There is growing awareness of postpartum depression in the medical community, within mother-baby support communities, and in the recent years, it is even screened for 6 weeks after delivery at Ob and Peds follow up appointments. There are however, a host of other postpartum disorders that often present themselves in the postpartum period that are lesser-known and lesser-diagnosed though they can be as impactful as depression in the perinatal period. We will cover some signs and symptoms of postpartum anxiety, postpartum obsessive-compulsive disorder and more rarely, postpartum psychosis.
What is Postpartum Anxiety?
Having a newborn at home, especially for new moms, can feel like a whole new world. There are often so many things to think about, things to learn, to plan for, to schedule around etc. It is very common for new moms to find themselves overwhelmed. Sometimes this overwhelm spirals into anxiety. Postpartum anxiety is often missed by PCPs, ObGyns and even family members because the symptoms do not align with typical symptoms of depression, and are often incorrectly over attributed to the sudden life change of having a baby. So, what exactly is anxiety and what does it look like in new moms?
Anxiety is an adaptive response that our body and brains have when we feel threatened. The threat can be explicit e.g. walking into a dangerous situation or more of a feeling or foreboding of something bad about to happen. From a strictly evolutionary perspective, anxiety is helpful in avoiding danger and staying safe. However, especially in the postpartum period, this helpful response can become hyperactive. Some may feel anxiety in their bodies with increased heart rate, sweating, flashes of panic, chest tightness, knots in their stomach. Often moms will have difficulty falling or staying asleep, despite being exhausted and sleep deprived. Others experience in the form of racing thoughts, worrying and obsessing out of proportion to the situation. And finally, others experience it in their behaviors and will notice they are persistently avoiding certain situations, engaging in checking behaviors and or constantly seeking reassurance.
Anxiety can present in one or multiple ways and can wax and wane over time. Postpartum anxiety is fairly common, about 15% of new mothers will experience this. Often cognitive behavioral therapy, mind-body interventions, and sometimes medication are very effective in treating this.
What is Postpartum Obsessive-Compulsive Disorder?
Postpartum Obsessive-Compulsive Disorder is a very close sister of postpartum anxiety. It is estimated about 3-5% of new moms will have symptoms of perinatal OCD. Common symptoms of postpartum OCD are repetitive, intrusive images and thoughts that can come up randomly and feel very alarming. Sometimes the thoughts or images are disturbing and or gruesome. They often cause shame for the woman experiencing them and women fear that sharing these thoughts will result in their babies being taken away or judgment from others.
Sometimes OCD presents as compulsions where a new mom will do certain things to help avoid and reduce fear. Examples of this are counting behaviors, checking behaviors or time-consuming rituals. Feelings of hypervigilance and fear of being left alone with the infant are common. The important thing to note is that these thoughts are very rarely dangerous and mom’s seldom act upon them. The other silver lining is that postpartum OCD is very treatable. SSRI’s are often the mainstay of treatment in addition to therapy that may include exposure and response prevention as well as cognitive behavioral therapy.
What is Postpartum Psychosis?
Finally, postpartum psychosis is one of the most rare but serious disorders that can develop in the postpartum period. Typically, a combination of genetics (personal or family history of bipolar disorder or episode of psychosis) as well as hormonal fluctuations with sleep deprivation can result in a psychotic episode. Usually these develop suddenly, often within the first two weeks of birth but up to six weeks postpartum and affects 0.1-0.2% of new moms. Symptoms include delusions, hallucinations, irritability, paranoia, mania, decreased sleep and/or mood swings. Postpartum psychosis is considered a medical emergency for both mom and baby. Postpartum psychosis is treatable with medication and supportive measures, but early detection and immediate treatment is imperative.
Reach out to our Therapists and Psychologists today!
I know, I’ve just written a two-part series about all the things that can go wrong in the post-natal period! But, there is so much hope! As both a perinatal psychiatrist and as a mom of 4 littles myself, I think the biggest barrier to mom’s living their best life is often the detection of the mood disorder as so much is normalized and chalked up to the “difficulties of being a mom.” I hope with these articles and the incredible power of education around these stigmatized disorders, that more women are empowered to get the support and treatment that they need. Help is just a phone call away! Please check out our resources section for more information.
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