In this article, I will discuss symptoms of postpartum psychosis and other PMADs in an effort to spread awareness. I do not mention specifics of the Lindsay Clancy case here, though I do mention the case itself.
We all know why perinatal mood and anxiety disorders (PMADs) are in the news right now. They are one of the leading subjects of social media posts across the country and beyond.
The Lindsay Clancy trial has consumed many of our feeds, and not just those of us in the motherhood space. This article isn’t about her or the trial outcome, though. It’s about the conversation it has started and the realization I came to that the general public is woefully uninformed about PMADs.
And it has really been getting to me.
Unfortunately, those who are new to the terms postpartum psychosis, depression, anxiety, and other mood disorders associated with the postpartum period are the same people posting loudly and confidently about these very diagnoses. They’re using incorrect vocabulary, which is furthering misinformation. So let’s get a few things straight.
“Postpartum” is not shorthand for postpartum depression.
Postpartum is the term for the period of time after having a baby, and the word by itself is not a reference to mental health. There are perinatal mood and anxiety disorders that start with the word postpartum, but interchanging the word to mean PPD (the actual abbreviation for postpartum depression) is confusing and inaccurate.
Postpartum depression is a term most people are familiar with, but many had not previously heard of postpartum psychosis, which is the diagnosis at the center of the Lindsay Clancy case. One of the issues in the discourse has been the use of those two very different conditions interchangeably.
Postpartum psychosis is the rarest of the PMADs, but it isn’t actually that rare. It impacts 1-2 women in every 1000 births. Given the potential consequences of a psychotic break, we should probably know more about it. It often involves delusions and breaks from reality, leading to potential self harm or harm of one’s baby. In these scenarios, the person experiencing psychosis believes their delusions or hallucinations are very real. It often comes on within the first few weeks of postpartum, though cases of later onset have been documented as well. The following list of symptoms is from the International Society for Psychological and Social Approaches to Psychosis- US Chapter (iSPS-US):
People experiencing postpartum psychosis may:
- Feel unusually energetic or unable to sleep for days
- Become confused or disoriented
- Experience rapid mood changes
- Hear voices or see things others do not
- Develop beliefs that feel absolutely real but seem unusual to others
- Experience frightening, confusing, or unusual thoughts about themselves, their baby, or the world around them
- Feel intensely connected to spiritual, religious, or symbolic experiences
- Have difficulty distinguishing dreams, thoughts, and reality
- Become fearful, suspicious, or overwhelmed
By contrast, postpartum depression’s incidence is between 10-20% globally and about 1 in every 8 women in the U.S. It is considered relatively normal to experience sadness and even crying as our hormones adjust after having a baby (some call this Baby Blues). But if symptoms last pasts 2-3 weeks postpartum and turn into despair, extreme fatigue, mood swings, lack of motivation, and/or feeling disconnected from your baby, it could have progressed to PPD.
Postpartum anxiety (PPA) may be even more common than PPD, with numbers as high as 1 in 5 women. Intrusive or catastrophic thoughts regarding baby’s safety are a hallmark of PPA. If anxiety is interfering with providing basic care to baby or if it prevents you from doing things you otherwise would (like leave the house), it could be PPA.
Postpartum OCD (obsessive-compulsive disorder) has a wider range, with an incidence of 2% up to 16% or more. A person experiencing PPOCD has overwhelming fears regarding their baby’s safety, but they are often very aware of the obsessive thoughts and repetitive behaviors involved and are not out of touch with reality like in postpartum psychosis. They may scald their hands washing things, count diapers multiple times in succession, or throw out a bottle because it can’t get clean enough in an effort to control their surroundings in the name of baby staying safe.
Postpartum PTSD (post-traumatic stress disorder) has a roughly 3-15% incidence, and is typically associated with a traumatic birth experience. 3-4% is the more general stat, with the higher range attributed to higher risk groups of women (such as those with the most severe birth complications or prior trauma).
As you can see, there are varying stats on these diagnoses, partly because they’re ever-changing and also because they are mostly self-reported, meaning accuracy is hard to pin down. Since many women do not report their struggles, the true numbers are likely higher.
If we don’t use accurate terms, it leads people to make assumptions that lead to misinformed takes and inaccurate paradigms. In Clancy’s case, people are basing their opinions of a woman who was experiencing a mental health crisis for months on incomplete and often inaccurate information. Basically, many of the chronically online folks screaming about this don’t really know what they’re talking about. They have a right to their opinion, but not all opinions carry the same weight when some are based in medical knowledge while others are rooted in understandably strong feelings about a horrific tragedy.
Outside of the case—which is really not the point of this article—it remains important for everyone to use the correct vocabulary if they’re going to speak on a topic such as postpartum or anything in the perinatal time period (which is typically considered pregnancy through one year postpartum). Postpartum itself has varying definitions of time. Some consider postpartum as the more immediate healing period of about 6 weeks, while others include the full first year, and still many more consider it to extend way beyond that. After all, anyone who is post (after) partum (childbirth) is postpartum, so… it’s technically forever!
One big reason why I care what words people use:
If we say things like “She has postpartum,” it creates confusion. This is not an accurate use of terminology. Postpartum isn’t something you have. It’s something you experience. Diminishing a whole lifetime of being a mother down to it meaning mental illness is wrong. Typical of our current society and its feelings towards mothers, maybe—but wrong.
Women may be avoiding content labeled “postpartum” if they assume it just refers to mental health disorders, when it fact it could be about anything someone has experienced after having their baby!
If you saw something labeled “postpartum tips” and you assumed it was advice on how to manage postpartum depression, you might either seek it out or avoid it depending on your own interests and experience. It matters to know what content you’re purchasing or consuming.
I have no doubt this is already happening. I recently described my upcoming book to a woman I had just met. I said, “It’s a postpartum recovery guide.” Her response was, “Oh! Did you have that after every one of your babies?” My inner response was huh?? but then I realized what she meant. She assumed it was a postpartum depression recovery guide (it’s not).
My big ask of you, dear readers and fellow writers, is to gently correct folks if you hear them speaking inaccurately about PMADs. Under normal circumstances, only those in the perinatal phase of life might think about these terms. But with the current news causing a spike in public discourse surrounding postpartum mental health, it’s an opportunity to set the record straight.
In the wake of this tragedy, there is an opportunity for improved awareness of postpartum mental health disorders. This information is important for all of us, as most of us know someone having a baby in any given year. Support for mothers and all parents in the postpartum time period is lacking (especially in the U.S.), and the system is failing women and families. Priorities include improved screenings, assessments, taking patient’s reports seriously, managing medications, multiple provider collaboration, paid family leave, breastfeeding support if needed, and general prioritization of a mother’s mental health.
Please spread the word.
Thank you for being here and for caring about this issue.
xo, Amy
Postpartum Mental Health Resources:
Postpartum Support International website (PSI)
PSI Helpline: 1-800-944-4773
Suicide Crisis Hotline: 988
National Maternal Mental Health Hotline: 1-833-852-6262