Postpartum Depression Is NOT Postpartum Psychosis: What Women Need to Understand About Infant Harm

Monday, July 07, 2014 by Meg   •   Filed under Postpartum Depression

Postpartum depression (PPD) is far too common among contemporary women. While current medical reasoning attributes postpartum depression symptoms to the hormonal fluctuations following childbirth, those fluctuations evolved to serve a specific purpose for our ancestors, one that weighed the benefits of childbearing against the stress in the environment. Postpartum depression in relation to this drive is discussed in detail here, in PPD, Maternal Investment Theory and the Drive to Abandon.

However, after a personal conversation over the weekend, I wanted to make one thing clear for those who suffer before we get into what PPD is. Because whatever it is, postpartum depression is NOT the same as postpartum psychosis, a condition more closely related to actual infant harm. Understanding what postpartum depression is, and what it isn't, may help reduce anxiety in those who suffer from it.  

So what does postpartum depression (PPD) feel like?

Like total, tweaky, sleep-deprived shit. But that's not very technical. Let me try again.

Signs and Symptoms of Postpartum Depression:

  • Hopelessness 
  • Sadness (or other depressive symptoms)
  • Loss of pleasure in things you used to enjoy
  • Anxiety symptoms 
  • Panic attacks (often severe)
  • Irritability
  • Trouble sleeping/insomnia
  • Thoughts of death or suicide
  • Thoughts of harming your child

How these symptoms play out in any one person varies a great deal, but when women show up for therapy after childbirth, the biggest fear by far is the one related to harming their baby. As we will get into next month, that type of thought comes from somewhere, but it doesn't mean you'll do it. If we acted on every thought we had, the roads would be paved with idiot drivers and jerky mother-in-laws. No matter how intense the thoughts seem, the odds of infant harm are exceedingly low. A general rule of thumb is, if it bothers you, you're not very likely to do it.

"But it happens," you say. "Don't you remember Andrea Yates? Casey Anthony? Women do hurt their kids."

Well, not so much. But thanks to douchebaggy television sensationalism, we get to hear about the tiny percentage that do, and that distorts our perception of danger. Fucking CNN needs to find something to talk about for the twenty-three-and-a-half hours when they have nothing better to do, and so we revisit the tiny fraction of horrible baby-killing stories, making us think these things are far more common than they are. In addition, they neglect to inform the public that those who hurt their kids don't usually have postpartum depression at all. Instead they usually have a condition called postpartum psychosis. If they told us that, we'd be a little less scared (and thus less likely to bother watching their shows), because less than 1% of women ever develop postpartum psychosis, and of that 1% less than 4% harm their children.

4% of 1% of women. Even for those who aren't math whizzes, that number is crazy small.  

Yet everyone is kinda convinced that they will be the one to do it. 

Postpartum psychosis is not an offshoot of PPD, though the news media often uses them interchangeably. Nor is it a disease of baby-killing, despite the much higher rates among those with postpartum psychosis. Instead, postpartum psychosis is a term used to describe a psychotic episode that occurs after birth. And while there are a few conditions including bipolar disorder that may increase risks for developing postpartum psychosis, psychosis is a different animal than anxiety, depression, bipolar conditions, postpartum depression or trauma. (For more, check out Understanding Postpartum Psychosis: A Temporary Madness.)

Don't feel better? How about this:

Here's what postpartum psychosis looks like:

  • Delusions
  • Hallucinations
  • Extreme agitation
  • Hyperactivity
  • Insomnia
  • Mood lability (fluctuating mood)
  • Confusion
  • Poor judgment
  • Irrationality
  • Difficulty concentrating 

This list of symptoms may not be comforting, mostly because we all have some of them, especially in the first months postpartum. Hell, I'm confused sometimes now, and the concentration level it took to write this post required more coffee than I want to admit. Immediately after birth, most people have a touch of insomnia worrying about their new child, as well as mood lability. The baby blues are no fun either, and that emotional roller coaster just happens to overlap some of these symptoms too. For those reading these symptoms for fear that they have this condition, I suspect the feeling is much like graduate school in the psychology field, as everyone starts to think that they have the illnesses they study. 

How about this then:

If you have postpartum psychosis, you may be hearing voices or developing some pretty outlandish beliefs about the state of the world.  And the same disorder that may encourage women to hurt their kids may also trigger a temporary break with reality, leading to lack of judgment.  

So, if you're reading this and using higher order processes to rationally weigh the information, you aren't so likely to actually harm your kid. And again, if the thought of hurting your kid still bothers you, you're probably in good shape. Scary thoughts are the brain's way of processing danger and they often revolve around those things that scare you the most.

Fear at the thought of infant harm = good sign

The belief that your new baby is the Devil incarnate who must be destroyed for the good of all mankind = bad sign

Hanging out, reading this article = good sign

Complete break with reality = bad sign

While these are extreme examples and postpartum psychosis occurs on a continuum, even less severe cases tend to involve hallucinations and delusions including the belief that harming the self or the child is a good idea. This lack of judgment is a hallmark of the postpartum psychosis diagnosis. 

Despite the extremely low odds that someone with postpartum depression will ever experience psychosis, most women can benefit from therapeutic help postpartum, particularly because isolation and stress after birth is one of the most critical and misunderstood triggers to postpartum depression in the first place. 

Any woman coping with postpartum depression should not have to go it alone. And judging by the fact that up to 15% of women get PPD, those suffering are not alone by any stretch of the imagination. And again, if 15% of women hurt their children, Gymboree would be a lot less crowded.

Postpartum depression is not a life sentence, nor is it something to be ashamed of. The fear surrounding the scary thoughts that come with PPD may be more indicative of a drive to keep your child safe than an indication of an actual desire to harm. There are some great resources out there including This Isn't What I Expected, however, please consider seeking professional assistance if you are suffering from postpartum depression. Though you aren't likely to harm your child, postpartum depression is not something to deal with alone. Don't suffer in silence.

Related Posts:

Topic-Relevant Resources

This Isn't What I Expected [2nd edition]: Overcoming Postpartum Depression
A great guide on combatting postpartum depression. You're not alone.

The Postpartum Husband: Practical Solutions for living with Postpartum Depression
A concise, practical guide full of useful information for the loved ones of those suffering with PPD

Understanding Postpartum Psychosis: A Temporary Madness
Great resource for understanding postpartum psychosis.

Mothering Through the Darkness: Women Open Up About the Postpartum Experience
Beautiful insight into the postpartum experience, this book uses personal essays to explore postpartum depression.