Episode 24: OCD, Intrusive Thoughts, and Motherhood: What Nobody Talks About
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Erin Leech (00:38)

Hey friend, welcome back to In the Middle of It. So to wrap up May and Mental Health Awareness Month, you heard me talk a couple of episodes ago about my postpartum experience. And I mentioned in there that I got my OCD diagnosis at the Women & Infants Day Hospital program. And I said I was going to save that for its own conversation.

Because it really does deserve more than just a fleeting mention in an episode. So here we are. This is that conversation. And my goal is to shed a little bit of light on my experience of OCD and a lot of moms' experiences of it — especially postpartum and how it can show up.

This is not going to be a clinical breakdown by any means. I'm not a psychologist or a therapist. I am just another woman who got diagnosed in her early thirties, postpartum, after a lifetime of thinking that a lot of the things I experienced due to OCD were actually just me.

And I feel like in general, OCD can be so misunderstood and misrepresented in these really stereotypical ways. So I would love to elaborate on some of the more unseen parts. And hopefully there is another mom out there who's experiencing something similar and can see herself in what I'm describing. If that is you, I want you to know that you are not broken and you are not a bad mom.

And hopefully if you resonate with this episode, it can spur a little motivation to either talk with your current provider or therapist about what's been going on, or to find somebody you can talk to and get the help that you deserve. Because a lot of these things with OCD can feel very personal — like they are you. Like you can tie them to your identity and just say, this is just how I am. And in reality, it is absolutely not. And there is so much better on the other side of getting help, speaking from personal experience.

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Erin Leech (03:15)

So first things first. When most people hear OCD, you think of a very specific stereotypical image. The rituals, the superstitions. The person who has to go back and check the stove or the hair straightener three times before leaving the house. The light switch that has to be flipped a certain number of times or something bad is going to happen. Needing things organized in a particular way, lining up your pens on your desk — that kind of really stereotypical clean freak or organization type of thing.

And yes, those things are absolutely a part of OCD. Those are very real experiences of OCD. But it is such a small slice of how somebody can actually experience it. And the fact that it just gets thrown around casually in conversation is not really helping anyone. You know, like — oh my gosh, I'm so OCD about how I load the dishwasher. Little phrases like that get thrown around and they kind of dilute the true meaning behind it.

And I used to say stuff like that all the time too, before I knew. Even still, I didn't know at the time. I was just using it to describe something really simple.

So in the most basic, straightforward way that I can — as again, not a psychologist or a therapist, just a woman with OCD, postpartum anxiety and depression, and yes, a bachelor's in psychology and a master's in community health education, because those do stand for something — I would love to share a little bit about what OCD is and what it can look like.

OCD stands for Obsessive-Compulsive Disorder, which I'm sure most people know. And I never really understood obsessions versus compulsions until I was diagnosed and got my own education on it for obviously personal purposes. The obsessions are probably a little easier to understand — they're the unwanted intrusive thoughts or urges that show up and cause distress. Compulsions are the behaviors or even mental acts that somebody does in response to those thoughts, usually to try to reduce the anxiety or make the thought feel a little less threatening.

And as you can imagine, compulsions will provide temporary relief — usually. But they also reinforce the cycle. You do the compulsion, but it's only temporary relief. So the obsession pops back up. And you feel like the only way to deal with it is to do the compulsion again. And the more you try to neutralize the thought, the more it comes back.

Versus what I know now — when those intrusive thoughts come through my mind, I can see them for exactly what they are. Having the diagnosis really helps, because I can recognize a thought as just that: an intrusive thought. Versus before, when it felt like it was truly me, Erin, thinking these things. It was a lot harder to separate myself from them.

But now, thanks to a lot of treatment, I can see it and almost talk to it. Say — yeah, that could happen. It's not impossible. But it's most likely not going to happen, so I'm not going to worry about it right now.

Towards the end of this pregnancy with Lewis, I had a lot of fear-based harm type intrusive thoughts — worrying that if we're all in the kitchen, I might drop a knife and Leon could get hurt, something like that. And I can see that thought come through now for what it is. I can say to myself — yep, that's entirely possible. I could drop it, it could slip, something bad could happen. And also, it's probably not that likely. So I see the thought, and I watch it float away.

One of the exercises I did in one of my programs — and this wasn't even specific to OCD, but it's really helpful with intrusive thoughts — is imagining your thoughts as leaves floating down a stream. And I have a very visual brain, so I can actually see the river, see the leaves floating along. And I can almost physically extract a thought out of my mind, put it on a leaf, and watch it float away downstream. Sometimes the thought comes back and I have to do it again. But the point is that I can recognize it. I can name it. And I know it's not me.

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Erin Leech (09:42)

So there are actually a lot of different subtypes of OCD — which I had no idea about until I was diagnosed. There's contamination OCD, checking OCD, harm OCD, pure O which is more thought-based, symmetry and order, and so many more. The one that's most prominent for me is called "just right" OCD, which I'll get into in a minute. But it was really the harm OCD that blindsided me — because of the intrusive thoughts that came with it and what I had made them mean about myself.

It was blindsiding in a positive way, ultimately, to realize that those thoughts were not actually me. So let's go a little deeper into that first.

I want to acknowledge, both from my own experience and from what I heard from other moms at the day hospital program, that intrusive thoughts are often the hardest thing to talk about. And that's a big reason why it can go so overlooked in a lot of women — because we feel so much shame around the thoughts we're having, and we don't understand why we're having them. So we keep them inside. We don't talk about them. Which means nobody knows. Which means nobody can help us.

Harm OCD involves intrusive thoughts about harming yourself or someone you love. And when I say intrusive, I mean they come out of nowhere. You absolutely do not want to be having them. And they are completely opposite to what you believe and everything you feel. The technical term for that is ego dystonic — meaning they go against your own values, your morals, your identity. They are not desires. It is basically your brain misfiring and presenting you with the thing that horrifies you most.

For me, postpartum with Leon, I had a lot of those thoughts. And they would come up most often during moments of extreme distress. To be clear — I did not want to hurt myself. I did not want to hurt Leon. That is exactly the point. The reason those thoughts were so distressing was because they were so completely against everything I felt. I love my son. I don't want anything to happen to myself. And yet there was my brain, bringing up these really graphic scenarios, these what-ifs, these awful images.

I can remember standing in Leon's nursery, holding him, probably during a hard nap attempt because that was often a trigger for me — looking at this closet in his room, and just this really gruesome thought crossing my mind. And even now, to revisit that moment is mildly distressing. Not nearly as bad as it used to be, because I know now. But still — the thought that my brain can even conjure something like that up.

And then the spiral: what kind of mom could I possibly be? How could I be a good mom if my brain even goes to this place? What is wrong with me?

And that shame kept me quiet for a very long time. I didn't tell anyone. I didn't even tell Scott — I don't think I told him until after I had the diagnosis, honestly. Because how do you say that out loud? How do you tell the people who love you that you've been having really dark, graphic thoughts about yourself and your baby? When you're already in a culture that scrutinizes mothers so heavily, the fear of what someone might think — or do — with that information is terrifying. I don't want to tell my doctor because she's going to call DCYF. My husband is going to leave me. My mom is going to — I don't know, something. And your brain just spirals further into the wild when you don't know that it's not you thinking it.

And I really wish I had someone earlier to tell me: these thoughts do not make you dangerous. They do not make you a bad mom. And if you have experienced something similar, neither are you. The reason those thoughts are so distressing is because you are a good mom. Somebody who actually wanted those things to happen wouldn't be horrified by having them. The horror is the proof.

Once I understood that these thoughts were ego dystonic — that they were not tied to my identity, not a reflection of who I am — I could start to separate myself from them. These thoughts were happening to me. They were not me.

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Erin Leech (17:20)

So how did I actually get the diagnosis? And when did I finally start talking about any of this?

I kept all of it quiet for a really long time. I figured it was just how my lack of emotional regulation skills was manifesting, given how much I had on my plate — the identity shift, the change in my career and business, all of it. I knew I had an incredibly active visual imagination, so I kind of just chalked it up to that. Just figured that's how I'm wired.

I was already in the day hospital program at Women & Infants for my postpartum anxiety and depression when I finally decided to be fully honest with one of my providers. Her name was Stephanie — she was my therapy provider there. We were talking one day, and I saw an opening. I had just had a really awful intrusive thought — probably one of the most intense harm-based ones I had experienced. And I just needed to get it off my chest.

So I told her. Not a glossed-over version. The thoughts and the nature of them and what they were like. I tried to be as specific as I could because I knew it would help her understand what I was actually dealing with. And I also kind of hoped it would show her — this isn't me. I don't want to be thinking these things.

And as I watched her face while I was talking to her, instead of alarm or concern or any of the reactions I was bracing for — I saw this spark. What I can only describe now as recognition. I know now that she had her own personal experience with OCD and specifically postpartum. So she probably saw herself in me in some way, as well as recognizing it clinically.

She asked a few more clarifying questions. I answered as honestly as I could — crying through most of it, because it was both hard to get the words out and also such a relief to finally say them out loud. And at the end of it, she just looked at me and said: I know exactly what's going on. You have OCD.

And my first reaction was honestly — great. Another one. I've joked for a long time that I have alphabet soup when it comes to mental health diagnoses. ADHD, postpartum anxiety, postpartum depression, and now OCD too. Another one, really?

But I've come to terms with all of it. And I've kind of embraced my alphabet soup, so to speak. Because what I've realized is that these diagnoses put a name to so many things I had experienced my whole life that just felt like — well, that's just Erin. This is just me being me. And in reality, no. My brain is just apparently wired really differently. For better or for worse, depending on the day.

After that conversation, I talked more with Stephanie and my other providers, and also with the woman who ran the OCD treatment program at Women & Infants. And the more I learned about OCD, the more things clicked. Not just the postpartum stuff — going all the way back through my life. Things I thought were personality quirks. Things that felt like just being really particular and organized. This slow dawning realization that oh — a lot of this has a name too.

And it was a lot to grapple with, even though it also felt reassuring. Because here I am, a couple of years past my ADHD diagnosis, having already gone through that whole process of realizing things I'd attributed to my personality were actually my brain being wired differently. And now learning that OCD had also been wiring my brain differently in all these other ways. So now these other things that felt very integral to who I am — were also not really me? Then who am I?

And on top of the identity transformation already happening from becoming a mom, it really threw me for a loop for a few weeks. They were encouraging me to consider the OCD treatment program, and it took me a while to even embrace and accept the diagnosis, let alone think about treatment. Because it genuinely felt like — I don't even know who I am anymore.

Eventually I got past that. And it started to become a little funny, truthfully.

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Erin Leech (25:08)

Fast forward to being in the IOP program — the OCD Intensive Outpatient Program at the hospital. And there would be sessions where the provider leading the group that day would describe some OCD tendency. And I would either internally or actually out loud just start chuckling to myself, because it was something I had done my whole life and thought was completely normal. Just a quirk. Just me being me. Nope. OCD.

And a lot of those moments were around what's called "just right" OCD — the subtype that is most prominent for me. It is really sneaky. Probably pretty underrecognized. And can very easily be written off as just being a particular person.

"Just right" OCD is, very simply: things need to feel a certain way. They just need to feel right. And it's usually not for a logical reason you can articulate. If something feels off — wrong, uncomfortable — you can't move on until it's been corrected. Until it feels right again.

A small example from my own life that honestly makes me laugh now: I have a big floor lamp in my living room and a smaller table lamp on the other side of the couch. Before we had Leon, I would get up early with Scott when he left for work and have my morning routine — journaling, all of that. And I would always turn on just the little table lamp. Over time, that lamp started to feel like morning light. And the big floor lamp started to feel like evening light — we'd turn that one on when the sun went down.

So if I turned on only the little table lamp at 8 PM, it wouldn't feel right. It gave me the vibe of 5 AM and my brain knew it wasn't 5 AM. So I'd have to turn on the floor lamp too, or switch them. And had to is sort of fluid — sometimes I could push past it. But a lot of the time, no. Something had to change or it just felt wrong.

And then there are sensory things I genuinely thought were just quirks of mine — or maybe even a little bit of autism, which still could be entirely possible, honestly. But like, I cannot wear a long sleeve shirt under a sweatshirt. I have tried numerous times over the years and I just cannot do it. It doesn't feel right. Even if everything is perfectly aligned. Or the seam of my leggings getting twisted around my leg. Or the way Scott loads the dishwasher.

And I know that last one sounds like a really relatable married couple thing. And for a lot of people it genuinely is just a preference. But for me, it would spiral. If I saw plastic things in the bottom rack that I knew should be in the top rack, I had to move them. I couldn't move past it. And I would worry about melting, about BPA leaching, and my brain would just keep going and going.

And that distinction — preference versus rule — is actually really important. Most people have preferences about how things are done. If it doesn't happen that way, they can shrug and move on. For a person with OCD, it's more like a rule. And when the rule is broken, it's not just annoying — it's genuinely distressing. You cannot let it go.

Another place this really showed up for me: event planning. Party planning. Hosting. I would stress so hard about even having our small family over for Christmas — my mom, my brother, my mother-in-law, my brother-in-law. Why do I care so much? They don't care if it's Pinterest-worthy. But I really struggled with letting anybody help me because things needed to be done in a specific way. It was just easier to do it myself than to deal with the anxiety of watching someone else not do it how I wanted. And if I did let somebody help, I would go back and check everything and rearrange whatever they'd done.

So as I was going through the IOP program and getting towards the end of it, we were asked to come up with a personal milestone — something that would mark real transformation, not just clinical progress. And I chose Leon's first birthday party.

If I could get to that party and let other people help me set up and just leave it — or if I could call things good enough without freaking out or spending an egregious amount of money on specialty decor — that would mean something. Growth I could actually see and feel.

And I did get to Leon's first birthday party. It was Harry Potter themed, something I had been envisioning for months. I made this Diagon Alley entry setup that ended up being more of an undertaking than I anticipated. And I had this vision for it to be more polished than it ended up being — but I stopped myself and said, this is already more than the average person would do. Leave it alone.

And then it rained that morning. Everything got all wonky. I had to let people help. A friend put up the little pennant signs and the house banners and the Hogwarts sign on the bouncy castle. It wasn't exactly how I had imagined it — she didn't have specifics from me, so she just did her best. And it was fine. It was totally fine.

Being able to get through that without losing it — the only real stress that day was the rain messing with the timing and the fact that I wasn't even dressed when people started showing up. But in terms of the setup, letting people help, letting go of the things that didn't really matter? I was genuinely proud of myself. And it meant more to me than any clinical metric because it was so personal. Even Scott could tell I was rolling with it better than I normally would have.

Still a lot of room for improvement. But those first little sips of progress felt monumental.

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Erin Leech (36:52)

And speaking of postpartum specifically — OCD really ramped up in a particular way when it came to letting other people care for Leon.

It was so anxiety-provoking to even think about my mom coming over for a few hours so I could run an errand or go to an appointment. And sometimes if I was still home while she was watching him — that was almost worse. Because I'd hear him fussing and immediately think, it's not worth it. It's not worth him being distressed. And I felt like such an awful mom for even having someone come over. But in reality, babies cry. A lot. And I just could not deal with someone else being the one caring for him.

The first time we left Leon for a few hours was for my birthday. We went to Foxwoods with my two best friends. And I wrote out these intense, detailed instructions — feeding schedules, how to console him, all his little quirks and intricacies. And the first time someone else did bedtime with him, I wrote out the exact routine. The sound machine — turn on this sound first, then switch to this one. Feed him first, then the sleep sack, then this, then that. Don't leave the light on or it'll stimulate him and he'll be up all night. Or actually — go in and turn it off rather than just leave it, because the risk of him waking felt less worrisome than just leaving it on.

All these little places where I had to surrender control — that is really where OCD showed up most as a mom. And honestly, it still does.

Right now, as I'm recording this at the end of May, Lewis — our second son — is ten weeks old. And we have a wedding coming up in New Hampshire. Scott is in the wedding. And we've decided to pay for a whole Airbnb so our moms can come with us. That logistically made sense, yes. But it's also, if I'm being honest, a little tongue-in-cheek acknowledgment that I am just not ready to leave Lewis in Rhode Island for three days while I'm in New Hampshire. It would not be an enjoyable experience for me to be up there worrying.

And I'll still write things down for our moms. There is a level of that that is just normal and reasonable — he's a two-month-old with his own little quirks and wonky things happening right now. But I also know it won't be as pinpoint detailed as that first bedtime checklist was with Leon. And that, too, is progress.

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Erin Leech (42:15)

So to wrap up — I don't share any of this because I want to over-share my personal medical history just for the sake of sharing. I do it because OCD is wildly misrepresented in our culture. And the version that gets talked about — the cleaning rituals, the checking, the casual "I'm so OCD about that" — it leaves out an entire world of people who are suffering and don't know why. Who think that these thoughts and these experiences are just them. Who have never considered that there's a diagnosis that explains it, let alone a treatment that actually helps.

And I specifically think about moms. Because postpartum is such a significant trigger window for OCD. The hormonal shift, the sleep deprivation, the enormous weight of being responsible for a tiny human being — it creates exactly the conditions where OCD can escalate dramatically. And a mom who starts having intrusive thoughts about harming her baby is not just going to casually bring that up at her six-week checkup. She is going to carry it alone. She is going to be consumed by it while also trying to keep her baby alive. And I just really want that to change.

If I can help one woman who listens to this and realizes — so you mean I'm not a terrible mother? — and it gets her to talk to someone, then sharing my experience will have been worth it.

So if something in this episode felt familiar — thoughts you've been too ashamed to say out loud, things that have to feel a certain way before you can move on, rituals or checking that doesn't actually make you feel better — please talk to somebody. Maybe it's your partner. Maybe it's your best friend. Or ideally, if you feel like you're really struggling, find a therapist who specializes in OCD and look into ERP — Exposure and Response Prevention therapy. Or an IOP program like the one at Women & Infants.

And to say this one more time, as clearly as I possibly can: having these thoughts does not make you a danger to your child. It does not make you a bad mom. The horror that you feel about those thoughts is the proof that that's not who you are. It is just your brain doing something it was never supposed to be doing at that volume. And there is real, evidence-based treatment that works.

You are not even close to being the only one.

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Erin Leech (46:30)

OCD is not a punchline. It is not a personality trait. It is not just being really clean or really organized. That is an aspect of it — but for a lot of people, and a lot of moms especially, it is a real and significant thing that can affect daily life, relationships, finances, and your sense of self. And it deserves to be talked about with the same seriousness and compassion as any other mental health condition.

I'm really grateful that I got the diagnosis when I did. That Stephanie asked the right questions, and that I finally decided to just tell the truth. Because having a name for something was just the beginning of doing something about it. And it's what got me to where I am now — where I can navigate life and navigate the intrusive thoughts that are showing up again postpartum with Lewis, and have an entirely different experience with them. Because I know they're not me. I know how to work with them. And I have medication that helps me with that too, which is also nothing to be ashamed of.

If you have questions, if something resonated, if you just want to talk about any of it — my DMs are always open. Instagram at @iamerinleech, TikTok at @erinleech, or my website erinleech.com.

Maternal mental health is a topic that is really close to my heart and it is a big reason for doing what I do. I hope this lands for somebody who needed it today.

As always, I am Erin Leech. This is In the Middle of It. And this week's reminder: your brain can think some really messed up thoughts. But the fact that it bothers you — the fact that you care — means you are not a bad mom. I'll see you next week.

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EDITOR'S NOTE — FLAGS TO REVIEW:

1. (Around 40:12) — IOP definition: Erin says "IOP stood for intensive occupational program, question mark — I don't actually remember." The correct expansion is Intensive Outpatient Program. Confirm before publishing and update the transcript accordingly.