Talking About Intrusive Thoughts with Black Mothers: Breaking the Silence
By Lediya Dumessa, PhD
Intrusive thoughts after birth are far more common than most parents realize. Research shows
that up to 90% of new mothers experience unwanted thoughts of accidental or intentional harm
coming to their baby (Abramowitz et al., 2014). These thoughts are often part of postpartum
obsessive-compulsive disorder (PPOCD), a treatable condition characterized by distressing
mental images and compulsive checking or avoidance behaviors.
Yet Black mothers may be especially hesitant to share these experiences. Fears of being judged
“unfit,” worries about child protective services involvement, and cultural narratives like the
Strong Black Woman schema make disclosure even less likely (Woods-Giscombé, 2010; Prather
et al., 2018). As a result, clinicians risk missing symptoms until they escalate into crisis.
The key is how we ask. Here are a few strategies:
• Normalize first: “Many new parents have scary thoughts they don’t expect. It doesn’t
mean you’ll act on them, and it doesn’t mean you’re unsafe.”
• Clarify intent vs. distress: Distinguish between ego-dystonic thoughts (unwanted,
distressing, inconsistent with values) and intent to harm.
• Affirm strengths: Frame vigilance as love while gently helping mothers reduce
compulsive checking or avoidance.
• Ensure cultural safety: Use plain, affirming language (“feeling worn down” instead of
“depressive symptoms”) and directly acknowledge fears of judgment.
When intrusive thoughts are named and normalized, mothers often feel relief: “I’m not crazy,
and I’m not alone.” For Black mothers, this validation is a lifeline, transforming silence into an
opportunity for healing.
Clinicians who create safe spaces for disclosure — while practicing cultural humility and
trauma-informed care — play a crucial role in reducing stigma, strengthening trust, and
connecting mothers to timely, effective treatment.
References
Abramowitz, J. S., Schwartz, S. A., Moore, K. M., & Luenzmann, K. R. (2003). Obsessive-
compulsive symptoms in pregnancy and the puerperium: A review of the literature. Journal of
Anxiety Disorders, 17(4), 461–478. https://doi.org/10.1016/S0887-6185(02)00205-6
Prather, C., Fuller, T. R., Jeffries, W. L., Marshall, K. J., Howell, A. V., Belyue-Umole, A., &
King, W. (2018). Racism, African American women, and their sexual and reproductive health: A
review of historical and contemporary evidence and implications for health equity. Health
Equity, 2(1), 249–259. https://doi.org/10.1089/heq.2017.0045
Woods-Giscombé, C. L. (2010). Superwoman schema: African American women’s views on
stress, strength, and health. Qualitative Health Research, 20(5), 668–683.
https://doi.org/10.1177/1049732310361892
