'Vanderpump Rules' star Scheana Shay says postpartum OCD is a 'battle every day.' Here's what to know, and tips for how to deal with it

Despite the name, reality TV isn't typically known for being, well, real. That's why "Vanderpump Rules" star Scheana Shay's recent confession is so impactful.

In the most recent season of the show, Shay opened up about her struggle with postpartum obsessive compulsive disorder (PPOCD), since the birth of her now two-year-old daughter. She previously shared her experience with People, saying "It is, you know, a battle every day in my brain."

PPOCD refers to a mental health disorder that affects people in the postpartum stage of birth, and is characterized by obsessions (intrusive thoughts, urges or images that cause distress) and compulsions (repetitive behaviours to alleviate anxiety), typically about perceived dangers to their child's well-being.

It is also the most misunderstood and misdiagnosed perinatal disorder; something Shay spoke to, noting that PPOCD is rarely talked about, despite its severity.

What causes postpartum OCD and why is there stigma?

Catherine, an Ontario woman, had no idea she'd be experiencing extreme fear after the birth of her first child in 2013.

She had known she had OCD, as she was diagnosed at 10 years old, but believed it was something she had overcome. Going into her first pregnancy a decade ago, the thought of her OCD flaring up wasn't on her mind, mostly because no one had warned her.

"I came into parenting more concerned that my kids would end up with OCD or my kids would end up with some type of mental illness that I had passed on to them," Catherine told Yahoo Canada. "But I didn't come into parenting with any sort of knowledge of what could happen to me."

Shortly after giving birth to her first, "my OCD just exploded," she recalled. "And then I started to realize that it was happening during my pregnancy, as well."

Despite affecting 1-2 per cent of pregnant women, PPOCD, as well as perinatal and postpartum mental health issues, aren't widely talked about. Patricia Tomasi, the Executive Director of the Canadian Perinatal Mental Health Collaborative, says this silence can continues stigma. "They're afraid to come forward because they're afraid that they might be viewed as crazy or have psychosis, or that their children will be taken away," Tomasi said.

But that's not the case. While research hasn't been able to identify an exact cause for postpartum OCD, there are a few factors that may contribute to it.

"Postpartum OCD may be associated with the hormonal changes that occur during pregnancy and birth," according to Angie Blandford, the clinical director of Grounded Minds. It can also be associated with the psychological changes that are involved in becoming a parent, which can include the new responsibility of caring for an infant, a lack of sleep, or the stress of being a new mom.

"The rapid increase in responsibility, stress, and lack of sleep may cause new parents to misinterpret normally occurring intrusive thoughts as important or dangerous," Blandford told Yahoo Canada.

Once Catherine gave birth, she started "heavy tracking" how much her child was eating and sleeping — and stressing about whether or not it was enough. "Down to the minute, how long my baby was napping, how long they were awake for; the sleep/wake cycle became a daily obsessive ritual."

She also had intrusive thoughts. While she was used to these thoughts popping up and being there throughout her life, "suddenly, my baby was the centre of all of those thoughts," she said. "Suddenly it wasn't about me accidentally stepping out onto the street and getting hit by a car, it was about my baby being hit by a car."

And it started to overtake her life. "There was a certain point where I had to call my husband every 15 minutes, just to make it through another 15 minutes," Catherine said.

"It was terrifying," she confessed. "And it was also terrifying in the sense that it was familiar in terms of how distressing it was; it reminded me of what it was like [as] a kid, I was like, 'Oh, no, we cannot go back there, we can't be that dysfunctional again.'"

How is PPOCD treated in Canada?

Because of her previous experience with OCD, Catherine was able to identify that what she was feeling wasn't right. She was referred to the Reproductive Life Stages Program at the Toronto's Women’s College Hospital within five weeks of giving birth. She went on medication for the first time since her childhood.

Medication is often the standard recommendation for many people when it comes to treatment.

"Postpartum OCD can be treated with therapy and/or medication, like all subtypes of OCD," Blandford explained. While treatment typically includes a specific type of therapy called Exposure and Response Prevention (ERP), Blandford advises other effective therapies like Inference-Based Cognitive Behavioural Therapy (I-CBT) and Acceptance and Commitment Therapy (ACT).

"Postpartum OCD is very treatable, but OCD is a chronic condition that may never fully go away," Blandford claimed.

Despite the fact that postpartum OCD is treatable, there are still barriers to access in Canada. "We have a health care system that just is not equipped to deal with perinatal mental health issues," Tomasi noted. "We have the frontline workers, family doctors, who are the gatekeepers, nurses and midwives who... don't feel equipped to properly assess a woman for perinatal mental health care."

Another issue stems from the mistaking of postpartum OCD for anxiety or an overprotective parent, a vigilance that's often still welcomed by healthcare professionals. That's why it's more important than ever to be having discussions around postpartum OCD. "Rates are rising for perinatal mental illness," Tomasi said. "And it's also extremely underreported, so we don't actually have the true picture of what the prevalence is, and the effects on the children.”

When it comes to treatment, Blandford recommended seeking treatment from an experienced OCD therapist and talking to your doctor to see if medication is right for you. "Talk to the people around you and get support," she said, "it's also important to be gentle with yourself."

For Catherine, having this support was essential. When she got pregnant with her second child, she felt better prepared, having been in therapy and with the help of medication.

"Thoughts are just thoughts, they aren't meaningful just because we have them," Blandford said. "You wouldn't be horrified by these thoughts if you didn't love your newborn and want desperately to keep them safe. Seeking help takes incredible strength, but remember that OCD is incredibly treatable."

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