Perinatal Mental Health: Differentiating Mood and Anxiety Disorders From the Expected Emotions of New Motherhood
Perinatal mood and anxiety disorders (PMADs) are frequently underdiagnosed among health and mental health professionals alike. Too often the symptoms that coincide with these disorders are confused with “expected” emotions during this time. It is important that clinicians know the risk factors and presenting symptoms for PMADs, in order to ensure proper assessment and treatment. Without such treatment, PMADs can impair the developmental trajectory of the baby and family.
There are numerous risk factors that can increase a woman’s vulnerability to PMADs. Biological risk factors can include a genetic predisposition to anxiety or depression, a family history of PMADs, a history of hormonal sensitivities (i.e. severe PMS), thyroid problems, or infertility issues. Social risk factors include family stressors, unplanned pregnancy, a history of pregnancy loss, or a lack of social support. Psychological risk factors can include perfectionist behavior, worrying, high need for control, or a history of physical or sexual abuse or neglect.
Differentiating Between PMADs and Expected Emotions
Differentiating PMADs from a “normal” reaction to childbirth primarily depends upon the factors of timing and the degree to which functioning is impaired. The DSM IV states a postpartum onset specifier of within 4 weeks postpartum for mood disorders; however, most experts in the field believe the onset to be anytime within the first year postpartum. Below, the four disorders associated with PMADs are described in brief detail.
Postpartum Depression (PPD): 80% of women experience the baby blues within the first 2 weeks after childbirth. Baby blues consists of crying, mild sleep disturbances, moodiness and sadness, but the woman can still function well enough to adequately care for her baby. In contrast, women experiencing PPD may not be able to function well enough to take care of the baby and/or herself, and she will meet the criteria outlined in the DSM IV for major depression.
Postpartum Anxiety (PPA): All new moms worry, but in moms with PPA the worry affects their functioning (e.g., a mom cannot sleep when her baby sleeps because she is watching her baby breathe, or a mom doesn’t want to leave the house for fear of the baby crying.) Generalized anxiety and /or panic disorder may be present.
Postpartum OCD (PPOCD): These women often suffer from intrusive thoughts of harm coming to their baby or of them harming their baby. These thoughts are ego dystonic. Women may change their behavior to avoid the feared image (e.g., avoiding crossing bridges for fear of throwing her baby over the edge).
Postpartum Psychosis (PPP): Research suggests that most women with PPP are those who have not been previously diagnosed with bipolar disorder or who are off their medication postpartum. The onset is usually within the first two weeks postpartum. PPP is a psychiatric emergency. It is important that women with a history of bipolar disorder be followed by a psychiatrist throughout pregnancy and postpartum.
For more detailed information on PMADs or for resources, please visit the following web sites.
Submitted by Gretchen Mallios, LCSW and Yvonne Rothermel, LCSW on behalf of the San Diego Postpartum Health Alliance (PHA). To become a member of PHA and be listed in our provider directory, please visit www.postpartumhealthalliance.org or call 619-254-0023.