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.