Recognizing Perinatal and Postpartum Anxiety Disorder: Beyond the Baby Blues

While postpartum depression, which affects about 6% of new moms, has received mass media attention in recent years, postpartum anxiety disorder remains relatively unknown despite the fact that it is much more prevalent, affecting approximately 11% of women. Psychologist Jonathan Abramowitz says, “We call postpartum anxiety the hidden disorder because so few moms recognize it and it goes undiagnosed. It hasn’t been discussed or studied much, even though it’s a lot more common than postpartum depression (PPD).” One of the reasons postpartum anxiety often goes undetected is that worry is an overwhelmingly common and natural response to becoming a parent; between the hormonal upheaval of pregnancy, birth, and breastfeeding, lack of sleep, new relationship dynamic with your partner, and having to learn how to care for a new human life, it is normal to worry about whether or not you’re doing everything right. Powerful and often conflicting cultural messages about everything from the ideal labor to parenting approach to work/family balance often serve to exacerbate stress levels. While most women are able to deal with their worries, for some, anxiety becomes a painful, debilitating force that takes over and limits their life. Sarah Allen, a clinical psychologist and director of the Postpartum Depression Alliance of Illinois, says:

Every parent worries that they’re not doing something right … that there’s going to be some harm to this little precious baby that’s so vulnerable and tiny. And that’s normal. But anxiety is when it goes on and on – day in, day out, night in, night out – and there’s no let up. That’s the difference.

Although most anxiety develops after birth, about 30% of women with the condition start experiencing anxious symptoms during pregnancy, called perinatal anxiety. If you have a pre-existing anxiety disorder, you are at heightened risk for developing perinatal and postpartum anxiety, but these conditions can affect women without any history of psychiatric illness.

For some women, perinatal and postpartum anxiety manifest as Obsessive-Compulsive Disorder, a combination of intrusive thoughts and compulsive behaviors undertaken to alleviate those thoughts. Elizabeth van der Beugel’s OCD was triggered early in pregnancy when she realized she may have touched sausages without washing her hands. Her fear of toxoplasmosis, an infection that can cause fetal abnormalities and death, became all-consuming and she soon spent hours washing her hands and disinfecting her kitchen in addition to hours of online research regarding dangers to her unborn child. Perinatal and postpartum OCD differs from the ordinary articulation of the illness in that your obsessions and compulsions center around your child. Even for women who have pre-existing OCD, symptoms that manifest around their children may be particularly distressing. However, as Laura Slater explains, there may be a biological basis for perinatal and postpartum OCD:

Why would a woman be vulnerable to OCD during and directly after pregnancy? Why wouldn’t our bodies be set up, in some sort of genetic, evolutionary sense, to produce the kind of liquid calm that best allows for bonding with a baby and thus survival of the species? It may be, actually, that [perinatal] OCD is a kind of maternal survival mechanism gone a little haywire. Some experts hypothesize that OCD is really a manifestation of ancient grooming and guarding behaviors — two things a mother needs to do — that have slipped their chemical loopholes and are acting in an overamplified fashion.

Research suggests that some women are more sensitive to the powerful biochemical changes that happen during and after pregnancy, putting their natural protective instincts into overdrive and manifesting in a dysfunctional hypervigilance. While fear of environmental sources of harm, such as that experienced by van der Beugel, is a common focus, others are consumed by intrusive thoughts of themselves as the source of harm, which many women mistakenly identify as a sign of postpartum psychosis. However, OCD differs from PPD in a critical way: women with OCD are not at increased risk of hurting their children. In fact, you are fixated on preventing harm. You understand that your thoughts are irrational, maintain a firm grasp on right and wrong, and go out of your way to preserve the safety of your child. As psychologist Kiara Timpano points out, “Moms with postpartum OCD may be the least likely to harm their babies, since their symptoms revolve specifically around not wanting something bad to happen.”