Postpartum OCD

Postpartum OCD
Treatment Options

Postpartum OCD treatment in Ontario comes down to Exposure and Response Prevention (ERP), medication, or both, delivered through one of a few routes: a private ERP therapist, a hospital perinatal mental health program, free Ontario Structured Psychotherapy, or a specialty hospital OCD program. They differ in cost, referral rules and how specific they are to OCD. Here's how they compare.

I run a private clinic, so read this with that in mind. I'd still rather you get the right treatment somewhere than the wrong treatment with anyone. If you're not sure this is postpartum OCD yet, start with what postpartum OCD is.

How do the options compare?

Wait times change too often to print. Ask each program when you or your doctor make contact.

What does ERP for postpartum OCD involve?

ERP for postpartum OCD involves gradually approaching what you've been avoiding with your baby and dropping the rituals that keep the fear going. Bath time, the knife drawer, being alone in the nursery. Each practice tests what the fear predicts, so your brain gets new information instead of another escape.

It's the most OCD-specific option on this page, which is also why who delivers it matters. Ask any therapist the questions below. To see a plan from the inside, ERP therapy for postpartum OCD follows one composite parent week by week.

Where can you get postpartum OCD treatment in Toronto?

In Toronto you can get postpartum OCD treatment privately with any ERP-trained therapist, or publicly through a hospital program. Two Toronto hospital programs we checked directly:

• Women's College Hospital, Reproductive Life Stages Program. Assessment and short-term treatment for ages 18 and up, from pregnancy to one year postpartum. It lists obsessive-compulsive disorder among the conditions it treats. Referral from a physician, nurse practitioner or midwife (program page).
• Mount Sinai Hospital, Perinatal Mental Health Program. Assessment and treatment during pregnancy and up to one year postpartum, for patients and their partners. You need to be receiving perinatal care at Sinai Health, with a referral from a physician, nurse practitioner or Toronto Public Health nurse (program page).

For OCD-specific hospital care at any life stage, and for free public CBT across the province, the Ontario OCD treatment guide covers Sunnybrook's Thompson Centre, Ontario Structured Psychotherapy and the rest. Program rules change, so confirm eligibility when you or your doctor make contact.

What about medication?

Medication is a first-line option for OCD, and for some parents it's what makes the ERP doable. If you're pregnant or breastfeeding, the decision is one to make with your doctor or psychiatrist, who can weigh it for your situation. I'm a psychotherapist, not a prescriber, so I won't tell you what to take. What I will say: needing medication isn't failing at therapy.

Should your partner be part of treatment?

Often, yes. Partners get pulled in: they take over the baths, answer “do you think I'm dangerous?” at 2 a.m., check the locks for you. That's called family accommodation, and across 41 studies it was linked with more severe OCD (Wu et al., 2016). Bringing your partner into a few sessions teaches them how to help without feeding it. That's what couples ERP is for.

What should you ask a therapist before you start?

1. Do you use Exposure and Response Prevention for OCD, and how often?
2. Have you treated harm thoughts about a baby? What do you do when someone tells you one?
3. How do you explain the limits of confidentiality?
4. What would the first exposures look like for me?
5. How will we know if it's working?

If the answers are vague, or the plan is mostly talking about why the thoughts happen, keep looking. Why talk therapy doesn't work for OCD explains the difference. If you want to see how we'd answer them, here's postpartum OCD therapy in Toronto with us.