We hear about it all the time…the depression many women face after having a baby, called postpartum depression. We see frequent warnings on how how to spot it, tips on how to get help for it, and thoughts on how to help someone going through it. And yet as difficult and common as postpartum depression is, other, equally difficult conditions are getting brushed under the rug: postpartum anxiety and OCD. They’re shockingly common…we suspect, more common than postpartum depression.
So what is the difference between postpartum depression and postpartum anxiety? Postpartum depression, which goes beyond the typical, short-lived the baby blues, is characterized by enormous feelings of sadness that don’t go away…a deep ache that cannot be explained. It can sound like this: “I just had a baby…This should be the happiest time of my life…Why am I so sad?” Some moms experience deep regret, questioning whether they should ever have had a baby at all. The days may feel long, tiring, and empty, usually forcing the new mother to question what is wrong with her, why she can’t feel happy during a time that “should” be happy. Of course, postpartum depression can look different for different women. Some may be irritable, angry, or unmotivated.
Postpartum anxiety, on the other hand, usually looks different, but it can be nonetheless hard to recognize since people frequently haven’t heard of it. The person’s thoughts are filled with “what-ifs,” and they may experience intense worry, feel constantly keyed up and physically on edge, experience panic attacks, and have a general feeling of unease and restlessness. If you’re trying to figure out if you have postpartum depression or anxiety, a key question is, Are you feeling sad and hopeless? Or are you feeling excessively worried and scared? Maybe you’re feeling both. Some women struggle with both postpartum depression and anxiety.
Women with postpartum anxiety may worry about:
- The health of the baby. This worry is particularly common and can result in the mom excessively check the baby’s breathing. They think, “What if she stops breathing in her sleep? What if she gets sick?”
- Making mistakes: “What if I accidentally leave the baby in the car?”
- Leaving the baby for even short periods of time in the care of others
- Breastfeeding. The mom might constantly question, “Am I producing enough milk?” despite reassurances by the lactation consultant or the baby’s weight gain
- Whether they are bonding with the baby
- Whether they’re doing a good job as a mom
- Whether they have ruined their life by becoming a parent
Some women experience postpartum OCD (obsessive compulsive disorder), which is surprisingly common. They may experience “intrusive thoughts,” thoughts that horrify them and make them wonder if they’re a good mom. Some examples of intrusive thoughts are
- Thoughts or mental images of the baby dead
- Thinking, Maybe I want to harm the baby
- Thinking, Maybe I’ll just throw the baby or stab him or her
- Thinking of putting the baby in the microwave or dryer
- Imagining shaking the baby
The mom may also experience intrusive images of acting on these thoughts.
As you might imagine, having intrusive thoughts or images is highly distressing. Note that postpartum OCD, which produces horrific thoughts that are highly distressing to the mom, is distinct from postpartum psychosis, which produces thoughts of harm that are NOT considered horrifying by the mother. Imagine the relief a new mom may feel when they learn that having these thoughts is a well-known anxiety disorder and does not mean they are a terrible mom and that they won’t act on these thoughts.
In response to these scary thoughts, the mom usually develops numerous rituals to alleviate the anxiety, such as excessive cleaning, asking for reassurance from others repetitively, checking on the baby, avoiding any “risky” items such as knives, and conducting exhaustive google searches.
Postpartum anxiety and OCD cause the mom to suffer greatly, at what is already one of the most difficult times in a woman’s life. The mom may experience:
- Extreme worry
- Physical activation
- Inability to relax
- Racing heart
- Being overly cautious or controlling
- Avoiding things that cause anxiety
All three conditions—postpartum depression, anxiety, and OCD—can be brought on by numerous factors. The hormonal changes of pregnancy and delivery can be factors, as can a prior history of anxiety.
Fortunately, all forms of postpartum anxiety are highly treatable. Counseling by a therapist trained in cognitive-behavioral therapy (CBT) can help enormously. Counseling can provide support and the opportunity to discuss what is happening and learn skills for responding differently to the anxiety. For postpartum OCD, a form of therapy called exposure and response prevention (ERP) is critical. Medications may also be helpful and women should speak to their physician about which medications are best if they are breastfeeding.
Pregnancy and recent motherhood are difficult enough without these issues. If you’re suffering from postpartum depression, anxiety, or OCD, reach out for help as possible to prevent the condition from worsening. With support and specific treatment for your anxiety, you can experience motherhood as the joy you had always hoped for.