“A little anxiety is normal during pregnancy,” the OB/GYN told me with an accommodating smile as she ushered me out of the exam room. “Try some Epsom salt foot baths. You should feel better in no time.”
Well, yes and no. On one level, she was correct: To some degree, worry is a normal, even healthy, part of child-bearing. Worrying can help us clarify what we value, and make us vigilant about guarding or preserving it. But with no offense to my well-intentioned and well-credentialed doctor, Epsom salts weren’t going to cut it. By that point in the summer of 2016, eight weeks into my pregnancy, my worries had catapulted far past a little anxiety and into a full-blown recurrence of obsessive-compulsive disorder.
To be fair, anxiety was the complaint I’d brought to her. My doctor knew about my history of both OCD and anxiety disorder, but at the time, both of us assumed my issues were an effect of the latter. All I really knew was that something was off.
Ever since I’d discovered I was pregnant, my brain had come to feel like a war command center, issuing my body warnings of phantom danger everywhere I went. My life was dictated by borderline-outrageous possibilities — and the only way to quiet these obsessive thoughts was to respond to them with equally irrational behavior. When I became obsessed with the idea that my prenatal vitamins would make me sick or hurt my developing fetus, I made my husband take them with me, so I had hard evidence my brain was lying to me when I started to convince myself I was dying. When I came down with a yeast infection, I was too scared to take Monistat, lest I have an anaphylactic reaction — so instead of treating the infection per my OB’s prescription, I self-prescribed yogurt. Let’s just say it didn’t end favorably.
Ridiculous as these things seem to me now, I believed every false claim my mind invented — and the worst part was, every time I acquiesced to these fears, they became more powerful. The only way to escape the tyranny of OCD was to dismiss the obsessions, the very forces I believed were protecting me and my pregnancy from danger. Instead, I did what they told me to do.
There’s a distinction between obsessive anxious thoughts and actual obsessive compulsive disorder, explains Patricia Widra, a clinical assistant professor of psychiatry at the University of Maryland Medical Center. Obsessive anxious thoughts, which are also more common, often fit more neatly into a person’s personality — for example, if you’re a tidy person in general, you might become especially anxious about the cleanliness of your home. OCD takes things a step further — each thought comes comes with a compulsion, or a corresponding behavior a person must do to ease the obsession.
In general, rates of anxiety disorders are disproportionately high for women, but pregnant women are especially vulnerable — in one 2016 study, nearly 16 percent of pregnant women reported suffering from an anxiety disorder. There’s also clinical evidence that the perinatal period is a time of high risk for OCD onset, given that OCD affects 2.07 percent of pregnant women, compared to 1.08 percent of non-pregnant people. According to another study, up to 50 percent of women with existing OCD experienced an exacerbation of symptoms during pregnancy.
Experts still aren’t totally sure whether the cause is purely physiological or cognitive. Some researchers trace it back to hormonal changes — fluctuations in estrogen and progesterone could affect levels of serotonin, a brain chemical related to OCD — while another study theorizes that an onset or exacerbation of OCD in pregnancy might be due to “an increase in feelings of responsibility for preventing harm.”
I have my own theory: During my pregnancy, my compulsions gave me a sense of the control I so desperately craved — just like they had the last time, when my parents split up unexpectedly when I was nine years old. As a response to the instability of being volleyed between their homes, my brain created a world of its own, one in which I was in charge — if, of course, I heeded the demands of my obsessions. I flipped light switches up and down until my hands became raw, and suspiciously checked locks dozens of times a day.
While my OCD stole the better part of my childhood, it also offered me a sense of solace. That’s what each of my OCD episodes has always been for me: a way to feel like I’m in the driver’s seat of my own life. So it makes sense that it would resurface months after I moved my family halfway across the country for a job and became pregnant.
Widra says that although it’s difficult to pin down an exact cause for my OCD relapse, a preexisting anxiety disorder alongside some major life changes could have put me at greater risk. “Stress on someone who is already experiencing a chronic anxiety disorder is going to find a way to manifest itself,” she says. “Anyone who already has anxiety disorder needs to be aware of their vulnerability during times of stress, whether good or bad.”
And I — pregnant and constantly feeling ill, in a new place without the support I was used to — was certainly vulnerable. Feeling generally disoriented was enough to merit anxious hypervigilance; add a growing fetus inside my body, and I simply became obsessed with creating a mirage of safety in everything I did. A cognitive-behavioral expert might say that my OCD caused me to exaggerate the risk and responsibility of my pregnancy, resulting in a loop of obsessive thoughts about my health and corresponding actions to establish the illusion of control.
While giving in to my obsessive thoughts with compulsive behavior may have allayed my fears in the short-term, in the long-term, it only reinforced my belief that I always had to do something to protect myself. To break the thought pattern, I knew I eventually had to expose myself to the thing I feared the most: the potential of losing control.
There’s a clinical term for that, according to Widra: Exposure and Response Prevention, a form of Cognitive-Behavioral Therapy that slowly and gently exposes OCD-sufferers to their triggers without letting them act on their compulsions. Widra recommends that women suffering from OCD during or after pregnancy work with their doctors to figure out a care plan that’s beneficial for both mom and baby, whether that’s starting a new medication, increasing an existing one, or working through obsessions in therapy.
For me, it was a combination of exposure and response prevention and medication — I also increased my SSRI dose early on, which certainly helped me in my decision to relinquish that sense of control. If I wanted to end the loop of obsessive thoughts about what would happen if I took my prenatal vitamin, I had to take it by myself and await my fate. And to my surprise, I survived. Every time my vitamins didn’t kill me, my framework for defining reality got stronger. And so did I.