What’s Normal and When to Get Help

What Are Intrusive Thoughts, and Why Do They Happen in Postpartum Depression?

“When we talk about intrusive thoughts, what we mean is these thoughts just pop into our head all of a sudden, and we’re like, ‘Whoa, where did that come from?’” says Milicent Fugate, MD, a reproductive psychiatrist and the director of the day program at the Motherhood Center in New York City, where she specializes in treating people who are pregnant, postpartum, or trying to become pregnant.

“The thing I like to remind people about intrusive thoughts is that they’re actually very common in the postpartum period,” says Laudy Burgos, LCSW, a licensed clinical social worker, board member of Postpartum Support International, and the associate director of social work in the women’s and children’s division at Mount Sinai Hospital in New York City.

“I always describe them as these unwanted, distressing thoughts or images that usually have to do with the safety of the baby,” Burgos says. “Whether that’s involving harm coming to the baby or even Mom causing harm to the baby, these thoughts are typically what we call ego-dystonic. And what that means is that they’re not consistent with the parent’s values or intentions.”

Some common examples include:

• Your baby falls down the stairs.
• A car hits you and your baby while you’re crossing the street.
• The baby flies out of their car seat.
• The baby falls off the changing table.
• You get so upset you shake the baby.
• You smother, suffocate, or drown the baby.
• You sexually harm the baby.

Sometimes, it’s a matter of your brain working in overdrive, scanning for potential danger, such as when you’re carrying your newborn downstairs, handling sharp objects around your baby, or crossing the street with your stroller, Dr. Fugate says.

“The brain is trying to protect something that feels incredibly precious and vulnerable. You’re going through hormonal changes, and a lack of sleep could really make your anxiety and your emotional reactivity more intense, but you’re also changing your role. It’s almost like having that animal instinct that’s there to protect,” Burgos says. “And sometimes that protective system becomes overly sensitive … your brain becomes especially alert to potential threats or harm.”