Maternal Instinct, or O.C.D.?

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I flick my eyes to the rearview mirror again and again.

He’s there. He’s there. He’s there.

Did I really see the baby? How can I be sure? How do I know that this moment is real, and that I didn’t leave his car seat on the hot asphalt of the driveway?

I don’t stop checking when I drop my infant son off with his grandma for the day. I need to make sure I haven’t left him in the back seat by mistake, where he might roast to death in the car. And so I keep flicking my eyes to the rearview mirror, again and again. He’s not there. He’s not there. He’s not there.

The constant checking makes my heart beat a little faster. It feels like I’m heading down a slippery slope toward a condition I thought I’d escaped.

Postpartum obsessive-compulsive disorder affects about 2 percent of childbearing women, about twice the rate of O.C.D. in the general population. My struggle with the disorder began in my teens. The diagnosis came after I’d spent too many afternoons sobbing in the bathroom, convinced I’d never get it clean. My parents took me to a psychiatrist, who taught me that my O.C.D. stemmed from communication errors in my brain. These errors trapped my thoughts in a distressing cycle: The bathroom is dirty. Clean it. The bathroom is dirty. Clean.

No one knows exactly what causes these communication errors — studies suggest that brain chemistry and genetics play a role — but psychiatrists do know how to treat them. Many people with O.C.D. do not get treated for it, but for those who do, medication and cognitive behavioral therapy can benefit about 70 percent. My psychiatrist prescribed both.

In therapy, I learned how to separate myself from my obsessions, ignore my compulsions and refocus my attention elsewhere. I did exposure therapy, sitting amid the soap scum in a bathtub and trying not to hyperventilate. Slowly my anxiety subsided. I still preferred a tidy bathroom, but I no longer panicked at the sight of a few hairs on the floor tile. I began to think of O.C.D. as a problem I’d solved.

Fifteen years later, I had a baby.

I spent the first few weeks after my son’s birth washing my hands over and over. (What new parent doesn’t?) I developed elaborate rituals for wiping the sink. (Who knew what germs were left over from last night’s chicken?) My mind hummed with a tinnitus of dread. (What parent isn’t nervous?)

“Things are fine,” my husband told me. “Try to relax.”

“I can’t relax. Every second I’m thinking: ‘Where is the baby? What’s the baby doing? Is he breathing? Is he O.K.?’”

“Well, that’s good. That’s what all new moms think.”

Research backs him up. Studies show that most new parents — mothers especially — can’t go more than a minute or two without thinking about their newborns.

In research by Nichole Fairbrother, a clinical psychologist and assistant professor in the University of British Columbia department of psychiatry, all new mothers had intrusive thoughts of accidental harm befalling their infant — a symptom commonly associated with O.C.D.

“I think there has to be an evolutionary component,” Dr. Fairbrother said. “We can see how the accidental thoughts are protective: What if I trip down the stairs? What if I get too close to the balcony? They impel us to behave in a very cautious way.”

Dr. James Leckman, a professor of child psychiatry, psychology and pediatrics at Yale who studies postpartum O.C.D., said he has experienced these thoughts firsthand.

“When we were expecting our first child, my wife and I changed,” he recalled. “We became much more focused on making sure everything was perfect and just right. I needed to wash under the refrigerator in our apartment. I needed to check and repaint the room.”

He added: “I often tell my friends and colleagues when they’re expecting a child, they may not be prepared for the transformative experience and the level of preoccupation that is typically associated with parenting.”

This preoccupation can feel a lot like mental illness to even the healthiest parents: a maddening blend of near-constant anxiety, sleep deprivation and stress. So where is the line between normal parental instinct — that natural drive to keep our children safe — and true mental disorder?

“We can administer diagnostic interviews and determine if the symptom causes significant distress or impairment in functioning,” Dr. Fairbrother said.

But what newborn doesn’t impair functioning? How do I make sense of my compulsions, now that they come dressed as maternal instinct?

“If you look for reassurance and you get it, that feeds into the symptoms,” Dr. Leckman said. “On the other hand, it makes sense to ensure your baby’s O.K.”

Dr. Leckman said that parents who are overwhelmed by preoccupations generally don’t talk to their babies as much as other parents do. They don’t respond to their child’s subtle cues. They may even avoid contact with their children to save themselves the discomfort of anxiety and intrusive thoughts.

It seems contradictory that such concerned parents might be worse parents, but it’s true. I think of all the times I’ve taken my eyes off the road to check on my child in the back seat. All the times I greeted my son with stony silence because I was lost in a fog of my own anxiety. My obsession with safety isn’t helping me keep him safe — it’s becoming a dangerous distraction.

For me, it turns out that motherhood is just a continuing education course in my mental illness. What I thought I’d conquered has come back in an altered form. If I want to be a good parent, I must find a better balance. I must be attentive to the risks, but also present for my son. I must face my fears and resume exposure therapy. This time, though, I’m not exposing myself to a grimy bathroom. I’m exposing myself to the world.

Now when I’m reminded of all the horrible things that could happen to my son — the accidents, the illnesses, the hot cars — I no longer push my feelings away. I sit with the dread, feel my adrenaline rise, try to welcome this newfound appreciation that I am not in control.

It’s excruciating, but it helps me keep my eyes on the road. It’s getting easier over time. And when I’ve reached my destination and am gathering my things to leave, I allow myself one quick glance in the rearview mirror to check the back seat. Just once. Just to be sure.