Anxiety vs. OCD in Motherhood: What’s the Difference and Why It Matters

Feeling overwhelmed by racing thoughts, constant worry, or intrusive images that make you question your sanity? You’re not alone and you’re not broken. Many new moms struggle to understand whether they’re experiencing anxiety, OCD, or something else entirely. This post will break down the difference between anxiety vs. OCD, how each can show up in motherhood, and why getting the right support matters.

When Your Mind Won’t Stop Spinning

You check the baby monitor again. Then again.

You washed the bottle three times, but it still doesn’t feel clean.

You’re always researching Google, but the answers never satisfy you- you search and search and search, just trying to calm that anxious voice in your head.

You lie awake at 3 a.m., heart pounding, trying to calm your brain. The thoughts are nonstop: What if I’m not doing enough? What if something happens to my baby? What if I’m the reason they’re not okay?

You’re exhausted, irritable, and constantly second-guessing yourself. But what’s really going on here?

For so many new moms, it’s hard to tell the difference between typical postpartum worry, clinical anxiety, and symptoms of OCD. They can all feel consuming, shame-inducing, and deeply isolating. Understanding the difference between anxiety vs. OCD is an important step toward getting the right kind of support—and finding your way back to yourself.

Anxiety vs. OCD: What Does It Feel Like?

Anxiety and OCD in motherhood can look a lot a like. OCD is under the umbrella of Anxiety and unfortunately, many times someone will attend therapy for anxiety years before they will get diagnosed with OCD. This is certainly a disservice, as OCD is treated differently than anxiety and unfortunately, some Anxiety treatment can actually enforce OCD.

Let’s break it down by how these two conditions often show up—especially in motherhood.

What Anxiety Can Look Like in Motherhood

Many moms have dealt with anxiety prior to becoming a mom. They often worried and stressed about many different things. In college they stressed about their coursework, grades, relationships, etc. Then in their career they worried about doing a good job, what their boss thought of them, did they know enough for the job, etc. In pregnancy they worried about the baby’s growth, the upcoming birth. Then in postpartum (and beyond), the anxiety can certainly creep up and often includes the following:

• Constant worry about something going wrong

• Fear of not being a “good enough” mom

• Overthinking every decision (sleep schedule, feeding, screen time)

• Physical symptoms like muscle tension, headaches, racing heart, and restlessness

• A sense of impending doom or chronic unease

• Trying to do everything to feel in control, even if you’re exhausted

What OCD Can Look Like in Motherhood

While OCD can include many of the above types of worries, you can think of it a bit like Anxiety on Steroids. It also plays out a bit differently as the worry thoughts are often stuck in a loop and there is no turning it off. Then because this can be so distressing, there becomes an urgency to do something about these thoughts, which then leads to some sort of compulsive behavior.

OCD includes:

• Intrusive thoughts: unwanted, often disturbing mental images or fears (e.g., “What if I drop the baby?” “What if I accidentally hurt them?”)

• Compulsions: repetitive behaviors or mental rituals to “neutralize” the thought (e.g., checking, cleaning, counting, praying)

• Feeling intense shame or fear about your own thoughts

• Avoiding situations that could trigger intrusive thoughts (e.g., avoiding the kitchen knives or bath time)

• A sense of urgency or dread if a ritual isn’t performed “correctly”

Key Difference Between Anxiety & OCD:

While anxiety is typically fear-based and focused on real-life stressors, OCD centers around intrusive thoughts that feel irrational, scary, and may be misaligned with your values or aren’t based in reality/facts. Moms with OCD often say, “I know it doesn’t make sense, but I still can’t stop.”

Why It’s Easy to Confuse Anxiety and OCD

There’s a lot of overlap—especially postpartum. Both conditions can involve:

• Worry and racing thoughts

• Difficulty sleeping

• Physical symptoms like a racing heart or fatigue

• Hyper-vigilance and mental “checking”

• Avoidance and overwhelm

But here’s where it gets tricky: OCD thoughts are often ego-dystonic—they go against what you believe or value. That’s why they feel so disturbing. A mom with postpartum OCD might obsess over the fear of accidentally harming her baby, even though she would never actually do that.

These thoughts aren’t signs of danger or instability. They’re signs of OCD, and they are common- even if no one talks about them. And this not talking about them is why OCD is often overlooked and treated as Anxiety.

When OCD Doesn’t Look Like OCD: Relationship OCD and Pure “O”

To further complicate why it’s easy to confuse Anxiety vs. OCD, there are some subsets of OCD that can completely fly under the radar- especially in early motherhood. These are Relationship OCD and Pure “O” OCD.

Relationship OCD (ROCD)

Relationship OCD is a form of OCD where your obsessive thoughts and compulsions center around your relationship. For new moms, this might sound like:

• “What if I don’t really love my partner?”

• “What if we’re not meant to be together and I’m ruining my child’s future?”

• “What if I made the wrong choice?”

These thoughts can create overwhelming doubt—even in previously secure relationships—and often lead to compulsive reassurance-seeking, constant analysis of your partner’s behavior, or emotional withdrawal.

From the outside, this might look like classic relationship anxiety. But the obsessive looping, intense distress, and compulsive checking (even if it’s all internal) points toward OCD. This can also include other relationships outside your partner such as other family members, friends, and co-workers.

Pure “O” OCD (Primarily Obsessional OCD)

Pure “O” is short for Purely Obsessional OCD, though the name is a bit misleading, there are compulsions, but they’re mostly mental and invisible. That’s what makes it so hard to spot.

In motherhood, Pure “O” OCD might look like:

• Repeated, disturbing mental images of harm coming to your baby

• Obsessive fear of being a “bad mom” without any visible rituals

• Internal “checking” of your thoughts, intentions, or identity: “Why did I think that? Does that mean something is wrong with me?”

• Silent mental compulsions, like mentally reviewing events, replaying conversations, or silently repeating phrases to “cancel out” bad thoughts

• Constant researching of concerns- googling, searching Reddit, joining common Facebook groups and continually looking/refreshing for new content.

From the outside, this might look like high-functioning anxiety or perfectionism. But the distress, fear, and compulsive mental loops tell a different story.

How Postpartum Anxiety and OCD Show Up Differently

After baby comes, many moms report feeling an increase in anxiety. A lot of this can be more hormonally driven due to the abrupt changes after birth. Also, you’re now in charge of this brand new baby and the stakes are high, so it’s natural to experience more worries and stress during this time.

Postpartum Anxiety

Postpartum Anxiety will cover a wide variety of worries around your baby and motherhood and often overlaps with Postpartum Depression symptoms. It will include:

• Worry about baby’s health, sleep, feeding, or development

• Difficulty relaxing, even when things seem “fine”

• Feeling overwhelmed by day-to-day decisions and tasks

• Persistent fears about being a failure or doing things “wrong”

Postpartum OCD

Postpartum OCD will again often look like Postpartum Anxiety, however it will hit a bit different. There will be an increase in intensity of the anxiety, there’s a constant looping of thoughts, and the need to engage in compulsive behaviors to help “soothe” the initial anxiety. It will include:

• Scary, unwanted thoughts or images that feel out of character

• Repetitive behaviors or mental rituals to “undo” or neutralize the thoughts

• Avoiding the baby or certain tasks to prevent perceived harm

• High levels of shame, secrecy, and fear of being judged

Hormonal shifts, sleep deprivation, and past trauma can intensify both anxiety and OCD symptoms. That’s why postpartum mental health deserves specific, specialized care.

Why the Diagnosis Matters

While both anxiety and OCD respond well to therapy, they often require different approaches:

• Anxiety is typically treated with Cognitive Behavioral Therapy (CBT) and nervous system regulation tools.

• OCD is best treated with Exposure and Response Prevention (ERP), a specialized form of CBT that helps you tolerate distress without performing compulsions.

• EMDR therapy can support both by addressing underlying trauma that fuels anxiety loops or intrusive thoughts.

Mislabeling OCD as “just anxiety” can delay the most effective support. That’s why it’s so important to work with a therapist who understands perinatal mental health and these important nuances.

You Are Not Your Thoughts

Let’s be clear: Having intrusive thoughts doesn’t make you a bad mom nor does it mean you are going to act on any scary/distressing thought.

Worrying doesn’t mean you’re failing.

Being overwhelmed doesn’t mean you’re broken.

You are a good mom having a hard time. And it’s okay to need help.

In fact, getting help is one of the bravest and most loving things you can do for yourself and your baby.

Marla’s Story: How a Mom’s “Anxiety” Was Actually OCD and What Actually Helped

Marla* came to me due to struggling with her anxiety. She described herself as a “worrier and an over-thinker” that had started to get out of hand after having her son two months prior. Marla had been in therapy off and on throughout her life, starting as a teen due to difficulties in navigating her parents’ divorce and her “acting out.” Marla also attended therapy in college after a bad break up, and again when she was just starting out in her career. Now that she was a mother, Marla was finding the anxiety getting “out of control” again and wanted help so that it would interfere with being a good mom.

Initially, Marla described her anxiety around many common things in early motherhood- including worries about her baby’s development, if she was doing “enough” for him, if she and her husband’s relationship could “handle” the stress of the newborn time, etc. As therapy progressed, Marla shared she had something “scary” to talk about. She emphasized multiple times prior to sharing that these thoughts and images she was having were things that she in “no way would ever actually do.” As a therapist trained in perinatal mental health, I had a good guess that she was likely hinting at intrusive thoughts. I assured Marla, that there was nothing she could tell me that I haven’t heard before or that would make me judge her. I shared about intrusive thoughts of harm coming to baby and how they are common in postpartum and that intrusive thoughts do no equal intent. Marla’s distress told me that this was something that she obviously did not want to have happen.

This helped Marla feel more comfortable and she opened up in detail how she had intense thoughts and images of horrific violence happening to her son, sometimes at the hands of herself, or by someone else. This included things such as dropping her son down the stairs, leaving him in the bath and him drowning, or even stabbing him with a knife. This lead her to avoid these potential situations at all costs- she would get her husband to bring her son up and down the stairs and where ever she was when she was alone with him, she’d stay in that space the entire time. She also had her husband do all the bathing and cooking, as she didn’t trust herself. To help deal with these thoughts, Marla turned to repetitive behaviors such as a constant checking on her son to make sure he was breathing, checking the kitchen to make sure the knives were put away, repeating certain phrases to herself over and over again, and seeking out reassurance from her husband. Outside of these scary thoughts, Marla would also get stuck on her son’s development and any possible illness symptom he could have and would research for hours, often waking up in the middle of the night, feeling stuck on these thoughts and continuing to research, and again a constant seeking out of reassurance from her husband and her mom.

Based on Marla’s symptoms, I shared to her that she was actually experiencing Postpartum OCD. I went over in more detail about OCD and how it differs from Anxiety. With this explanation, Marla was able to identity that these symptoms were actually something she has dealt with for a long time and much of her anxiety she felt as a teen and young adult, was likely OCD and not Anxiety. We then developed a treatment plan that included my specialized approach using a combination of Exposure Therapy and EMDR Therapy, as much of Marla’s OCD seemed to manifest from past childhood trauma (which is something that I have found is common with those who have OCD). Marla also explored psychopharmacology support (medication) as well.

The combination of ERP and EMDR Therapy along with medication has helped Marla greatly. Marla is no longer having intrusive thoughts of harm coming to her son. While she does occasionally get stuck in an “OCD loop”, she knows how to respond to it and she’s often able to get out of the loop rather quickly and move on with her day. At the conclusion of her therapy, Marla expressed that “no one had understood me like you did” and it was by finally getting the right diagnosis that she was truly able to feel better.

How Happy Moms Therapy Can Help

At Happy Moms Therapy, I specialize in supporting moms through the messy, complicated realities of early motherhood. I offer:

• Trauma-informed therapy tailored to postpartum and motherhood mental health

• EMDR therapy to help process past trauma, current overwhelm, and intrusive thoughts

• CBT and resourcing tools to build emotional regulation and reduce anxiety

• ERP therapy to address compulsive behavior and decrease intrusive thoughts.

• A deeply non-judgmental, compassionate space where you can finally breathe

Whether you’re navigating anxiety, OCD, or both- I’m here to help you make sense of what’s going on and feel more like yourself again.

Key Takeaways

• Anxiety vs. OCD in motherhood can look similar, but they involve different thought patterns and treatment needs.

• Anxiety tends to focus on realistic fears and overwhelm, while OCD centers around intrusive, unwanted thoughts and compulsions.

• Forms of OCD like Relationship OCD and Pure “O” OCD can be especially hard to spot—but they’re real, and they are treatable.

• Effective therapy is available, and the right support can help you feel more grounded, confident, and connected in motherhood.

• You are not alone. You are not broken. And help is here when you’re ready.

Feeling seen?

Let’s talk. Schedule a free consultation with Happy Moms Therapy and take the first step toward peace of mind and compassionate support.

Disclaimer: This is not a replacement for a therapeutic relationship or mental health services. This is for educational purposes only and should be in used only in conjunction in working with a licensed mental health professional. If you are in California and looking for a professional therapist feel free to contact me to request an appointment or search Psychology Today for local therapists in your area.