Postpartum Anxiety Check: New Parent Worry or More?
Welcome to Part 2 of our blog series shedding light on postpartum anxiety. In this post, we'll help you distinguish between normal anxieties and postpartum mood disorders.
Why is this so important? Because anxiety disorders are more common than you might think, affecting up to 21% of postpartum moms—that's 1 in 5 mothers! And believe it or not, anxiety rates are even higher among postpartum mothers than in the general population (Zappas et al., 2021; Ali, 2018). Despite this, postpartum anxiety often flies under the radar among clinicians, making it crucial for us to keep moms informed about the latest developments in this area so they can seek the support they need (Cena et al., 2021; Dennis et al., 2017).
If you're a new mom grappling with anxiety after childbirth, it's essential to validate your feelings and seek support if necessary. You may be wondering about psychological diagnoses and how they relate to your experiences. Often, the first step involves consulting your healthcare provider, who may use screening tools like the Edinburgh Postnatal Depression Scale (EPDS) or the Generalized Anxiety Disorder 7 (GAD-7) to assess your symptoms (Garapati et al., 2023). Noting the types and frequency of scary thoughts and behaviors, as we discussed in the last blog post, can help your health care provider at this stage of your evaluation and to help you access the appropriate level of care and mental health provider. Depending on your healthcare provider’s evaluation, they may refer you to a mental health professional for further assessment and treatment.
Understanding that anxiety comes in different forms—from mild to severe—can help you recognize when it's time to reach out for help (Kleinman & Wenzel, 2020). Remember, while the diagnosis process may seem daunting, it's a crucial step toward receiving appropriate care.
Let's explore some common psychiatric disorders that new moms might encounter as outlined by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). A general understanding the diagnostic criteria can be helpful as you navigate treatment or attempt to employ self-help strategies to help manage your symptoms. For each condition, seeking assistance is recommended when symptoms significantly disrupt daily life or cause emotional distress. Such disruptions may manifest in behaviors like avoidance or excessive protection of your baby (Kleinman & Wenzel, 2020). Even if your experiences don't fit neatly into diagnostic criteria, your feelings deserve attention.
Generalized Anxiety Disorder (GAD) is more than just everyday worry; it's an overwhelming, excessive, and uncontrollable concern about various aspects of life, often dominated by relentless "what-if" questions. Diagnosis typically requires at least 6 months of persistent worry accompanied by at least three specific symptoms like restlessness, muscle tension, irritability, difficulty concentrating, fatigue, and sleep disturbance, all of which significantly interfere with daily functioning and quality of life. During the postpartum period, research indicates that GAD affects 1 out of 10 mothers (Fawcett et al., 2019).
Sometimes, new mothers may meet the diagnostic criteria for GAD outlined in the DSM-5 but may not experience a severe disruption to their lives, known as subsyndromal GAD. Given the stressors of the postpartum period, healthcare providers tread carefully to distinguish between typical new mom nerves and clinical anxiety levels, ensuring accurate diagnosis and appropriate support (Ali, 2018).
Adjustment Disorder is marked by profound emotional or behavioral turmoil arising within three months of a significant life stressor. This diagnosis may be considered if symptoms align with those of GAD but fall short of the required six-month duration (Kleinman & Wenzel, 2020).
Major Depressive Disorder (MDD) is a significant concern in postpartum mental health, with a higher likelihood of screening and treatment during this period compared to other mood concerns (Cena et al., 2021; Dennis et al., 2017). MDD is characterized by persistent sadness, hopelessness, loss of interest or pleasure in activities, changes in appetite and sleep patterns, feelings of worthlessness or guilt, psychomotor agitation, and thoughts of self-harm or suicide lasting at least two weeks. In the postpartum period, the term Postpartum Depression (PPD) is commonly employed, often encompassing not only the depressive symptoms of Major Depressive Disorder (MDD) but also anxiety and even panic attacks. In fact, among women diagnosed with PPD, 2 out of 3 also have an anxiety disorder.
Ever wondered about the difference between the baby blues and MDD? Baby blues, experienced by as many as 85% of postpartum mothers, typically resolve spontaneously within a few weeks postpartum (Kleinman & Wenzel, 2020). However, persistent, or late-onset symptoms warrant attention (Kleinman & Wenzel, 2020).
Social Anxiety Disorder is characterized by an intense fear of specific social situations where scrutiny or negative judgment may occur, leading to embarrassment or humiliation. Individuals with this condition often avoid certain settings or events due to their apprehension about potential outcomes, or they endure them with intense fear and anxiety, experiencing distress or impairment that interferes with daily living. This fear, anxiety, or avoidance persists for six months or more to qualify for a diagnosis. After childbirth, approximately 1 in 15 mothers are impacted by social anxiety disorder, which may be exacerbated by heightened social pressures experienced by many new parents. This apprehension may arise from unsolicited evaluations, opinions, and negative feedback from family, friends, and strangers, prompting them to limit social interactions, thereby reducing their overall well-being and access to support systems.
Panic Disorder (PD) involves sudden and recurrent panic attacks, characterized by symptoms such as shortness of breath, a racing heart, chest pains, dizziness, and a fear of dying. It often prompts significant fears about future attacks and/or health repercussions (e.g., fearing a heart attack resulting from the panic), leading to alterations in behavior. For new mothers, these panic attacks can be especially frightening and debilitating, leading them to avoid leaving their homes in fear that they may have a panic attack in public. In these cases, it is suggested that mothers reach out for prompt intervention and support (Ali, 2018). Postpartum panic disorder occurs in 1 out of 30 mothers in the first couple of months postpartum. Additionally, this period may present a period of risk for the worsening of panic symptoms for women with pre-existing panic disorder (Ali, 2018).
Obsessive-Compulsive Disorder (OCD) is characterized by intrusive images or thoughts (i.e., obsessions) and repetitive behavior or thought patterns (i.e., compulsions). Despite its name, individuals with OCD may experience either obsessions or compulsions independently. These patterns typically aim to temporarily reduce anxiety and may relate to the newborn's well-being, causing interference in daily functioning (Kleinman & Wenzel, 2020). For new mothers, OCD can be distressing and time-consuming, impacting their enjoyment of motherhood and ability to care for their baby (Kleinman & Wenzel, 2020). Postpartum obsessions often involve intrusive thoughts about harming the baby, which can be embarrassing, leading mothers to avoid discussing these symptoms with their providers (Ali, 2018; Arnold, 1999; Johnson, 2013). Postpartum OCD occurs for 1 out of 25 mothers typically starting 1 to 3 weeks after childbirth.
In Dropping the Baby and Other Scare Thoughts: Breaking the Cycle of Unwanted Thoughts in Motherhood, authors Kleinman & Wenzel (2020) highlight significant findings for new mothers, indicating that those diagnosed with OCD often experience obsessive thoughts. These thoughts, common during the perinatal period, often center around the baby's well-being, including concerns about harm, accidents, or illness. Postpartum women may engage in compulsive behaviors like excessive checking or cleaning to prevent harm to the baby, though behaviors like counting and hoarding are less common unless practiced before childbirth.
As you assess your symptoms, their severity, and the most suitable course of action, it's crucial to recognize that certain symptoms necessitate immediate mental health assistance for you or your loved ones.
If you're grappling with feelings of despair or thoughts of suicide, it's vital to take them seriously and seek professional help promptly. Such thoughts can signify a profound mental health challenge that demands immediate intervention and support. If you require urgent assistance, don't hesitate to visit your nearest emergency room. Alternatively, you can reach out to the National Suicide Prevention Lifeline at 1-800-273-8255 if you're experiencing suicidal ideation.
Psychosis, while rare, can be dangerous and may occur among some mothers after childbirth. Psychosis is characterized by delusions, hallucinations, and disorganized thinking. During the postpartum period it may additionally present with rapid mood swings, confusion, agitation, and impulsivity (Garapati et al., 2023; Raza & Raza, 2023). These experiences can be distressing and alarming, requiring immediate intervention and support, as they can pose risks to both the mother and her baby (Garapati et al., 2023; Raza & Raza, 2023). Seeking urgent medical attention and specialized care is crucial. Treatment for postpartum psychosis involves a collaborative approach with an interprofessional team consisting of physicians, specialists, mental health professionals, specially trained nurses, and pharmacists working together across disciplines to ensure the best possible outcomes for the patient (Raza & Raza, 2023).
If you ever require immediate mental health services and you reside in Rochester, NY, you can contact the Rochester Regional Health Emergency Department at 585-922-3728 or reach out to mobile crisis at 585-275-5151 for immediate assistance.
Postpartum anxiety disorders can emerge at any time within the first year following childbirth, though predicting the duration of symptoms can be challenging. Recovery timelines vary and depend on many factors, such as symptom severity, duration before seeking support, treatment efficacy, mental health history, support systems, current well-being, and your baby's health. Remember, these disorders are treatable, and seeking support and resources is a courageous step toward healing.
Stay tuned for our next blog post, where we'll delve into coping strategies, with and without therapy, to bring comfort and tranquility to your postpartum journey.
References
Ali, E. (2018). Women's experiences with postpartum anxiety disorders: a narrative literature review. International journal of women's health, 10, 237–249. https://doi.org/10.2147/IJWH.S158621
Arnold, L. M. (1999). A case series of women with postpartum-onset obsessive-compulsive disorder. Primary care companion to the Journal of Clinical Psychiatry, 1(4), 103.
Cena, L., Gigantesco, A., Mirabella, F., Palumbo, G., Trainini, A., & Stefana, A. (2021). Prevalence of maternal postnatal anxiety and its association with demographic and socioeconomic factors: A multicentre study in Italy. Frontiers in psychiatry, 12, 737666. https://doi.org/10.3389/fpsyt.2021.737666
Dennis, C. L., Falah-Hassani, K., & Shiri, R. (2017). Prevalence of antenatal and postnatal anxiety: Systematic review and meta-analysis. British Journal of Psychiatry, 210(5), 315–323. doi:10.1192/bjp.bp.116.187179
Fawcett, E. J., Fairbrother, N., Cox, M. L., White, I. R., & Fawcett, J. M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate bayesian meta-analysis. The Journal of Clinical Psychiatry, 80(4), 18r12527. https://doi.org/10.4088/JCP.18r12527
Garapati, J., Jajoo, S., Aradhya, D., Reddy, L. S., Dahiphale, S. M., & Patel, D. J. (2023). Postpartum mood disorders: Insights into diagnosis, prevention, and treatment. Cureus, 15(7), e42107. https://doi.org/10.7759/cureus.42107
Johnson, K. (2013). Obsessive-compulsive disorder in the perinatal period. International Journal of Childbirth Education, 28(1).
Kleiman, K., & Wenzel, A. (2020). Dropping the baby and other scary thoughts: Breaking the cycle of unwanted thoughts in parenthood (2nd ed.). Routledge. https://doi-org.libezproxy2.syr.edu/10.4324/9780429274657
Raza, S.K., Raza S. Postpartum psychosis. [Updated 2023 Jun 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544304/
Schiller, C. E., Meltzer-Brody, S., & Rubinow, D. R. (2015). The role of reproductive hormones in postpartum depression. CNS Spectrums, 20(1), 48–59. doi:10.1017/S1092852914000480
Zappas, M. P., Becker K, & Walton-Moss, B. Postpartum anxiety. J Nurse Pract. 2021;17(1):60–4. doi: 10.1016/j.nurpra.2020.08.017.