Postpartum OCD

Intrusive Thoughts
About Harming
Your Baby

Intrusive thoughts about harming your baby are unwanted images or urges, like dropping the baby down the stairs or hurting them with a kitchen knife, that arrive out of nowhere and horrify the parent having them. Research shows they are common in new mothers and fathers. When the thoughts, and what you do to escape them, start running your days, that pattern can be postpartum OCD.

If you're reading this at 3 a.m. with your baby asleep in the next room, here's what this page will and won't do. It won't tell you what your thoughts say about you. Nobody can honestly promise that, and the people who try usually make it worse. It will tell you what the research shows, what I see in my room, and what actually helps.

What do intrusive thoughts about harming your baby look like?

Intrusive thoughts about harming your baby are sudden, unwanted thoughts, images or urges about the baby being hurt, either by accident or by you. They feel like the opposite of what you want, and that's exactly why they're so upsetting. The ones I hear most often in my room:

• Dropping the baby down the stairs or over a balcony railing
• Drowning the baby during a bath
• Stabbing or cutting the baby with a kitchen knife
• Shaking the baby when they won't stop crying
• Smothering the baby, or the baby stopping breathing because you weren't watching
• Unwanted sexual images during a diaper change or bath

That last one is the thought parents are most afraid to say out loud. In my room it's also one of the most common, and it belongs on this list.

None of this is new. Back in 1978, Stanley Rachman and Padmal de Silva showed that people without OCD report unwanted intrusive thoughts too, and that their content looks a lot like clinical obsessions (Rachman & de Silva, 1978). The thought itself isn't the disorder. What happens after the thought is.

Why do new parents get these thoughts?

New parents get these thoughts because responsibility and perceived threat spike overnight, and the brain starts scanning for every way things could go wrong. That's the core of the cognitive-behavioural model of postpartum OCD, and it's why beliefs about thoughts, not the thoughts themselves, predict who gets stuck (Abramowitz et al., 2025).

It's like your brain installed a security camera pointed at your own mind. Before the baby, a weird thought drifted past and nobody was watching. Now there's a camera on it, an alarm wired to the camera, and a voice asking what it means that you just thought that.

The thought shows up. The alarm goes off. And the alarm is what makes it stick.

Do these thoughts mean I'm going to act on them?

No study can answer that question for one person, and I won't pretend to. What the research can do is describe groups of parents.

In the 2022 study above, parents who reported unwanted thoughts of intentionally harming their baby did not report more physical aggression toward their infant than parents without those thoughts. Mothers with OCD didn't either (Fairbrother et al., 2022). That's one sample, using self-report, and it can't tell any single reader anything about themselves. It's still the best direct evidence we have on the question.

What I see in my room is a pattern I've watched for years. The parents with harm OCD treat the thought as an emergency. They hide the knives. They stop bathing the baby. They ask their partner, again, whether they seem like a good parent. The thought goes against everything they want, which is what clinicians mean by ego-dystonic.

Here's the part that matters most. “Will I act on it?” is the hook. Every time you try to answer it with certainty, the OCD gets stronger. If you came to this page hoping for a promise, I understand. Searching for one is the compulsion.

When does it become postpartum OCD?

It becomes postpartum OCD when the thoughts come with rituals and avoidance that eat real time, cause real distress and start shrinking your life with your baby. Prevalence estimates vary by study. One large study found 7.0% of women met criteria for OCD in the postpartum period (Fairbrother et al., 2021). Signs that the thoughts have turned into a pattern:

• Avoidance: you stop bathing, changing or holding the baby, or you won't be alone with them
• Removing dangers: knives, scissors or cords get hidden or locked away
• Checking: you check the baby's breathing over and over, or check yourself for signs you're that kind of person
• Reassurance seeking: you ask your partner, your doctor or forums whether parents who think this are dangerous
• Mental reviewing: you replay moments to prove nothing happened
• Confessing: you feel driven to tell someone about each thought

If that list sounds like your week, the postpartum OCD guide explains the condition in full, and am I dangerous? covers how clinicians tell harm OCD from intent.

Why does avoiding the baby make the thoughts stronger?

Avoidance makes harm thoughts stronger because every time you avoid, and nothing bad happens, the avoidance gets the credit. I call this the keys problem.

I'll use myself as the example. When I was a kid, I was attacked by a dog. For about 20 years after that, I held my keys like a weapon on the way home. I was never attacked again. And the bully in my head had a simple explanation: you're safe because you're holding the keys.

The hidden knives work the same way. The baby is fine, and the knives in the locked drawer get the credit. Your brain never gets to learn the thing it actually needs to learn: that you and a knife and your baby can be in the same kitchen.

Modern exposure therapy is built on this. It works by setting up experiences that violate what the fear predicts, and by dropping the safety signals that steal the credit (Craske et al., 2014).

Is it postpartum OCD, postpartum depression or postpartum psychosis?

These are three different conditions that can all involve frightening thoughts about the baby, and the difference matters for what you do next. This table is a guide for a conversation with a professional, not a diagnosis.

The conditions can overlap, and depression often shows up alongside OCD. Postpartum psychosis is a medical emergency. In Canada, call or text 9-8-8 (Suicide Crisis Helpline), call 911, or go to the nearest emergency department.

Can fathers and non-birthing parents have these thoughts?

Yes. Fathers and non-birthing parents get intrusive thoughts about harming their baby too. In a study that followed new mothers and fathers through the birth, most of them experienced intrusive infant-related thoughts, and beliefs about those thoughts predicted who developed obsessive-compulsive symptoms (Abramowitz et al., 2006).

In my experience, dads are the ones most likely to be told they're just tired. Take a composite I'll call Daniel. A few weeks after his daughter was born, he got a flash of throwing her during a diaper change. Within a month he had handed every bath to his partner, moved the knife block into the garage and was reading news stories about fathers who hurt their children, looking for proof he was different. His family doctor told him to get more sleep. He did need more sleep. He also had OCD.

Will my doctor or therapist report me for these thoughts?

In Ontario, the duty to report under the Child, Youth and Family Services Act applies when a professional has reasonable grounds to suspect a child is or may be in need of protection. I can't promise what any individual provider will do, and nobody honestly can. What I can tell you is that clinicians trained in perinatal and harm OCD know what intrusive harm thoughts are, and know how they differ from intent. A good therapist explains the limits of confidentiality at the start.

Training is the issue. In one study, mental health professionals misidentified 38.9% of OCD presentations overall, and 31.5% of presentations with aggressive obsessions (Glazier et al., 2013). That's why who you tell matters.

The wrong kind of help can make postpartum OCD worse. When a professional who doesn't know OCD treats the thought itself as the danger, with a long risk assessment or an instruction never to be alone with your baby, the doubt grows and so does the avoidance (Veale et al., 2009). If you're a clinician, our harm OCD risk assessment guide covers the assessment side.

How is postpartum OCD treated?

Postpartum OCD is treated with Exposure and Response Prevention (ERP), sometimes alongside medication. ERP means you deliberately approach the situations and thoughts you've been avoiding, and you stop doing the rituals that keep the fear alive. The postpartum OCD treatment options page compares every route in Ontario, public and private.

At The OCD Clinic, we run ERP using inhibitory learning. Each exposure is designed to test a prediction. If the fear says “if I hold a knife near the baby, I'll lose control,” we build a practice that lets your brain find out what actually happens. The goal of each rep is learning, not feeling calm. Research shows the amount your fear drops during an exposure doesn't predict how well you do afterwards (Craske et al., 2008).

Think of me as your personal trainer. Nobody lifts 300 pounds on day one. For a new parent, early reps might look like:

• Giving the baby a bath while your partner is in another room
• Cooking dinner with the knives back in the block and the baby in the bassinet nearby
• Changing a diaper without checking your own reaction afterwards
• Writing the thought down, exactly as it shows up, and leaving it unanswered

Every plan is built with you, at your pace, and decisions about caring for your baby, including time alone together, are made with a clinician who has assessed you. You'll feel it. That's the point. You can see what ERP therapy for postpartum OCD looks like week by week.

Medication is a valid part of treatment too. If you're pregnant or breastfeeding, talk with your doctor or psychiatrist about the options. When you're ready, postpartum OCD therapy in Toronto and online across Ontario is how we work with it. The goal, always, is that you fire us for the right reasons.

Research used for this article

1. Abramowitz, J. S., Hellberg, S. N., Krasnow, J., et al. (2025). Prenatal obsessive beliefs predict postpartum obsessive-compulsive symptoms: A prospective study. Psychiatry Research, 351, 116620. doi:10.1016/j.psychres.2025.116620
2. Abramowitz, J. S., Khandker, M., Nelson, C. A., Deacon, B. J., & Rygwall, R. (2006). The role of cognitive factors in the pathogenesis of obsessive-compulsive symptoms: A prospective study. Behaviour Research and Therapy, 44(9), 1361 to 1374. PubMed
3. Craske, M. G., Kircanski, K., Zelikowsky, M., et al. (2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46(1), 5 to 27. PubMed
4. Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10 to 23. PubMed
5. Fairbrother, N., Barr, R. G., Chen, M., et al. (2019). Prepartum and postpartum mothers' and fathers' unwanted, intrusive thoughts in response to infant crying. Behavioural and Cognitive Psychotherapy, 47(2), 129 to 147. PubMed
6. Fairbrother, N., et al. (2021). High prevalence and incidence of obsessive-compulsive disorder among women across pregnancy and the postpartum. Journal of Clinical Psychiatry. PubMed
7. Fairbrother, N., Collardeau, F., Woody, S. R., Wolfe, D. A., & Fawcett, J. M. (2022). Postpartum thoughts of infant-related harm and obsessive-compulsive disorder: Relation to maternal physical aggression toward the infant. Journal of Clinical Psychiatry, 83(2), 21m14006. PubMed
8. Glazier, K., Calixte, R. M., Rothschild, R., & Pinto, A. (2013). High rates of OCD symptom misidentification by mental health professionals. Annals of Clinical Psychiatry, 25(3), 201 to 209. PubMed
9. Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy, 16(4), 233 to 248. PubMed
10. Veale, D., Freeston, M., Krebs, G., Heyman, I., & Salkovskis, P. (2009). Risk assessment and management in obsessive-compulsive disorder. Advances in Psychiatric Treatment, 15, 332 to 343. doi:10.1192/apt.bp.107.004705