This article is not a screening tool. It is intended as a resource for anyone supporting a new parent who describes intrusive thoughts about harming their baby.
Coverage of the Lindsay Clancy trial has repeatedly discussed intrusive thoughts and postpartum psychosis in the same breath, without clearly distinguishing between them.
That can be deeply triggering for new parents with obsessive-compulsive disorder (OCD)—and it risks conditioning people to hear an intrusive thought as a red flag for psychosis or danger, when intrusive harm thoughts, images, and urges are a common feature of OCD and do not, on their own, indicate intent.
What do we know about Lindsay Clancy’s mental health?
Less than the coverage and speculation would suggest.
Clancy was treated for anxiety, insomnia, and depression in the months before the killings, including an inpatient psychiatric stay. She was prescribed 13 psychiatric medications over about four months by multiple providers—psychiatrists, nurse practitioners, emergency department physicians, and inpatient staff.
Her mental state has been contested throughout the trial. Defense experts testified Lindsay had bipolar II disorder and was experiencing postpartum psychosis, including a command hallucination—a male voice telling her to kill her children, then herself. It told her she had no choice.
A prosecution psychiatrist testified that Lindsay had experienced a major depressive episode but found no evidence of mania, hypomania, or psychosis. Several of her own treating providers also testified that they had not observed signs of psychosis or mania or diagnosed her with bipolar disorder.
There is no evidence in the trial record that Lindsay was ever diagnosed with OCD, and neither the prosecution nor the defense has argued that she had it.
What intrusive thoughts look like in OCD?
An intrusive thought is unwanted, distressing, and inconsistent with a person’s goals and values. In Perinatal OCD, these thoughts—also called obsessions—often center on harm coming to the baby, either accidentally or at the parent or guardian’s own hands.
Intrusive experiences don’t always come as thoughts. People may experience vivid images, sensations, or urges: a pull toward the knife drawer, or a frightening sense that their hands might do something on their own.
The cycle becomes clearer in what happens next: the compulsions. A parent might avoid bathing the baby alone for fear of drowning them, hand the baby to someone else because they’re afraid of dropping them, or repeatedly check the monitor because they fear sudden infant death syndrome (SIDS). They may ask their partner, friends, or therapist for reassurance that it’s safe for them to be around their baby—and then ask again. And again.
Avoidance, checking, and reassurance-seeking are hallmarks of OCD. They’re also an important part of what distinguishes OCD from the experiences described in coverage of this trial.
For a depiction of what postpartum intrusive thoughts can look and feel like in OCD, watch For All I Know, a short film created by Healthline with support from NOCD.
OCD vs. postpartum psychosis: what should providers look for?
The content of a person’s thoughts is not what separates OCD from postpartum psychosis. A parent with OCD and a parent experiencing psychosis can both describe a thought about harming their baby. What differs is the parent’s relationship to that thought.
In OCD, the thought is unwanted, and the parent is trying to prevent the outcome they’re imagining. They recognize the thought as their own, but it feels abhorrent to them. They’re often ashamed of—or terrified of—admitting their intrusive thoughts. The behaviors that follow are typically attempts to prevent harm: creating distance from their baby, repeatedly checking the baby’s safety and well-being, or seeking reassurance that they are not a danger to their baby.
Postpartum psychosis looks different. Look for a loss of insight: beliefs that don’t respond to evidence, or experiences in which a thought feels like an instruction or command rather than a feared possibility. Other signs can include hallucinations, confusion or disorganization, and severe insomnia without fatigue. A personal or family history of bipolar disorder is also a potential risk factor.
| Obsessive-compulsive disorder | Postpartum psychosis | |
| Core experience | Unwanted, distressing thoughts, images, sensations, or urges about harm | Hallucinations or delusions, including commands or beliefs about harming the baby |
| Insight | Generally preserved insight and reality testing; distress about what the experience might mean | Often impaired insight and reality testing; hallucinations or delusional beliefs experienced as real |
| Response | Avoidance, checking, reassurance-seeking, or other compulsions intended to prevent harm | Actions influenced by hallucinations or delusional beliefs |
These are clues to notice, not a diagnostic checklist. OCD and postpartum psychosis can also occur together, which can make the clinical picture more complex.
If a parent describes unwanted, distressing thoughts alongside behaviors such as avoidance, checking, or reassurance-seeking, it’s generally appropriate to refer them to a provider who specializes in treating OCD with exposure and response prevention (ERP). ERP is a first-line psychological treatment for OCD that helps people face feared thoughts and situations without using compulsions to reduce distress or prevent a feared outcome. Naming OCD as a possibility may, in many cases, be the first time the parent has heard an explanation that fits their experience.
If a parent shows signs of psychosis—or you have any reason to believe they may act on thoughts of harming themselves or their baby—treat it as a psychiatric emergency. Arrange a same-day psychiatric evaluation or direct hospital referral; if there is an immediate safety concern, call 9-1-1 or go to the nearest emergency room. Psychosis does not automatically mean someone is dangerous—most people who experience psychotic symptoms never harm anyone—but it does require urgent assessment.
For pregnancy or postpartum mental health support that is not an immediate emergency, parents can also contact the National Maternal Mental Health Hotline, which offers free, confidential support 24/7, or the Postpartum Support International HelpLine for support and connections to perinatal mental health resources.
Find the right OCD therapist for you
All our therapists are licensed and trained in exposure and response prevention therapy (ERP), the gold standard treatment for OCD.
How to respond when a parent discloses intrusive thoughts
Many parents who have intrusive thoughts about harming their baby never say them out loud. The ones who do have often carefully rehearsed it, and they’re watching your face while they say it.
So it’s important to build a space where people are comfortable broaching the subject.
Your first reaction is key. Visible alarm, a long pause, or immediately treating the disclosure as evidence of danger can confirm what they already feared: that the thought means something terrible about them, and that telling someone was a mistake. Many won’t raise the subject again, choosing instead to suffer in silence.
Don’t assume the disclosure is an emergency based on the content of the thought alone. A few things can help you understand what’s actually happening:
- Ask how the person experiences the thought. Whether it’s unwanted, how they respond to it, and what they’ve been doing to prevent the outcome will tell you more than the content of the thought.
- Name the fact that unwanted thoughts are common. Studies show that roughly half of postpartum parents report unwanted thoughts about intentionally harming their infant. Most of them probably haven’t heard this statistic.
- Tell them what you’re going to do. If you’re going to consult a colleague, explain why. If you want to refer them out, address their concerns. Silence gets filled with the worst assumptions.
If the picture points toward OCD, saying so can bring relief—but it can also be confusing for someone who has never associated OCD with thoughts like these. Part of the reason is that OCD is common but poorly recognized: roughly 2% of U.S. adults experience it over their lifetime, yet people with OCD wait about seven years on average to receive an accurate diagnosis. For someone who has been afraid to say these thoughts out loud, hearing that they may be symptoms of OCD can be the first explanation that makes sense.
Bottom line
A thought about harming a baby does not, on its own, mean a parent is dangerous. For some parents, these thoughts are part of OCD—a treatable condition that responds well to exposure and response prevention (ERP) therapy.
If you’re a mental health provider, there’s a good chance people in your caseload have experienced thoughts like these, whether or not they’ve ever told you. Knowing how to recognize OCD—and how to respond when someone does speak up—can help get them to the right care.
If you’re experiencing these thoughts yourself, bring this article to your provider and explain not just what you’re thinking, but what you do when the thoughts show up. If you’re supporting someone who is experiencing them, share this article and encourage them to talk openly with a provider about what they’re experiencing. Both can help make sure they get the right care.
