Postpartum OCD, PTSD, and Psychosis: What They Really Look Like
Postpartum OCD, postpartum PTSD, and postpartum psychosis often get overlooked. Psychologist Dr. Hannah Cassedy details each disorder and explains how to get help.
They have tongue-twisting names, and while you may not have heard of them, postpartum obsessive-compulsive disorder, postpartum post-traumatic stress disorder, and postpartum psychosis are serious conditions that some mothers develop shortly after giving birth. And although they’re less common than postpartum depression or anxiety, they are still very much worth knowing about. These mental health conditions affect an enormous number of women every year, yet information about them is limited and often wrapped up with shame. Below you’ll find hard facts about the least-discussed perinatal mental health conditions, so you don’t have to keep wondering.
As many as five percent of new parents experience obsessive-compulsive symptoms. Obsessions are repetitive, persistent, and horrifying thoughts, typically related to the baby. Some people are haunted by vivid fears that they will harm their baby. Compulsions are behaviors that are intended to avoid or minimize the triggers of the obsessive thoughts: these behaviors may include constantly cleaning, organizing, counting, or putting things in order, for example. People with postpartum OCD tend to be extremely worried about their baby’s safety, and they fear that they shouldn’t be alone with the baby. They might worry that they are terrible, dangerous parents — and those feelings can understandably cause overpowering feelings of guilt and shame.
The term “OCD” often gets thrown around to describe people who keep a tidy house or have a preference for order. This is usually not a psychological disorder but just a matter of personal preferences and personality traits. Unlike your run-of-the-mill “neat freaks,” people with diagnosable OCD deal with sometimes-crippling thoughts and mental images that feel very much out of their control. Treatment is available, however, by reaching out for help from mental health professionals who specialize in OCD.
It’s important to know that people with OCD are very unlikely to act on their thoughts. Even though they are anxious about harm coming to their baby; there is very little risk that they would actually harm their baby. Typically, they develop compulsive behaviors (such as cleaning or organizing) that temporarily make them feel more in control and able to avoid their distressing thoughts. These behaviors, however, do not actually resolve anything, and they can get in the way of being able to do much else in life. Sometimes people with OCD worry that their thoughts will become delusional. But rest assured: OCD is much more closely linked to anxiety than to psychosis.
Post-traumatic stress disorder (PTSD) develops for some women after a traumatic birth or loss. Traumatic births could include medical complications either in the mother and/or the baby, such as an unplanned C-section, uncontrollable hemorrhaging, eclampsia, or the baby being whisked away to the NICU. Sometimes extremely premature babies look unlike how you’d expect a baby to look; the sight of them at birth can be traumatic. Some parents experience the terrible tragedy of losing an infant; this, too, can be a trauma. It can be helpful to remember that trauma is a subjective experience, such that two people could experience the same event with different reactions to it.
Also, not everyone who experiences a trauma develops PTSD. PTSD involves a set of responses to a trauma that make processing the trauma extremely difficult. Symptoms include anxiety, flashbacks to the trauma, nightmares, avoidance of reminders of the trauma, feelings of detachment, and feeling like you’re on the constant lookout for danger (e.g. being startled easily, not being able to sleep, or generally being on edge).
Mothers are more at risk of developing postpartum PTSD if they have had past traumas, such as sexual assault or abuse. Another risk for postpartum PTSD is feeling that your delivery experience was out of your control, or that you lacked support and the ability to communicate during delivery. All the more reason to communicate your birth plan early and often, and to plan for contingencies! But the fact of the matter is that traumas do happen, as much as we like to think that that we can plan around them. Having solid support and communication in place always helps.
If you develop PTSD symptoms after a trauma (birth-related or otherwise), reach out for help from a provider who specializes in treating the disorder. The U.S. Department of Veterans Affairs has developed great resources for the disorder. It is very treatable with professional help.
Postpartum psychosis is quite rare. It occurs in only one or two out of every 1,000 births. It develops very quickly after delivery, usually within the first two weeks postpartum. So if you’re eight weeks out and afraid that you might “snap,” you’re probably in the clear (although getting help for your fears might be a good idea!).
Symptoms of psychosis include strong, strange beliefs that are not based in reality; seeing or hearing things that others don’t; or becoming highly suspicious that others are trying to harm you. Other symptoms may include a decreased need for sleep while feeling extremely energetic, and having trouble communicating with other people. The biggest risk factor is having a history of psychosis or bipolar disorder, or having a close family member with that history.
Postpartum psychosis is treatable, but it may be an emergency that needs immediate medical attention. If you are concerned that you or someone you know has postpartum psychosis, call a crisis hotline right away. To learn more, I recommend visiting Postpartum Support International.
Dr. Hannah Cassedy is a Dallas-based clinical psychologist with specialty training in perinatal mental health. She treats women and men struggling with anxiety, depression, and adjustment to major life changes like the birth of a child.