Lawrence et al have written about intrusive and unwanted thoughts of intentional harm to infants in the context of maternal postnatal depression, anxiety, and obsessive compulsive disorder (OCD). 1 We know that these thoughts are common in new parents, not only affecting almost 50% of mothers, 2 but also fathers. Their advice to health professionals is to normalise these thoughts for concerned parents with reassurance and to understand that by themselves the thoughts signify nothing sinister. The thoughts become significant when they interfere with the ability to live a normal life because the level of distress is so high, linked to the personal meaning of having the thought, rather than the specific content. These parents have no intention of harming their child. This is very different from a 'delusion', when a mother with psychosis or depression absolutely believes that her thoughts are real. However, in the list of possible intrusive thoughts given, they do not include common examples of the most violent and repugnant thoughts that parents can experience, such as sexual abuse and cutting with knives. As a result, parents make elaborate plans to ensure these things cannot happen by avoiding changing nappies and refusing to cook, respectively. Not surprisingly, comorbidities with anxiety and depression are common. Parents are extremely unlikely to disclose these thoughts spontaneously because they are afraid that social services will be informed, and the child removed. But health professionals are not used to hearing such awful thoughts expressed; a knee-jerk referral to social services is very possible. Within the context of perinatal OCD or depression and anxiety this would compound the damage and feed into the parents' worst fears. GPs need to understand the condition of perinatal OCD and make the right diagnosis so that the optimum treatment is offered and social services are not involved. 3 The treatment of choice is psychological cognitive behavioural therapy (CBT) with exposure and response prevention treatment (ERP). For more information, visit https://maternalocd.org/.
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