In the weeks leading up to the birth of her first baby three years ago, Kate* was excited and upbeat. She and her husband had been trying to have a child for eight years, and she hoped some of the pain of infertility would ease when she finally held their son in her arms.
Instead, Kate, who is now 39, was overwhelmed by feelings of dread that grabbed hold of her while she was recovering in the hospital and would not let go.
Her son had a lip-tie, which made breastfeeding difficult, and Kate worried that he wasn’t eating enough. She couldn’t eat anything herself and lost all of her pregnancy weight — plus another 20 pounds — in a single month. She couldn’t sleep. When Kate put her baby down in his crib, she was unable to tear herself away, convinced that he would somehow choke. Her fears were so vivid, she would see him dying in her mind while he slept peacefully in front of her.
“I had all of these thoughts, like, ‘What is going to happen? Is he going to be OK? Can I take my eyes off him?’” Kate told HuffPost. “It was completely all-consuming.”
The racing thoughts that threatened to pull Kate under were a hallmark of postpartum anxiety, a mood disorder characterized by relentless worrying that goes beyond the fears and emotional vulnerability that all new parents face.
Estimates suggest that “PPA” is at least as common as postpartum depression (“PPD”) if not more so — affecting anywhere between 10 and 17 percent of new moms, according to various estimates. Yet it tends to be overshadowed. PPD has an awareness month; celebrities have divulged the intimate details of their struggles in articles and blog posts and health care providers now screen for it as a matter of course. Postpartum anxiety, by contrast, has been called the “hidden disorder.” It remains under-studied and under-covered, leaving many new moms to wonder if paralyzing dread is simply the price they must pay for becoming a parent.
What It Does To Moms
“Postpartum depression tends to be a wastebasket term. It’s got everything in it,” Dr. Catherine Birndorf, a clinical associate professor of psychiatry and OB-GYN at the New York Presbyterian Hospital and co-founder of The Motherhood Center of New York told HuffPost. “But nomenclature is a big issue, and I think when women hear ‘postpartum anxiety’ they’re excited, because it’s like, ‘Oh my gosh! Someone’s actually naming what I have. Because I’m not sad. I’m just so anxious.’”
And for many women with postpartum anxiety, those thoughts tend to whirl around one subject: their babies.
“These women will have persistent and excessive worry about the baby, the baby’s health, the baby’s wellbeing, the baby’s viability,” said Dr. Margaret Howard, director of the Women’s Behavioral Health program at Women & Infants Hospital of Rhode Island. Howard made a point of emphasizing that this focus on the infant is what tends to set postpartum anxiety apart from generalized anxiety disorder. “They have a lot of fear, tension, poor concentration ... and they’ll have a lot of these intrusive, unwanted persistent thoughts, images, fears of the baby being harmed.”
Elissa*, 35, said it felt as though those unwanted, intrusive feelings “crawled all over” her after she gave birth to her eldest five years ago.
My head would not shut up. It was like this running loop, like, 'She's gonna die. She's gonna die.'
“I was petrified of everything. Taking her somewhere in the car. Just being with her by myself, I was worried that something might happen and that I wouldn’t be able to take care of her. But then I couldn’t stand for anyone else to watch her,” she said. She also worried about her husband. When he left the house, she was convinced he was going to get in a car accident. If he wasn’t home right when expected, she called him frantically to make sure he was OK.
Elissa thought maybe all moms deal with that kind of constant anxiety, but her mother (who is an OB-GYN) told her to talk to her doctor. Elissa started a relatively low-dose of Zoloft, which soon helped take the edge off the symptoms to a point where she could function day-to-day.
For some women, the intrusive thoughts are severe. A 34-year-old mother who spoke to HuffPost on the condition of complete anonymity described how, at about two months postpartum, her anxiety crossed a frightening line. She was out at the movies at the time, and her husband was home watching their daughter.
“I’m sitting there watching this movie and I had this thought pop into my head — that I was going to kill her,” she said. “It was terrifying. I had never experienced anything like that, ever.” The woman works in mental health and did not want to say anything, because she had seen people put on involuntary holds before. She worried someone would take her daughter away.
But the thoughts did not stop. When she put her daughter down for a nap, she was certain she would not wake up. If they were out running errands together, she would check every five minutes to make sure she was still breathing. Emotionally, the mom held back from connecting with her daughter because she was convinced she was going to die and could not risk the heartache of losing the best thing that ever happened to her. A month or so later, she had what she called the “most terrifying moment of my life.”
“My head would not shut up, it was like this running loop, like, ‘She’s gonna die, she’s gonna die.’ And I thought, well, if I do it, then at least the anxiety will go away,” she said. “I would never, ever, ever do anything to actually hurt her — and I knew that in the moment — so the fact that I was still having these thoughts was so scary. It was like, what is wrong with me?” (Birndorf pointed out that women who have postpartum psychosis, which is rare, differ from women with PPA or even PPD in that they are unable to recognize in the moment that those intrusive, threatening thoughts are wrong.)
Why Does PPA Fly Under The Radar?
One reason why postpartum anxiety continues to be overlooked is that it doesn’t exist as a standalone diagnosis. Instead, women may meet criteria for generalized anxiety disorder, for something called “adjustment disorder with anxiety” (in which symptoms develop within several months of a specific stressor) ― or even for obsessive compulsive disorder (OCD). Before the release of latest version of the The Diagnostic and Statistical Manual of Mental Disorders (DSM) ― the “bible” of mental health diagnoses ― some perinatal mental health advocates lobbied to have PPA recognized as its own separate category. At the very least, they hoped for a postpartum onset modifier for generalized anxiety, like there is for depression. It would have sent a message that anxiety that begins during pregnancy (or within the first six months after a woman gives birth) is somehow distinct.
As it stands, however, the DSM does not recognize much of a difference between anxiety in the postpartum period and generalized anxiety.
PPA also sometimes gets wrapped up in postpartum depression because moms who get one often get both.
“Anxiety symptoms are the same postpartum as they are at other times ... feeling keyed up all the time, anxious, nervous, an inability to relax, etc.,” Howard told HuffPost. Postpartum Support International also lists symptoms like changes in sleep, appetite and physical manifestations such as dizziness and hot flashes, and notes that women with a history of anxiety are at higher risk of developing the disorder in pregnancy and postpartum.
PPA also sometimes gets wrapped up in postpartum depression because moms who get one often get both — and because anxiety can be a symptom of depression, Birndorf explained. Because the lines aren’t necessarily clear, clinicians vary in terms of what they will write down as an “official” diagnosis, she explained. Some might write generalized anxiety disorder. Some might simply put it down as PPD. Birndorf said she often writes “PPD/A” when she sees a patient who seems to have both.
Breaking The Cycle
When discussing her anxiety with HuffPost, Kate made it a point to emphasize that she loves her children ferociously, and that her anxiety did nothing to change that. So did both Elissa and the anonymous mother, each anticipating, perhaps, the judgment that struggling with postpartum anxiety (or any kind of perinatal mood disorder) makes them bad moms. It’s that fear of outsiders judging their parenting abilities and commitment — or worse, threatening to take their kids — that leaves many women to feel they must suffer in silence. That, of course, is where awareness comes in. The more women know, the less likely they are to feel they are the only ones being crushed by the weight of new motherhood. Because all of the experts interviewed for this story emphasized that postpartum anxiety is eminently treatable — if women get help.
We always try and assure people that this is treatable. You don't have to tolerate it."
“We need more education for partners and parents and friends, because it’s very difficult for women to recognize that this is going on inside of them, and they do need to rely on their base of support to be educated enough to say, ‘Hey, you’re exhibiting X, Y and Z. This is not your normal,’” said Paige Bellenbaum, LMSW, program director of The Motherhood Center.
“We always try and assure people that this is treatable,” she said. “You don’t have to tolerate it.”
For the anonymous mother with severe intrusive thoughts, the combination of a prescription for anti-anxiety medication, therapy and connecting with a moms’ group helped to get her postpartum anxiety and obsessive compulsive disorder under control. Likewise, Kate began taking Celexa a month after her son was born, which took the edge off to the point where she was able to function. She went off the medication when she got pregnant again 13 months later and struggled with anxiety again after the birth of her youngest. It was less acute, but also more intense in a way. Now she had two children to worry about.
“Even though my brain was so scrambled or something, I did always love them,” Kate said. “It almost made it worse, because I loved them so much.”
*For privacy reasons, only first names have been used.