26 November 2012

Of my struggles with Postpartum OCD

While there's still a lot of work to do to educate the public about the realities of Postpartum Depression and raise awareness of this devastating mental illness, it is at least a phrase that most people are familiar with on some level, even if it's just "Oh yeah, I've heard of that..." on a basic level. What too many people are not familiar with at all is another PPMD called Postpartum Obsessive-Compulsive Disorder, or PPOCD.

I myself had never heard of it until I came across a blog post on Postpartum Progress listing the symptoms of PPOCD in "Plain Mama English".  This was during my bout with PPD back in 2009. It wasn't until a while down the road that I started thinking "Hey, maybe some of what I thought was PPD was actually PPOCD...". This was reinforced recently when I was reading a two-part guest post on Postpartum Progress about the mother's struggles with PPOCD (Part 1 and Part 2). I sat back in my chair with my mouth open going "Oh my gosh, Becky wrote my story! That's exactly what I dealt with!".

When I was at the ER and then being admitted at Laurel Ridge, of course I was asked if I was having thoughts of hurting or killing myself or my baby. I answered yes. What I realize now that I wish I had realized then was that what I was calling "thoughts of hurting/killing my baby" were actually intrusive thoughts, a signature symptom of Postpartum OCD.

I would have these thoughts just pop into my head from out of nowhere and they would terrify me, horrify me. For me, it revolved around the stairs. I would find myself thinking "What if I trip on the stairs and fall on her or drop her down the stairs?". It upset me so much that I would stay away from the stairs. There were instances where I actually changed my plans to not go out because it would have meant carrying her down the stairs and I was so afraid of what might happen.

An article titled Beyond the Blues: Postpartum OCD by Dr. Jonathan Abramowitz, Ph.D., ABPP goes into more detail of the symptoms of PPOCD and intrusive thoughts and the differences between PPOCD and Postpartum Psychosis. I found the entire article to be very informative and educational but one part in particular really stood out to me:
     My colleague Dr. Nichole Fairbrother and I have recently developed a psychological model of postpartum OCD. It begins with our finding that most new parents (mothers and fathers) experience unwanted infant-related thoughts (perhaps such thoughts have evolutionary significance). That is, we consider such thoughts as a completely normal and harmless part of early parenthood. The trouble begins, however, when a new parent mistakenly misinterprets these normal thoughts as indicating something very significant and threatening. For example, if a new mother misinterprets her violent thoughts as meaning that she is likely to kill her baby, or a new father who interprets his images of the baby dying as meaning that deep down he wants the baby to die. Why might someone misinterpret intrusive senseless thoughts as very significant? We think it has to do with the rapid increase in responsibility—which certainly is the case when one becomes a parent and gains the responsibility of caring for a helpless infant.
     When normally occurring postpartum thoughts are misconstrued as dangerous or very significant, it leads the person with such thoughts to become anxiety and fearful. Moreover, it leads to behaviors such as avoidance of the baby, seeking reassurance, and excessive ritualistic checking or praying. All of these behaviors are consistent with feeling threatened by upsetting thoughts about one’s child. Because these avoidance and ritualistic strategies seem to work (that is, no harm is committed), the new parent keeps on believing that the strategies have prevented catastrophe (when in fact, the thoughts are meaningless). Therefore, the strategy becomes a compulsive behavior, and the fear of acting on the unwanted obsessional thought remains intact (it is never disproven). Furthermore, when the new mother or father keeps their negative thoughts to themselves (“they would put me in the hospital if I told them about the thoughts I was having”), it further prevents them from learning that such thoughts are normal occurrences (other have them too).  
(Bolded added by me for emphasis) 
My third baby is 10 weeks old now and I've been having some of the same intrusive thoughts. It doesn't center around the stairs this time but it's usually when I'm walking through the loft upstairs while holding him and the thought pops unbidden into my head "What if I drop him over the side?". It horrifies me. I hold him tighter and move as far away from the half wall of the loft as I can get. I, in general, try not to walk close to it if I'm holding him.

I know on some academic level that the chances of me actually dropping him are EXTREMELY low but that doesn't make me feel any better. It still upsets me and makes my chest get tight. I hate these thoughts and I hate that I see myself again starting to change my actions to try to "avoid" my fears coming true.  Even writing about it makes my chest get tight and makes me feel a little panicky.

I debated writing and publishing this. It was a hard decision to make. I still struggle with "What if they take my kids away because I'm struggling with this stuff", even though I know better. I still struggle with "What if people read this and stop trusting me or think less of me?". It's difficult to actually put this all into words because if I avoid talking or thinking about it, I can pretend it doesn't exist.

So why am I writing about it?

Partly because I firmly believe that choosing to write about it helps me to take the power away from this bastard of PPD and PPOCD. Instead of letting it control me and what I write, *I* control what I write. Instead of giving in to the stigmas and fears, I strike at them and overcome them, I face them instead of hiding from them. I write about it because if it's out there, I can't keep putting off going to the doctor to see if they need to adjust my meds or something (my thyroid levels were already checked and I'm within normal limits). I write about it so that if there's someone else out there who's fighting this and feeling alone, maybe they'll read this and know that someone else is going through it too. I write about it so that people can comment and leave their support for me and for everyone else who's fighting this battle.

Lest anybody get unnecessarily worried, I don't have depression nearly at the level that it was at after my first pregnancy, thank goodness. I'm not stuck in that deep pit that seems hopeless to escape. In fact, I'm not really having any big issues with depression itself (the Zoloft seems to be keeping that pretty well under control). But I won't ignore the fact that there is something wrong because I know that it's something that can be treated. I won't let it control me, I will control it.

I am a survivor.

I am a fighter.

I. Will. Win.

03 November 2012

Of oxygen masks, airplanes, and being "selfish".

Last week, I had the chance to make a quick trip back home to visit my family and let them meet Aaron. As is my preference, I flew with my favorite airline, Southwest. At the beginning of the flights, the flight attendants did the requisite safety demonstrations about how to use a seat belt, safety vests, and oxygen masks.

I never would have thought that an airplane safety demonstration would inspire a Postpartum Depression blog post but it did. For those who have never flown before, the Flight Attendants give a little spiel that if the plane loses cabin pressure, oxygen masks will drop from the ceiling and then go over how to use them properly (you have to pull on the mask to get the air flowing). At the end, they say that if you are traveling with a small child or someone else who will need assistance, you should put your own mask on first. The thought process is that if you don't put your own oxygen mask on first, you're not going to be any help to the person you're sitting with if you pass out.

It occurred to me that this is a perfect parallel to the need to take of ourselves as moms. If I run myself into the ground, I can't take care of my family properly. It's vital that I take some time for myself on a regular basis. But sometimes (okay, too often) I buy in to the idea that taking time for myself is selfish and that I should be putting my kids and my husband first 100% of the time. This is false. Don't let yourself go there. Don't let other people try to send you there. There's no reason for us to be martyrs, it doesn't do anybody any good to sacrifice our own well-being, it actually negatively affects the well-being of the entire family. We HAVE to start looking out for ourselves

Taking care of yourself is taking care of your family. Next time you catch yourself in this mindset, remember to put on your own oxygen mask first and take a few minutes to take care of yourself.