Other perinatal mental health conditions

Perinatal adjustment disorders

When symptoms are less severe than those found in depression and anxiety, the person could be experiencing an adjustment disorder. This is a stress related condition that develops in response to the many stressors of parenthood. Symptoms can be emotional as well as behavioural. Perinatal Adjustment Disorders are common, with nearly 50% of Australian parents experiencing an adjustment disorder.  

An adjustment disorder differs from perinatal depression and anxiety (PNDA) in that the symptoms are often mild and do not last as long as other conditions, however they still impact daily functioning. This can be distressing because it affects how new parents think and feel about themselves, their baby and others, and often requires support and treatment.

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Post-traumatic stress disorder (PTSD) after birth

PTSD after birth can occur following a real or perceived traumatic birth experience or when other traumas resurface as a result of the birth. Birth trauma can include unplanned Caesarean-section, baby going to NICU, physical injuries because of the birth, previous significant loss, as well as feelings of powerlessness and lack of support during the birth process. Resurfacing traumas can include a previous traumatic birth or loss, or previous personal history of trauma. PTSD can occur in conjunction with other mental health conditions.

Symptoms for women and partners include intrusive re-experiencing of past events, flashbacks, nightmares, avoidance of reminders of the birth and anxiety or emotional numbness. It is a temporary, treatable condition and may require professional help if it continues to impact daily functioning and the ability to parent.

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Acute stress disorder (ASD) after birth

Acute Stress Disorder can occur immediately after a traumatic event and is a short-term condition often lasting less than a month. A person who has ASD experiences psychological distress and its symptoms are similar to PTSD. ASD is a temporary condition, and the treatment focuses on decreasing symptoms, improving coping strategies and preventing PTSD. In dealing with ASD, talking to family and friends and seeking community support is often enough to deal with the effects of trauma if it is not complicated or perceived as life-threatening.

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Perinatal obsessive-compulsive disorder (OCD)

OCD is defined as repetitive, disturbing thoughts or images (obsessions), often revolving around the baby’s safety, that cause anxiety and stress. These are commonly followed by thoughts or actions (compulsions) a person keeps repeating to try and reduce the anxiety. The occurrence is between 2-3% of women in the perinatal period.

In OCD the obsessive-compulsive cycles can become overwhelming and dominate a person’s day, stopping them from being able to do other things. The cycles may also be accompanied by feelings of frustration, guilt and shame. It is a disturbing and distressing condition, significantly affecting capacity to cope during early parenthood. It is treatable and benefits from an experienced GP and/or psychiatrist/psychologist or other health professional who can help with strategies and treatments.

Parents who have previously experienced OCD or extreme anxiety may be more susceptible to a recurrence in the perinatal period. However, some parents experience OCD for the first time during pregnancy or after birth.

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Postpartum psychosis

Postpartum Psychosis is a rare but serious condition, affecting approximately 1-2 in every 1000 births. Symptoms appear acutely, usually within the first two weeks after delivery, and can present as a mixture of distorted thought processes (such as delusions and hallucinations) and significant shifts in moods (such as extreme highs to extreme lows). Where delusions are present, they often centre on the baby.  

Symptoms can be very distressing and can also include sudden and significant changes in thinking, behaviour and sleep patterns. It is a treatable condition but requires immediate medical and professional intervention.

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Other perinatal mental health conditions

The following mental health disorders may have been present prior to the perinatal period. However, with the stressors associated with pregnancy and birth, coupled with increased screening and input from professionals during this time, these mental health conditions may be diagnosed, re-emerge or intensify during this time.

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Eating disorders

Eating Disorders (including anorexia nervosa, bulimia, avoidant restrictive, body dysmorphia and others) can arise or relapse during increased periods of body change, stress and vulnerability during the perinatal period. They can affect 5-10% of pregnant and up to 11.5% of postpartum women. Women in stable remission prior to pregnancy can have a higher relapse rate especially in the early stages of pregnancy. Additionally, women with no disordered eating history may be at increased risk of developing an eating disorder for the first time. Someone diagnosed with an eating disorder will need extra professional support, not only during their pregnancy, but also post-birth, to manage any arising symptoms.

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Bipolar disorder

Bipolar Disorder is classified as a mood disorder, characterised by extreme highs and lows in mood and activity levels. A diagnosis of bipolar disorder can occur for the first time during the perinatal period in up to 3% of women, or if previously diagnosed, a relapse can occur during this time in up to 54% of women. It can look like severe depression and anxiety however is a less common condition and requires thorough diagnosis and assessment with an informed professional.

Expectant and new parents are encouraged to disclose any thoughts and fears to their health practitioners so they can understand them to receive supportive care and treatment.

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Borderline personality disorder (BPD)

BPD is a mental health condition that significantly impacts a person’s ability to regulate their emotions. This dysregulation of emotions can increase impulsivity, affect how a person feels about themselves and negatively impact their relationships with others. It often arises because of trauma.  

In the perinatal period symptoms and behaviours associated with BPD can be heightened or re-emerge post birth. A mother with BPD could have increased difficulty managing the stresses of parenthood. For example, they may have a difficult time bonding with their child or find it challenging to take care of the infant.

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Schizophrenia

Schizophrenia is a severe, chronic mental disorder characterised by disturbances in thought, perception and behaviour. People who have been diagnosed with schizophrenia in the past may be more vulnerable to relapse during the perinatal period. This condition requires close support and management from medical and other health professionals during this time.