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If you are trying to understand and support a loved one who is struggling with scary thoughts, it can feel overwhelming and frightening. How do you know if her thoughts will lead to action? How do you know if her thoughts are an indication of a serious mental health concern that requires immediate and aggressive intervention? Undoubtedly, her scary thoughts will stir up your own anxiety, as you wonder what the best plan of action at this time would be.
Let's start with the following bullets points which can help reduce your own anxiety by clarifying what is really going on.
What are Scary Thoughts?
• Scary thoughts are a very common symptom of postpartum depression and anxiety.
• Scary thoughts are defined as negative, repetitive, unwanted, or intrusive thoughts that can bombard a woman and feel as if they come out of nowhere.
• The majority of both mothers (91%) and fathers (88%) report intrusive thoughts about their baby at some point following the baby's birth (Abramowitz, Khandker, Nelson, Deacon, & Rygwall, 2006).
• Scary thoughts can come in the form of thoughts, What if I burn the baby in the bath? images (visions of the baby falling down the stairs), or impulses What if I can't help it and I hurt my baby? Scary thoughts can be indirect or passive, Something might happen to the baby, or they can imply intention.
• Scary thoughts are NOT an indication of psychosis. They can make a woman feel as if she is going crazy, but she is not.
• This means the thoughts are anxiety-driven and will respond well to treatment.
• Scary thoughts can be part of a general anxiety or mood disorder, or they may occur in the absence of this diagnosis.
• Women who disclose that they are having scary thought and report distress and life interference, should be referred to a mental health provider who can assess for proper treatment.
Ways You Can Provide Support
The most important thing you can do for someone you love who is struggling with scary thoughts is to let her know you understand that this is common, you are not scared by this, and you will be there for her. Scary thoughts make it difficult to ask for help. Offer it. Do your best to learn more about this so you can better understand the impact this phenomenon can have on her life. Understand that fear can be paralyzing. Your reassurance and support can provide incredible nourishment when she feels so fragile. Sit with her. Listen to her. Reassure her. If she has expressed concern that she is unable to manage her scary thoughts, ask her if she would feel better if she got professional help, and then, assist her with that process. Remind her that there is no shame in asking for help. It takes great courage and strength of character to say, I don't like the way I am feeling. I am ready to ask someone to help me feel better. Help her do that.
As you continue to provide support, it will be helpful to follow these guidelines:
Trust your instincts. This is the same truism we profess to postpartum women who are suffering. If you think something is wrong, you are probably right. That does not mean anything terrible is happening. It means your intuition is sending out a distress signal, and the best response to that is to honor it, take it seriously, and seek support. It also means that everyone will feel better if more information is obtained and all bases are covered. It is prudent to have a professional assess the situation if everyone involved is worried in the unlikely event that there are other variables contributing to her suffering.
Listen to what she is telling you. This is not always easy because it may require you setting aside your own anxiety to hear what she is trying to tell you. Ask her what she is afraid of. Try to tolerate her anxiety. Remember that anxiety will not hurt her; it will just feel terrible to her. Remind her that she is safe and that you will be okay no matter what she wants to share. If you do not feel you are able to endure this level of anxiety, be honest about that with yourself and with her and find someone to help you help her.
Avoid empty words of cheer. Remember that sweeping reassurances when you are not confident about the nature of her suffering may not be helpful. Telling her that "everything will be fine" when you are not clear how much she is suffering, or saying you know how she feels when you do not, will not help. Rather, you should validate how bad this must feel to her. Find the balance between taking her seriously while not appearing startled.
Confront gently. Here is a sequential guide for initiating a dialogue if you are worried about a loved one, which captures many of the points included in this section:
• Ask her if she is having thoughts that are scaring her.
• Ask her what you can do to help.
• Ask her whether she would feel better if she talked to you about the specifics.
• Gently review for her what you have learned about anxiety and the nature of scary thoughts in general in order restore her confidence that you can handle this.
• Ask her if she thinks she can manage the thoughts or if she would feel better finding a therapist or doctor who can help her.
• State clearly that you believe her if she says she is not going to hurt the baby or act on any of the thoughts that might be scaring her.
Remember that your greatest act of support will be your absolute acceptance of how she is feeling and what she may tell you. Your ability to be present with her in spite of her remorse and self-condemnation will help heal her broken spirit. Never underestimate the meaning and value of true unconditional support.
Below is a summary of the decisive points for you to keep in mind:
• Scary thoughts are extremely common - almost all postpartum women have them.
• Even though they are common, they can also be disabling.
• Scary thoughts do not lead to action, although women fear that they will.
• Scary thoughts are associated with anxiety and are not a sign of psychosis, although they can make a woman feel and fear that she is going crazy.
• It may be painful for you to witness her fear, but her fear of her thoughts is actually a good sign. Her fear indicates that the scary thoughts are a symptom of intense anxiety that can managed or treated professionally.
Adapted from Dropping the Baby and Other Scary Thoughts (Routledge, 2010) Kleiman & Wenzel
copyright Karen Kleiman, LCSW
