Common but Often Overlooked: Postpartum Anxiety Disorders
Postpartum depression and its impacts have gotten a lot more attention in recent years, and that's a good thing. However, there are many other types of postpartum mental health issues besides depression, and many overlook their symptoms because they don't even know the condition exists. One of the most common postpartum mental health issues is Postpartum Anxiety (PPA), and that includes Postpartum Obsessive-Compulsive Disorder (PP OCD) and Postpartum Panic Disorder. According to Postpartum Support International, approximately 6% of pregnant women and 10% of postpartum women experience significant anxiety, which is often coupled with depression.
PPA can develop due to a variety of reasons. First, there is a huge flood and dissipation of hormones that occurs after birth, along with sleep deprivation that can have a serious impact on well-being. Additionally, having a new baby is a huge life transition and adjustment. Many people also experience major shifts in their relationship with their partner. All of these factors can lend to postpartum issues and make PPA feel more intense. Moreover, there are some risk factors for PPA. If you have suffered from an anxiety disorder before, developed an anxiety disorder during pregnancy, have developed PPA with a previous baby, or have a thyroid imbalance, you are at greater risk of developing PPA.
The following are ways in which PPA commonly manifest:
Isn't a little worry normal for a new parent? Particularly for a first-timer, it is common to feel like you don't know what you're doing. You want to make sure your new little one is safe, healthy, and has a good start in life. From a psychological standpoint, a little bit of anxiety can be a healthy motivator for doing a good job. However, when the worry is too much, when the anxiety is so strong that it negatively impacts your quality of life, then it's a problem. Here is a list of common Postpartum Anxiety symptoms:
1.) Constant worry, dread, or feeling as if something bad is going to happen. For many mothers with PPA, these thoughts are frequent, intrusive, and scary. For example, thinking, "What if I drop the baby?" or "What if the baby drowns in the bath?" The number of things to worry about can seem infinite, and often these thoughts can involve vividly imagining the scary thought coming to life in detail. Or, sometimes the worry can seem to come rapid-fire, one after the other. To some extent, most new parents experience these types of scary thoughts. However, when these thoughts become relentless and overwhelming, it can make life as a new parent much more difficult to cope with.
2.) Restlessness or an inability to sit still. If you feel pressured to constantly be doing things, such as taking care of the baby, cleaning, or other tasks, it may be motivated by unhealthy anxiety. If you find yourself not taking time to rest, forgetting to eat, and not engaging in self-care, your physical and mental health will begin to deteriorate.
3.) Sleep and appetite disturbances. There is no doubt that having an infant impacts your ability to get a good night's sleep, so it can be difficult to determine what is "normal" and what isn't. Anxiety can interfere with our ability to sleep for the above mentioned reasons including racing thoughts and restlessness. That can turn into a big problem if a new parent is unable to get as much rest as possible. There is a reason why sleep deprivation is used as a form of torture! Changes in appetite may also occur—if you notice yourself eating far less or much more (with the exception of increased calorie needs for breastfeeding) than you typically do, that may be a red flag that you are struggling.
4.) Physical symptoms. The mind-body connection is real. When we are under a lot of stress and chronically anxious, we may manifest physical symptoms of anxiety. These symptoms include muscle tension, headaches, GI problems such as heartburn or upset stomach, and many others. Too much anxiety can literally make us feel sick.
5. Frequently crying and/or feeling overwhelmed. Being a parent can be tough. In fact, it might be the hardest thing you do in your life. Feeling overwhelmed at times, can be very normal and understandable. But for those plagued with Postpartum Anxiety, feeling overwhelmed may be a constant state of mind. If you constantly feel like you're at your breaking point and have difficulty recovering, every day may feel like you are just trying to survive the next 24 hours.
Panic attacks can be terrifying and completely overwhelming. Symptoms include heart racing/palpitations, hyperventilating, sweating, numbness, dizziness, shaking, chest tightness, feeling a loss of control, and having a sense of dread. These attacks are typically short, ending within minutes. They can feel so intense that a person may believe that they are having a heart attack. Frequent panic attacks may lead a person to avoid certain situations that trigger the panic, and some people may even avoid leaving their home. For postpartum women, these panic attacks may center around fears about their baby. While panic attacks are scary and feel difficult to control, they are treatable.
Obsessions and Compulsions
Obsessions are intrusive, anxiety-provoking thoughts about the baby. Compulsions are behaviors that a person with obsessive thoughts does to reduce anxiety. Examples of some more common compulsions include hypervigilance about checking the baby, excessive cleaning or hygiene activities, and being so afraid that you will do something harmful to the baby that you fear being left alone. These thoughts are disturbing, highly stressful, and difficult to control by yourself. Thankfully, PP OCD is treatable.
Sometimes PPA is misdiagnosed as PPD, and many times a person will be suffering from PPA and PPD at the same time. However, it is important to distinguish between the two conditions because the treatment needs to take anxiety symptoms into account, not just depression symptoms. If you believe you may be suffering from PPA, please talk to your health care professional about your concerns. PPA is treatable and can be relieved by a mental health professional trained in treating perinatal mental health.
Dr. Amber Sylvan is a psychologist in Ann Arbor, MI who helps pregnant and postpartum women cope with and heal from Perinatal Mood and Anxiety Disorders and birth trauma.
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