Mental Health 101: Intrusive Thoughts
In case you were too afraid to ask: Yes, everyone worries about whether their baby is breathing
Mental Health 101 is an ongoing series where I discuss a mental health concern that is common throughout pregnancy or early parenthood. I started the series by covering “the baby blues” and discussing the global prevalence of postpartum depression.
This week I discuss the unfun yet super common experience of unwanted, uncontrollable thoughts about harming one’s baby, and how these thoughts do not mean that you are actually going to hurt your child.
No one ever warns you how much time you will spend as a new parent worrying about whether or not your baby is alive. The fear of Sudden Infant Death Syndrome is burned into your brain by doctors, nurses, midwives, and those gigantic, CVS-receipt-length warning labels on literally everything made for babies about how this item can KILL your child and how you are THE WORST PARENT IN THE UNIVERSE if you let your child sleep on/wear/stand on/exist near this object. There were multiple times in those newborn days (maybe multiple times a day? Who’s counting?) where I would poke my baby’s cheek or feel under his nose for breath just to confirm that, yes, he’s still breathing. Flashes of images of dropping my baby down the stairs or scenes from movies like The Joy Luck Club where a baby is harmed would play, unbidden, in my head at random times.
All of this is normal, even though it’s no one’s idea of a good, chill time. These experiences are known as intrusive thoughts: thoughts that seem to occur from nowhere and that are unwanted and uncontrollable. These thoughts are very common for people with obsessive compulsive disorder, though most people will experience intrusive thoughts at one point in their life even without having a diagnoseable mental health concern. A common theme of these types of thoughts are related to harming oneself or someone else, such as your newborn baby. These thoughts may be passive, where you worry about whether or not your baby will be harmed by accident (“What if I drop my baby down the stairs?”), but they can also be active, where you worry that you will intentionally harm your baby (“What if I threw my baby down down the stairs?”).
Intrusive thoughts are pretty distressing to experience and a person does not actually want to harm someone else when they have the thought - instead, you are more worried that by having the thought, you will suddenly act on it1. It’s easy to take for granted the notion that our thoughts actually can’t control our behaviors. If you stop reading this right now and instead focus intently on your hand, thinking to yourself over and over again, “Make a fist. Make a fist. Make a fist,” you won’t suddenly make your hand curl up into a fist. You can have the thought “Make a fist” all day long, and your hand will still just lie there, stupidly not making a fist. You actually have to move your fingers and your palm into the shape of a fist to make the damn fist. Thoughts by themselves can’t control us, nor can they hurt us or the ones we love.
Generally, evidence on intrusive thoughts in new mothers supports the notion that, yes, these types of thoughts are common and no, they do not mean that you are more likely to hurt your child. Brok and colleagues (2017)2 reviewed 50 articles that examined what they referred to as “harming intrusions” in postpartum mothers. This review was fairly extensive and covered many topics, including reviewing studies that assessed these thoughts in mothers with and without mental health concerns, studies that tried to understand what causes these thoughts, and studies on different types of treatments for mothers who experience intrusive thoughts. I mostly want to focus on what the authors found related to intrusive thoughts for mothers without other mental health concerns. Of the studies they reviewed, they found three studies that examined the prevalence of both passive and active harming intrusions in healthy mothers. Together, these studies suggest that the majority of mothers experience a harming intrusion within the first month after giving birth. One study found that 100 out of 100 women assessed reported at least one passive harming intrusion (e.g., worried about an accident harming the baby), and 50 out of 100 reported at least one active harming intrusion (e.g., shaking, giving the baby away, hitting), within the first month postpartum.3
Further, the authors of the review did not find any evidence from any study to suggest that intrusive thoughts on their own are related to an increased likelihood of a mother harming a baby. For example, in the same study described above, the researchers compared women who experienced an active harming intrusion with those who did not. They found that these groups of mothers did not differ from one another in “incidents of harsh parenting” during the first month postpartum.
Generally, the authors found that intrusive thoughts tend to be more severe (e.g., more aggressive towards the baby) and more frequent for mothers who also experience postpartum depression and obsessive compulsive disorder. They also note the difference between intrusive thoughts and delusions (false beliefs), something that people who experience postpartum psychosis may deal with (e.g., believing that the baby is someone else’s child or that the baby is possessed by an evil force). Mothers who experience delusions like this about their baby are at a higher risk of child abuse, though, again, these types of thoughts are very different from intrusive thoughts. A comorbid mental health concern such as depression or psychosis in a mother who also experiences intrusive thoughts may put that mother at higher risk of harming their child, though, again, it is not the thought by itself that increases this risk for mothers. If you or someone close to you is experiencing intrusive thoughts along with other mental health concerns, it may be helpful to check in with one’s psychiatrist or other mental health care provider and seek additional, professional support.
So what helps alleviate the stress related to “everyday” intrusive thoughts for new mothers? Apparently, time, since for most mothers the frequency of these thoughts significantly decreases over the first few months after giving birth. Also, maybe this newsletter! The authors cite research that shows that teaching people what intrusive thoughts are, that they are common, and that they are unlikely to be acted on can help address or even prevent the occurrence of intrusive thoughts for new mothers.
Also, maybe cut off those stupid warning labels on all your baby’s toys? This was not suggested by the review authors, but it couldn’t hurt! Right?! Ugh, okay, I guess keep them…
Check out the Dark Thoughts episode of the podcast Invisibilia to hear more about intrusive thoughts and learn about different types of therapy that helps address this concern.
Brok, E. C., Lok, P., Oosterbaan, D. B., Schene, A. H., Tendolkar, I., & van Eijndhoven, P. F. (2017). Infant-related intrusive thoughts of harm in the postpartum period: A critical review. The Journal of Clinical Psychiatry, 78(8). https://doi.org/10.4088/jcp.16r11083
Fairbrother, N., & Woody, S. R. (2008). New mothers’ thoughts of harm related to the newborn. Archives of Women's Mental Health, 11(3), 221-229. https://doi.org/10.1007/s00737-008-0016-7