortnight, a black cloud started to lift and I was finally able to countenance the CBT / exposure therapy: I’d been too terrified to leave the house until then.
A3. We can’t respond to specific cases however it’s a good idea to rule out physical causes or manage them as best as you can if present. As you say it may get in the way of what’s possible at present so change the pace and do what you can whilst that is happening
Q4. CBT not working, please help
A4. Not all Cognitive Behaviour Therapy (CBT) and CBT therapists are the same (which is a good thing). Research from our clinic has also shown that what is called CBT often is not. Keep going and find someone you think really gets it. It’s a hard treatment to do and takes a lot of energy and commitment as you have to do the really hard work. Have a look and see if anything else getting in the way.
Q5. Emotional contamination, any guidance?
A5. We are all better parents when we feel better so it’s probably always a good idea to help ourselves manage what is, let’s face it, a very tough job- be self-compassionate and do our best. Children are not going to be affected by your feelings per se, it’s what you do and express directly to them (nice study demonstrated this) My advice to all parents is keep showing and telling them you care and working on your parenting skills.
Q6. Unwanted sexual intrusive thoughts, what can I do?
A6. Very common and the least talked about. Funnily enough, it has occurred to me that in general it’s a time of life where you see genitals all the time as well as going through lots of physical changes and experiences yourself if breastfeeding for example, so not surprising OCD plays on that. It’s all OCD and no different from any other type in that it will use whatever material it can.
Q7. Impact of feelings on child
A7. See A6 above
Q8. Themes of what people worry about
A8. In the perinatal period it’s contamination and deliberate harm which are the most common then all the others. OCD can have themes according to the societal preoccupation of the time – Hiv, bird flu, paedophilia. Other more religious societies have more religious OCD, for example. OCD goes on the material it can get.
Q9. Breastfeeding and intrusive thoughts
A9. See A6 above
Q10. Help partner understand more
A10. We have a ‘cut out and keep’ bit in our book about this. It may be that they don’t understand, it may be they are frightened and stressed by what’s going on, it may be they are finding some of the ocd stuff really hard and it’s getting in the way of family life. Try and understand where they are coming from, work together as much as possible and help them help YOU get OCD out of your life.
Break Free From OCD – Dr Fiona Challacombe, Dr Victoria Bream Oldfield and Prof Paul Salkovskis ISBN 978-0-09-193969-4
Q11. Accessing help for perinatal OCD when child is over 1 year old
A11. Yes it’s a fairly arbitrary cutoff for perinatal services but that’s what it is at present. Keep fighting to get treatment whatever point you are at – there are lots of excellent therapists in general services. Everybody deserves treatment, parent or not
Q 12. Please discuss the idea of accepting the idea of having only one child, or doing what’s best for you
A12. The decision to extend a family is a personal one and needs time and attention, see A2 and also know that there is no need to put pressure on yourself to have further children. Lots of people who have had a hard pregnancy or postnatal period feel averse to going through it again. It may not be the same, particularly if you have had treatment or have a lot of knowledge about mental health that you may not have had the first time round.
Perinatal Positivity Film
Watch this 6 minute animated film for parents-to-be which raises awareness of mental health problems in the antenatal and postnatal period and also highlights where you can find support from health professionals and ideas for self-care.
Recommended reading
For Adults
Break Free From OCD – Dr Fiona Challacombe, Dr Victoria Bream Oldfield and Prof Paul Salkovskis
ISBN 978-0-09-193969-4
How to Deal with OCD A 5-step, CBT-based plan for overcoming obsessive-compulsive disorder – Dr Elizabeth Forrester
ISBN: 9781473601314
The Beating OCD Workbook: teach yourself – Dr Stephanie Fitzgerald ISBN:978-1473601345
Obsessive Compulsive Disorder The facts – Padmal De Silva and Stanley Rachman
ISBN 0-19-852082-4
Obsessive Compulsive Disorder The Essential Guide – Joanna Jast
ISBN 978-1-86144-084-6
OCD and Me – Ben Gander
ISBN 978-0-9559926-0-5
Overcoming Anxiety – Dr Windy Dryden
ISBN 0 – 85969 – 816 – 5
The Imp of the Mind – Lee Baer, Ph.D.
ISBN 0 – 452 – 28307 – 8
Overcoming Obsessive Compulsive Disorder – David Veale & Rob Willson
ISBN 1 – 84119 – 936 – 2
Cognitive Behavioural Therapy for Dummies – Rob Willson & Rhena Branch
ISBN 0 – 470 – 01838 – 0
For Teenagers
Touch and Go Joe – Joe Wells
ISBN 978-1-84310-3912
Cognitive Behavioural Therapy and self-driven recovery
An article written with thanks from a Maternal OCD volunteer and mummy!
The first step on the road to recovery is to be formally diagnosed as having OCD by a clinician. Following this, OCD sufferers have the option of pursuing Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) either privately or through the NHS. CBT is recognised by NICE as the treatment found to be most effective in treating patients with OCD. It takes hard work and dedication to complete CBT, but the rewards are most certainly worth the effort. Most sufferers respond well to Cognitive Behavioural Therapy.
Thankfully, the NHS can provide OCD sufferers with CBT, the advantage of this being that treatment is free which is important for most, the downside is that limited funding within the NHS can sometimes result in long waiting lists and limited care. Others opt for private therapy but having to pay for therapy is not always an option and it is extremely important to be sure that it is CBT that is being used and not another type of talking therapy. In both cases it is important to ensure that the CBT therapist has experience of treating patients with OCD as CBT is used widely to treat a range of different disorders. A well trained CBT therapist will help you through your recovery. This is often not easy when you are in the midst of anxiety so finding an ally in your recovery such as a friend or relative can be very helpful. Here are a few pointers to help you get the most out of CBT and help yourself along the way:
• Go prepared for your initial assessment
When you attend an initial assessment, or begin CBT, take along some notes outlining your current issues. Details such as the type of obsessions you are experiencing, compulsions you are carrying out and end goals you have can help your therapist greatly and will save valuable time in sessions. Your therapist will go through these details with you but it can be helpful to already have thought them through before you attend your session.
Communicate with your Therapist
It is vitally important that you communicate with your therapist, discussing progress, problems or any areas of concern that you might have. With a limited number of sessions allocated you need to ensure that you are getting the most out of your therapy. If you do not feel that therapy is progressing as you had hoped it would, then discuss this with your therapist so that you can determine what is causing any such issues. You are also allowed to take an audio recording device to record the sessions – this will act as a reminder of the session.
• Ensure that you are committed to completing homework set
CBT can be an excellent therapy but for most it is not a quick fix or magic cure. The patient needs to work hard at their CBT homework between therapy sessions to ensure that progress is made. Your therapist will guide and support you through CBT but it is up to the individual to undertake the challenges. The more you practice, the greater your chance of recovery!
• Read NICE Guidelines (National Institute for Health and Care Excellence)
NICE Guidelines set the standards for high quality healthcare and are used by the NHS so please reference these guidelines to ensure that you are receiving the best possible care. You may not feel up to researching these guidelines yourself, in which case, ask someone close to you for support in doing this.
The guidelines detail standards which could be of use to you such as:
1. NICE states that all women who need psychological interventions in the perinatal period should start treatment within 4 weeks of initial assessment
https://www.nice.org.uk/guidance/cg192/ifp/chapter/About-this-information
2. ‘OCD and BDD can have a fluctuating or episodic course, or relapse may occur after successful treatment. Therefore, people who have been successfully treated and discharged should be seen as soon as possible if re-referred with further occurrences of OCD or BDD, rather than placed on a routine waiting list.’
(CG31 Obsessive-compulsive disorder – Issue date: November 2005)
https://www.nice.org.uk/guidance/CG31/chapter/1-Guidance#step-2-recognition-and-assessment
• For private CBT only
Most patients can self refer to a private therapist without seeing a GP first however if this is your chosen route please make sure the therapist has had experience of treating perinatal OCD and is on the www.babcp.com register..
• Learn about OCD
Learning about your OCD, and understanding that OCD is a disorder that you can recover from, can make you feel much more empowered and give you the strength you need on your road to recovery. Lack of knowledge about the disorder can make it even more frightening. Understanding what OCD is and having knowledge of it can make it all seem a little less frightening. There are many books available that can help you gain knowledge about OCD and reading about the experiences of others can also help and make you feel less alone – please see the Resources section for further details.
Knowing what triggers your OCD can also help vastly in managing OCD symptoms. Stress, for example, can be a huge trigger for many OCD sufferers so learning relaxation techniques and knowing how to manage stress in your life can make a huge difference.
• Help those around you understand how to support you
Support and understanding from those around you can make such a difference in recovery. It can be extremely hard and frustrating for loved ones to understand OCD when they have not experienced it for themselves. It is natural for friends and family to want the compulsions to simply stop but, as we all know, this takes time, patience and encouragement.
Point carers, friends and family in the direction of OCD books, websites and support groups to help them feel supported themselves, and enable them to learn about OCD. This can highlight the part they can play in your recovery – many books and websites also have sections aimed specifically at carers, friends and family which may help.
• Be kind to yourself
One of the most important parts of recovery is to be kind to yourself! Keeping as calm and comforted as possible will go a long way towards aiding recovery.
Remember, it is not your fault that you have this disorder, blaming yourself or beating yourself up about it will not help. See yourself similarly to someone who is physically unwell, after all just because our mental health is not always obvious, this does not make perinatal OCD any less serious or distressing than being physically unwell. We all need to look after ourselves when we are unwell and having OCD is no different.