Banner by Amy Zhang

When Fear Looks Like Danger: The Hidden Crisis of Misdiagnosed Perinatal OCD 

by Zola Mazzucato

  
Monique, a 35-year-old new mother, gives birth to her first son, Eli. Monique has suffered from Graves’ disease her whole life, and didn’t think it was possible to have kids. But miraculously, she had Eli. However, various complications emerged after his birth, a large one being his tongue-tie condition. This condition made it difficult to breastfeed Eli and Monique attributed the issues to allergies, cutting most foods out of her diet in response. She quickly became frail due to her malnourishment, causing her to experience dizziness and fainting. Later she was told that Eli had macrocephaly – a condition that could mean Eli had a brain tumor. This series of health issues constantly engulfed Monique's mind, leading to intrusive and spiraling thoughts. Her constant state of fight-or-flight induced panic attacks multiple times a day. Monique felt with her mental and physical instability, she was no longer safe to be around Eli. She would experience episodes of fainting, leading her to think of scenarios like “What happens if I faint while bathing Eli and he drowns?” Still, she was so afraid to tell anyone these thoughts, thinking it would put her in jail.  

Monique was eventually put into a Mother and Baby Unit due to her mental instability, where she and Eli remained for six weeks. She was later diagnosed with panic disorder and obsessive-compulsive disorder (OCD). She began medication that significantly helped, along with Cognitive Behavioral Therapy (CBT) and exposure therapy. Monique says her experience with treatment has changed her for the better and she is now able to enjoy Eli and delight in him every moment. 

What happens to a mother like Monique when her most terrifying thought is mistaken for her deepest intention? Perinatal OCD is a common, treatable condition that’s solely rooted in fear, not intent. Many mothers are misdiagnosed because intrusive thoughts are poorly understood by both society and healthcare providers, making the condition even more psychologically harmful. Misdiagnosis of perinatal OCD is common and preventable. The crisis is rooted in stigma, lack of training, and cultural assumptions about motherhood.  

Perinatal OCD is a subset of OCD that develops during the perinatal period, around the 20th week of gestation, and lasts until one year after childbirth. The condition is characterized by intrusive, unwanted, ego-dystonic thoughts (often harm-related), which are attributed as obsessions. These obsessions are followed by compulsions (repetitive behaviors), or avoidance behaviors. Research states that obsessions centered on infant harm are unique to pre-natal OCD. Studies have shown that obsessions at the beginning of pregnancy are likely to focus on contamination and are accompanied by cleaning and washing compulsions. Meanwhile, aggressive intrusive thoughts of infant harm are especially common postpartum. Postpartum onset obsessions are more likely to be accompanied by checking and avoiding compulsion. It’s extremely crucial to acknowledge that harmful thoughts are not intent with OCD. The condition is purely driven by fear and distress.  

Intrusive thoughts are unwanted, ego-dystonic, and often horrifying to the person experiencing them. They are entirely unwanted, unintentional, and not reflective of the mother’s true desires and intentions. Common themes of intrusive thoughts in perinatal women include harm, either accidental or intentional, to the baby (or others), or fear of being unable to care for the baby properly. Fear of contamination, such as germs, toxins, and “uncleanliness” are also common, as well as themes involving violence, such as intrusive violent imagery, or fear of oneself losing control, leading to harm.  

A common cause for intrusive thoughts is significant changes in hormones, specifically, fluctuations in gonadal steroid hormones (estrogen, progesterone). Additionally, pregnancy and the postpartum period naturally bring pressure of increased responsibility, causing hypervigilance which could account for compulsive/avoidance behaviors. The transition to motherhood brings considerable psychological and interpersonal demands, including new responsibilities. These stressors, in combination with the biological/hormonal changes during the perinatal period, may trigger or worsen OCD.  

A few examples of compulsive/avoidant behaviors in real life are a mother avoiding kitchen knives, constantly checking if the baby is breathing, avoiding bathing her baby, or feeling terrified of being alone with her baby. But again, none of these avoidance behaviors are evidence of intent. In fact, the shame, hiding, and fear of judgement a person with this condition experiences are far more damaging than the thoughts themselves. The reason these thoughts are so ego-dynostic and distressing for a mother is that they do not align with her core values, beliefs, or intentions. In postpartum psychosis, harmful thoughts about the baby can feel “right” or make sense to the person because they fit into their delusions. Insight is usually low, reality feels distorted, and these thoughts may come as strong beliefs or commands. Unlike in anxiety or OCD, there are usually no compulsive behaviors to try to counteract the thoughts.  

Perinatal OCD is far more common than what is recognized. Studies have shown that 8–70% of women with existing OCD will experience perinatal exacerbations. A recent article that carefully characterized women using strict diagnostic criteria found a period prevalence of 7.8% in pregnancy and 16.9% in the postpartum. Oftentimes, new parents experiencing OCD are labeled as “just new parents with typical new-parent worries,” or worse, misdiagnosed with far more severe conditions like postpartum psychosis. The lack of education on perinatal OCD is not only harmful to the parents experiencing it themselves, but ultimately contributes to the systemic issue of mothers being misdiagnosed and feeling alienated. In fact, vignette-based research with perinatal health practitioners found that 70% of non-psychiatric medical providers were unable to accurately identify obsessive-compulsive symptoms related to infant harm, and nearly a third misidentified the symptoms as psychotic. A fundamental mistake made by  providers is not making the distinction between thoughts and intent. Providers do not receive specialized training in perinatal mental health; instead, they rely on psychiatric frameworks that do not make this important distinction. One severe consequence of misdiagnosis is restricted contact with the baby and or CPS involvement. Research describes cases where symptoms of perinatal OCD were misinterpreted as high-risk for actual harm. Mothers were admitted to specialist “mother-and-baby” units, had contact with their babies severely restricted, and child-protection proceedings were initiated. As a result of this, maternal distress is worsened, and OCD symptoms become exacerbated. That separation and institutional response reinforced the mother’s own fears that their symptoms meant they might harm their babies, severely aggravating the OCD. Misdiagnosis can also impair the mother-baby relationship and potentially harm longer-term maternal-child attachment. Ultimately, the lasting effects of these occurrences, as well as the persistence of untreated OCD symptoms, lead to an overall poor quality of life, functional impairment, social and physical health problems6.  

The stigma revolving around perinatal OCD, or other mothers who have imperfect prenatal and postpartum experiences, has been the number one reinforcer to the vicious cycle of this condition. The cultural expectations of a mother needing to be selfless and a “natural nurturer” further reinforce the misconception that mothers with perinatal OCD are “bad mothers.” Research has situated perinatal OCD stigma within broader patterns in perinatal mental health, with many mothers fear being judged as inadequate, “unfit,” or even dangerous parents if they disclose the intrusive, taboo thoughts that they’re experiencing. This fear, research states, is rooted in societal expectations of motherhood and child safety and acts as a major barrier to disclosure and seeking help.  

There are many public health consequences to the stigmas associated with perinatal OCD. When this condition goes untreated (as it often does), other mental health issues such as chronic anxiety, depression, and impaired bonding are brought into the equation. This accumulation of challenges ultimately leads to system-level failure, as misdiagnosis braces distrust between mothers and healthcare. If a substantial fraction of pregnant/postpartum women are suffering from undetected or untreated OCD, the aggregate burden, in terms of maternal mental health, family disruption, adverse child-development outcomes, and increased demand on health and social services, could become significant.  

Misdiagnosis is not an inevitable outcome—it’s entirely preventable. Collectively, taboo symptoms, gendered stigma, and inadequate training harm women and their experiences as new parents. These outcomes call attention to the need for structural reform regarding perinatal mental health education. Only by dismantling these misconceptions and strengthening clinical education can we ensure that mothers receive compassionate, accurate care rather than punitive misinterpretation. 

Monique's experience shows how quickly a mother’s fear can be misread as danger. Perinatal OCD is rooted in fear, not desire, and the thoughts that come with it are ego-dystonic, unwanted, and deeply upsetting. Most importantly, this condition is highly treatable with evidence-based care like medication, CBT, and exposure therapy. But recovery depends on the condition being accurately recognized. Misdiagnosis continues because intrusive thoughts remain taboo, clinical training is limited, and stigma convinces mothers to stay silent. Change requires more than awareness—it requires better training across perinatal care, clearer screening practices, and a culture that makes room for honest conversations about intrusive thoughts without punishment.  

As a public health issue, this is a moment to rethink how we talk about motherhood and mental health. Reducing stigma, listening to mothers’ real experiences, and training clinicians to tell the difference between intrusive thoughts and psychosis can help bridge the gap between suffering and support. When we stop assuming scary thoughts mean someone is dangerous, mothers like Monique can get compassionate care and feel safe asking for help before things become a crisis.