Every time I held my son in those first months, my brain showed me the same terrifying image: dropping him. Not tripping, not stumbling — just letting go. What made it worse was that we were living in a basement apartment at the time, where the floors were hard beneath thin flooring. I could picture exactly what would happen if he hit the ground, and the image replayed in my head on a loop.
I knew enough to recognize it for what it was. I have OCD, so intrusive thoughts weren’t new to me, even if this one felt especially brutal. But knowing it was an intrusive thought didn’t make it disappear. And if you’ve never experienced intrusive thoughts before, they can feel incredibly convincing, making you question yourself in ways that are hard to explain. “Most mothers interpret intrusive thoughts as evidence that something is profoundly wrong with them because the content feels incompatible with who they are,” says Karen Kleiman, MSW, LCSW, founding director of The Postpartum Stress Center.
The truth is, if you’re experiencing intrusive thoughts during postpartum depression (PPD), you’re far from alone — and having them does not mean you want to hurt your baby.
Why Moms Stay Silent
No one wants to say out loud that they’re having distressing, unwanted, or even violent thoughts about their baby. For many moms, the fear of what those thoughts mean — or how someone else might interpret them — is exactly what keeps them buried. “Many [moms] are told that the postpartum period should feel happy, natural, and full of bonding,” says Laudy Burgos, LCSW-R, PMH-C, vice chair of the board of directors at Postpartum Support International. “So when scary or intrusive thoughts show up, [moms] often feel alone, ashamed, or frightened by what is happening in their own mind.”
That silence can make things feel even heavier. “Shame thrives in silence and the more a mother conceals the thoughts, the more isolated and convincing they become,” says Kleiman. And for many marginalized moms, opening up can feel especially complicated. Burgos notes that Black, Latina, immigrant, queer, and other marginalized parents may carry added fears shaped by discrimination, surveillance, or punitive systems, making disclosure feel risky rather than supportive.
Why Providers Miss It
Part of the problem is that PPD screening tools aren’t always designed to catch intrusive thoughts in the first place. “Intrusive thoughts are frequently overlooked because many screening tools focus primarily on depressive symptoms such as sadness, tearfulness, or hopelessness,” says Burgos. In other words, if a mom isn’t presenting in ways providers typically associate with depression, what she’s experiencing may go unnoticed.
There’s also a bigger gap in how we talk about postpartum mental health. “We don’t routinely prepare new mothers for the reality that unwanted, disturbing thoughts often emerge during the postpartum period,” says Kleiman. “When they appear, mothers are left to make sense of them alone — often against a cultural backdrop that expects joy, gratitude, and instinctive competence.”
The result is a frustrating disconnect: providers may not be asking the right questions, and moms often don’t know that intrusive thoughts can be a symptom in the first place. When no one names what’s happening, it can feel terrifying — and deeply isolating.
What Your Reaction Really Means
If an intrusive thought leaves you feeling horrified or panicked, experts say that reaction is actually important. When I pictured myself dropping my son on the hard floor of our apartment, the image terrified me precisely because it was something I never wanted to happen.
“When she responds with fear, horror, or an urgent need to push the thought away, this is typically a sign that the thought is ego-dystonic — meaning it is inconsistent with her values and fundamentally, who she believes herself to be,” says Kleiman. In other words, the distress you feel can reflect just how deeply you care. “The intensity of her fear mirrors the depth of her investment in protecting her baby,” Kleiman says.
This Doesn’t Make You Dangerous
Having an intrusive thought and being at risk of acting on it are not the same thing. “Research shows no association between anxiety-driven intrusive thoughts and an increased likelihood of acting on them,” says Kleiman.
When providers assess safety, Burgos says they’re looking at much more than whether a thought exists — including intent, emotional response, symptoms of psychosis, and overall functioning. As distressing as intrusive thoughts can feel, having them alone does not mean you’re dangerous or say anything about who you are as a mother.
What To Do — And When To Get Help
Here’s the most important thing to remember: a thought is not the same thing as intent. “The first step is to name it: This is an intrusive thought. This is anxiety,” says Kleiman. “Naming creates distance and reinforces the critical distinction that a thought is not the same as intent, desire, or danger.”
As hard as it feels in the moment, experts say trying to push the thought away can sometimes make it feel louder. Instead, the goal is to change your relationship to the thought so it feels less urgent and scary over time. And if intrusive thoughts start interfering with sleep, caregiving, relationships, or daily life, it’s worth reaching out to a perinatal mental health specialist. “Treatment becomes relevant when the associated distress begins interfering with daily functioning, relationships, sleep, caregiving, or quality of life,” Kleiman says.
If that’s where you are, support is available. Call the Postpartum Support International helpline at 1-800-944-4773 for free support, no diagnosis needed.
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