164. Perinatal OCD Explained: When Protective Instincts Turn Into Intrusive Fear

Summary

---

The OCD Whisperer Podcast with Kristina Orlova

Episode 164: Perinatal OCD Explained: When Protective Instincts Turn Into Intrusive Fear
Guest: Betty Flores (Perinatal Wellness)
Date: December 26, 2025

---

Episode Overview

This episode delves into the nuances of perinatal OCD, exploring how normal parental protective instincts can morph into persistent, distressing intrusive fears and compulsions. Host Kristina Orlova and guest Betty Flores aim to demystify perinatal OCD—addressing early signs, distinguishing symptoms from everyday worries, and sharing advice for both parents and healthcare providers.
The conversation is practical, compassionate, and focuses on helping listeners recognize when to seek help, what treatment options exist, and how to self-assess potentially misunderstood symptoms.

---

Key Discussion Points & Insights

1. Normal Protective Instincts vs. OCD-Driven Fear

Time: 01:45–03:59

• Protective Instincts:

  • Brief, flexible, and proportionate responses to real risks (e.g., checking if the car seat is fastened, thinking through feeding choices).
  • Anxiety or concern that settles after problem-solving.

• OCD-Driven Fear:

  • Thoughts are urgent, relentless, and "sticky."
  • Behaviors become repetitive compulsions—checking, seeking reassurance, monitoring.
  • The difference is in the relationship to the thought, not just the content.
  • Quote:

    “Normal protective instincts tend to show up briefly… Where[as] OCD driven threat feels urgent, really sticky, relentless...I really describe it as sticky and kind of this loop.” — Betty (02:20)

---

2. Common Symptoms & Signals of Perinatal OCD

Time: 03:59–06:16

• Intrusive thoughts are extremely common:

  • "What if I drop my baby?"
  • "What if I did something that will hurt my pregnancy?"
  • "What if I cause developmental harm?"

• The defining feature is compulsions:

  • Repeated checking (e.g., monitoring with a Doppler, obsessively reviewing parenting actions, checking the car seat multiple times).
  • Mental behaviors: seeking reassurance, ruminating, mentally reviewing events.

• Quote:

  “The thing that makes it OCD is the compulsive behavior, right? So am I checking every time I go to the restroom, or...getting a lot of reassurance that everything’s okay?... Reviewing could be some compulsive behavior.” — Betty (05:08)

• It’s the frequency, intensity, and inability to let go that are the clues—not just the existence of anxiety.

---

3. Mental vs. Physical Compulsions & Why Mental Loops Get Missed

Time: 06:16–07:31

• Many parents (and clinicians) mistake mental loops for normal worry.
• Providers often screen for physical compulsions (visible behaviors) and might not ask about mental compulsions (rumination, checking intentions, reassurance seeking).
• Lack of appropriate questioning can lead to missed recognition of OCD.
• Quote:

  “I think that they get overlooked because people aren’t asking...Providers might not be asking the right questions to assess for mental compulsions.” — Betty (06:46)

---

4. Challenges in Disclosure and Screening

Time: 07:31–09:08

• Parents may hide intrusive thoughts due to fear of being misunderstood or reported, especially if thoughts involve harm.
• Stigma and lack of clarity about intent vs. intrusive thoughts create barriers to honesty in screenings.
• Providers need to clearly distinguish between intrusive thoughts (common, not dangerous) and genuine intent.
• Quote:

  “If this provider really thinks that I have intent to do this to my child, I am no way going to disclose this.” — Betty (07:41)

---

5. Differentiating OCD Intrusions from Suicidal/Homicidal Intent

Time: 09:08–10:55

• With OCD, there’s typically a visceral, anxious response—"I would never want to do that"—rather than desire or intent.
• True intent involves hopelessness, planning, or lack of distress.
• Self-assessment tip:
  • If your response to a thought is fear and distress—not desire—it’s likely anxiety/OCD, not intent.
• Quote:

  “With OCD, individuals will have this like, visceral effect and like, really somatic or body response...Whereas...homicidal or suicidal, it’s that hopelessness, intent...” — Betty (10:11)

---

6. What Providers Should Know and Do Differently

Time: 10:55–12:27

• Intrusive thoughts themselves are not red flags—silence is.
• Thoughts are not facts or actions.
• Providers should
  • Normalize intrusive thoughts for perinatal individuals.
  • Assess compassionately—don’t rely only on standard tools like the Edinburgh Postnatal Depression Scale, which doesn't screen well for OCD.
  • Refer timely and appropriately.
• Quote:

  “Intrusive thoughts are not red flags, the silence is.” — Betty (11:45)

---

7. Lack of Training in Perinatal OCD Recognition

Time: 12:27–13:51

• Many providers (including mental health clinicians) lack specific training in recognizing perinatal OCD, particularly mental compulsions.
• Misdiagnosis as generalized anxiety is common.
• Quote:

  “I definitely think that there’s just a lack of education and training.” — Betty (13:48)

---

8. Does Perinatal OCD Go Away? Is It Just Hormonal?

Time: 13:51–15:28

• Perinatal OCD rarely emerges in a vacuum; patients usually have had prior symptoms mistaken for quirks or normal worry.
• It can improve with treatment, but often, untreated symptoms persist.
• Timely support leads to better experiences—treatment is effective.
• Quote:

  “If they are experiencing perinatal OCD, they likely had symptoms of OCD prior...It can obviously get better and you can get treatment for it...” — Betty (14:09)

---

9. Effective Treatment Approaches

Time: 15:29–16:51

• Exposure and Response Prevention (ERP) is the gold standard—even in perinatal cases, though it may require nuanced presentation.
• Acceptance and Commitment Therapy (ACT) can be integrated, focusing on values and motivation related to parenting.
• Coordination with prescribers for medication when appropriate amplifies results.
• Quote:

  “I do ERP...and...working really closely with prescribers...have been truly like game changers.” — Betty (16:35)

---

Notable Quotes & Memorable Moments

• Betty on normalizing intrusive thoughts:

  “It’s very common and normal for individuals in this phase of life to have some scary, intrusive thoughts...” (08:55)

• On disclosure concerns:

  “Thoughts aren’t facts, thoughts aren’t actions...” (11:47)

• On the chronic nature of perinatal OCD:

  “It's definitely something that's been chronic. It can obviously get better and you can get treatment for it and you don't have to like white knuckle through the experience.” (14:09)

---

Additional Highlights

• Encouragement:
  • Both Kristina and Betty emphasize: You are not alone, these thoughts are common, and there is help.
• Call to Providers:
  • Providers should normalize the conversation about intrusive thoughts to break stigma and encourage honesty.
• Action for Listeners:
  • Self-assess the response to intrusive thoughts: Is it fear and distress, or intent? If it’s the former, seek help without shame.

---

Resource Mentioned

• OCD Survival Kit & Support:
  • www.coraresults.com — free resources and self-help masterclasses for those seeking OCD support.

---

For Listeners

If you’re struggling with persistent, distressing thoughts in pregnancy or postpartum—know that OCD is common, treatable, and not a reflection of your intentions or capability as a parent. Effective help exists; you don’t have to navigate it alone.

---

Transcript

[A]

If you're feeling exhausted, puffy, anxious, foggy, gaining weight, or just not like yourself, you're not imagining it. Women in their 30s, 40s and 50s are experiencing massive hormonal shifts and no one is explaining what's actually happening. I'm Katie Whelan, co founder of joy. I built JOY because I lived this. The fatigue, the mood swings, the weight changes, the confusion. Your symptoms are biological, not personal, and AI generated lab reports won't fix them. Every Joy Lab includes a visit with a licensed clinician who specializes in women's hormones and connects every biomarker to how you feel, energy metabolism, mood, sleep, skin weight, everything. Then we personalize real solutions. Hormone therapy, peptide therapy, supplements and lifestyle protocols. Get [e-mail] today. This month, new customers get 50% off labs and you can add our estrogen face cream for just $1 with clinician approval. Use promo code [e-mail] when it's time.

[B]

To scale your business, it's time for Shopify.

[C]

Get everything you need to grow the way you want.

[B]

Like all the way. Stack more sales with the best converting checkout on the planet. Track your cha chings from every channel right in one spot and turn real time reporting into big time opportunities. Take your business to a whole new level. Switch to Shopify. Start your free trial today. Welcome to the OCD Whisperer Podcast. If you find these conversations grounding or helpful, please subscribe so you don't miss an episode. Today I'm joined by Betty Flores from Perinatal Wellness. Welcome to the show, Betty.

[C]

Thank you so much. I'm so excited to be here.

[B]

Hi, I'm Cristina Orlova, host of the OCD Whisperer Podcast. As someone who lives with ocd, I understand the struggles firsthand. If you're here, you're not alone. Before we start, grab your free OCD survival kit at www.corresults.com to help you take control. That's K O R results.com now let's dive into today's episode. I'm super glad you're here. And I also when I looked at your website, I saw that you focus on postpartum and pregnancy and perinatal OCD and mental health. So I thought let's dive in and talk a bit more about something pretty important that parents often ask about, which is how do you help parents differentiate between normal protective instincts in pregnancy or postpartum and and when it's an OCD driven threat or that monitoring system where we start to feel that thoughts Feel really urgent. Even though it seems like it makes sense to worry about these things, but it starts to cross that line.

[C]

Yeah, yeah, no, that's a, that's a great question. And something that I get often, right. Especially with parents of like, well, this makes sense. Or this is logical, this is a real possibility. And so it's not so much of like, is this question logical? But what is your relationship with this thought that comes up? Right. I think normal protective instincts tend to show up briefly, lead to like maybe flexibility, proportionate action, or like maybe something to kind of like buffer, like problem solve and then it settles, right? Like the angst or anxiety might settle. Whereas like OCD driven threat. Feels urgent, really sticky, relentless. I really describe it as like sticky and kind of this loop and so tends to be checking, monitoring, reviewing, which is the compulsion. Right. And like how often is this coming up? Frequency, intensity are the big things that I look at.

[B]

Okay, so you mentioned with, we're talking about perinatal. So I want to back up for a second and ask you if you can give us what are some basic symptoms, Just kind of everyday things that somebody could look out for or might pay attention to to say, oh, this might be a signal that this isn't just kind of your everyday, you know, normal process or worries because everybody can have, you know, a bad thought or worry thought or things pop in. But there is definitely a distinction between when it really is more perinatal ocd. So what would be some of those kind of maybe top symptoms that you know of that somebody could be paying attention to?

[C]

Excuse me. I think what you said is very valid, right? Like a lot of the research shows that I think 80 to 100%, depending on the research study, that people have intrusive thoughts of, like, what if I drop my baby? What if harm comes to my baby? What if I get in a car accident or during pregnancy, right? What if I ate something that then causes me to lose this pregnancy? So a lot of what ifs or intrusive, scary images that can pop up. The thing that makes it ocd is the compulsive behavior, right? So then am I like checking every time I go to the restroom or am I like utilizing a Doppler or getting a lot of reassurance that everything's okay in the pregnancy, right? Or postpartum? Am I then getting reassurance that I'm doing everything perfectly parenting, right? Even with a baby or doing everything I can with attachment in order to not maybe harm my baby developmentally? Or am I doing safety Behaviors like making sure that I check the car seat multiple times. Right. Or like everything that I needed to in order to maybe provide my baby with the best nutrition if I'm nursing. Right. Or did I pick the right and perfect breast or like formula. Right. So a lot of checking behaviors could be physically, it could be mentally of like, no, I did everything okay, or I, you know, and maybe reviewing even could be some compulsive behavior. So really, really emphasizing am I compulsing or am I doing some safety checking to ensure that this possible intrusive thought image urge won't happen?

[B]

Yeah, I almost hear like this like exaggerated over the top repetitive thing you're doing just over and over and over and like that's a big clue. Or like you said, it's not just like your average thought, but that you are consistently stuck with it. And so that leads me to my next question, which is in perinatal ocd, how do you see mental compulsions like reassurance loops, reviewing intentions or checking emotional, maybe rightness even? How do they get overlooked compared to physical behaviors?

[C]

I mean, I, I think that they get overlooked because people aren't asking, right. Or people whether if it's the individual themselves, it's like, well, this is normal worry, right? Like every parent worries. Every parent thinks about this because they want to protect their child. And in regards to providers, I think they're looking for physical compulsions, but they're not actually. They might not be asking the right questions to assess for mental compulsions. Like, okay, tell me more about like what your, what thoughts are coming up for you and really exploring it that way.

[B]

So then how do you think screening tools and maybe some safety protocols sometimes make parents with prenatal OCD maybe less honest about their thoughts? And what can providers do to reduce that?

[C]

Yeah, I think many individuals, parents feel judged, right. Have this fear of being reported or misunderstood or, or depending on the thought. Well, I think going back of the being reported, right, like if this provider really thinks that like I have intent to do this to my child, I am no way going to disclose this, right? Or like, what if I really want to do this to my child and I don't actually know? And there's a kind of that confusion that can happen in OCD of like, oh, is this really me as a person and I just don't know. So really wanting to protect them and, and you know, their child in this process. In regards to providers, I think I know for me in my practice, I very much, during even the initial maybe assessment or intake of talking about, like, when I do have to report, like, hey, everything in here is kind of going over my confidential confidentiality spill. And also being like, I, like.

[B]

I.

[C]

Know the difference between an intrusive thought and maybe one that has intent. Right. Where you might be homicidal or suicidal. Right. And I'll then go through the differences within that and how I might ask that. So I think really being forthcoming and asking some of those hard questions and normalizing intrusive thoughts in this phase of life. Right. It's very common and normal for individuals in this phase of life to have some scary, intrusive thoughts and then listing what some of those might be.

[B]

Yeah. So I kind of want to like, hone in on that a little bit if we can, because I think there's a lot of confusion that can happen between, you know, but do I want to harm myself or do I want to harm my baby? Or. I don't. I don't think I want to, but what if I do and I'm not sure, or the, you know, because I'm thinking this, maybe that means something. So I know for people listening, those are such kind of heated questions. And I know you, you know, you do this in your clinical practice, but can you share with us maybe what is a way somebody who's listening, how can they tell the difference? What could be one way that they can kind of self assess, perhaps, like, if this is actually somebody being suicidal or wanting to harm versus no, this is really driven by my anxiety and my. Or my ocd.

[C]

Yeah, no, that's a great, great question. And the way that I tell clients too is like, typically with ocd, individuals will have this, like, visceral effect and like, really somatic or body response. Right. Of being like, oh my gosh, I had this thought I would never want to do it, or I don't want to do that, or that was really scary. Why did I have that? Whereas, like the latter of being maybe homicidal or suicidal, it's like that hopelessness, intent kind of. Or hopelessness depressive. And not to say that, like, you can't have OCD and that can lead to that. But to go back to your question, it's really like, what is my response to that thought? And typically it's that, like, fear angst. I would never want to. Why am I having that thought?

[B]

That makes sense. So that, that's a really great distinction. That. Yeah. Like, this is, this is something that you, you are not actually wanting, you're not actually desiring, but it it's coming up and you're kind of just getting stuck and scared. Well, let me ask you, what do you wish every, you know, OB or midwife or primary care physician understood about perinatal OCD that would change perhaps how early people get help?

[C]

Yeah, I mean, one, I wish they had the time and space to assess. Right. Because the EPDs, which is the Edinburgh and is typically given out, doesn't. Doesn't really assess for that. Right. But ultimately the, like, intrusive thoughts are not red flags, the silences. Right. So being able to. For them to really recognize that, like, thoughts aren't facts, thoughts aren't actions, and OCD or these intrusive thoughts come up often after big identity shifts, lack of sleep. Right. Roles shifting and changing. Yeah. And so really trying to, I think, better educate providers in order for them to show up and when assessed, to be able to refer out appropriately and also like, normalize, validate, give compassion to these parents so that they want to seek support.

[B]

Do you think in general that OCD has, that there's enough training, I guess, for people to really recognize what it is if they're seeing people and to create enough kind of comfort to talk about the stuff? Or do you think kind of what I'm hearing is that they give this one. It sounds like assessment kind of screening tool, and that's roughly it. So is your sense that, like, truly across the board, basically, that everybody can. Should get a little better education about ocd?

[C]

I would say that there definitely is, including myself, where I've had to have some humility. Right. When getting my own training and realizing and recognizing that, oh, I missed. Probably missed, you know, quite a few clients or did some disservice. And. And I think that's part of growing as a clinician in general. But I definitely think that across the board, if. If providers, regardless of. Of where you're at, are going to support pregnancy, postpartum, or even those looking at expanding or starting a family should have some knowledge, education to at least be able to see some of these red flags, to be like, oof, I think this might be ocd. And who can we get you to, to further assess? But I definitely think that there's just a lack of education and training.

[B]

Yeah. And so I think I have one more thing, because I know people generally, I've noticed, ask the question of, you know, does this go away? Does prenatal OCD just go away? You know, is it hormones? And maybe once hormones, you know, readjust, does everything just stop? Does it. Or can it go away. So what's your experience with that?

[C]

Yeah, I would say that my experience is if they are experiencing perinatal ocd, they likely had symptoms of OCD prior. And so as I'm doing some history work, right. I'm like, oh, this is actually ocd. And they thought that it was just a quirk or like they, it was just normal worry, you know, or providers had diagnosed them with anxiety. And I think part of that too is some of the mental compulsions. Right. Not a lot of providers are educated or have had training in regards to mental compulsions and have misdiagnosed that for generalized anxiety. So I would say that from my experience, it's definitely something that's been chronic. It can obviously get better and you can get treatment for it and you don't have to like white knuckle through the experience. Right. And the sooner you actually get support, the better the experience can be.

[B]

So it sounds like it doesn't. It's not like it has to be there forever, but you. If, if it's on and it's there, it's like, it's like everything's kind of come online, then it's there. And you probably already had that predisposition.

[C]

So.

[B]

Yeah. So I guess if people want to know, like, well, does it go away? It's like, well, I guess, you know, you can, you can tame it if you, you know, do the, do treatment therapy, learn what it is, what's happening, how, how the whole city brain is working or not working properly.

[C]

Totally.

[B]

And kind of can you let us know from your experience what. Well, for you, at least in your practice, what kind of work do you see actually help Perinatal OCD or postpartum?

[C]

Yeah, So I, I do erp, so exposure response prevention. And I have found, I know that some providers have a difficult time with it, especially in the perinatal period. Right. And feel like it's very rough around the edges. But I have found that it works beautifully and there's like a way to finesse it for this population. And not necessarily in the way of like, you're changing the treatment modality, but it's how you're presenting it. Right. Really presenting and teaching like the, the learning that they're going to gain from this. Utilizing acceptance commitment therapy within erp. Right. And like really being able to utilize their motivation, their values, um, and how they want to show up for, for them and parenthood and also their kiddos. Um, I would say that and a combo of like working with, working really closely with prescribers that support OCD with medication management have been truly like game changers.

[B]

Got it. Okay. I love that. Thank you so much. I really appreciate you coming on the show and sharing all of this information with us.

[C]

Yes, thank you so much. I, it's, it's been an honor and I love your show. It has such a great variety of like guests and seriously, such so much information in a short amount of time which is tangible. I think that's awesome.

[B]

I'm really glad to hear that. That, that's kind of the, the goal and the intention. And if I may, for any of you that are watching, if you found this useful, please subscribe and grow with us. Thanks for being here today. Thanks for listening to the OCD Whisperer podcast. Remember, freedom from OCD is a journey and you're not alone. Visit www.coraresults.com to explore self help masterclasses like Sneaky Rituals with Jenna Overbaugh or ICBT Masterclass with Christina and Abe. Don't forget to grab your OCD CBT journal tracker and planner while you're there. If you found this episode helpful, please subscribe, share and leave a five star review to help others find the podcast. Together we can make a difference. Keep going and I'll see you in the next episode.

[A]

If you're feeling exhausted, puffy, anxious, foggy, gaining weight, or just not like yourself, you're not imagining it. Women in their 30s, 40s and 50s are experiencing massive hormonal shifts and no one is explaining what's actually happening. I'm Katie Whelan, co founder of joy. I built JOY because I lived this. The fatigue, the mood swings, the weight changes, the confusion. Your symptoms are biological, not personal, and AI generated lab reports won't fix them. Every Joy Lab includes a visit with a licensed clinician who specializes in women's hormones and connects every biomarker to how you feel. Energy metabolism, mood, sleep, skin weight, everything. Then we personalize real solutions. Hormone therapy, peptide therapy, supplements and lifestyle protocols. Get [e-mail] today. This month, new customers get 50% off labs and you can add our estrogen face cream for just $1 with clinician approval. Use promo code [e-mail].