About PNDA

Clinical Definition of Perinatal Depression

Pregnancy and the first year of parenthood (the perinatal period) is a unique time and involves major changes in a person’s life. The challenges of this adjustment to parenthood are often underestimated within our society and cultures. All expectant and new parents, including both mums and dads or partners will have some good days and bad days. Ups and downs are expected and common. But when bad days become the norm, a parent may be experiencing perinatal depression or anxiety.

Perinatal depression and anxiety affect almost 100,000 expectant and new parents in Australia each year. Often, estimates for anxiety and depression are combined because many new parents experience symptoms of both. Sometimes one may present more strongly than the other.

Depression alone affects up to one in ten women during pregnancy. In the first year after birth, it affects up to one in five women. Perinatal depression in dads or partners is not as well-researched. Evidence to date estimates about one in ten new dads are affected at some point from pregnancy through to the first year after birth. This rises to 1 in 5 if the mother is depressed. Dads’ roles have evolved in recent decades and some men can find this transition to parenthood challenging as they juggle all of the changes.

Mood disturbances such as depression tend to fluctuate more frequently and deteriorate more rapidly in the perinatal period than at other times. It is a vulnerable time. Perinatal depression is a recognisable and diagnosable medical condition. Genetic and prior life experiences can play a significant part in its development. Triggers can include biological factors (for example, genetics, hormonal changes), psychological factors (for example personal or family history of depression or anxiety), and social factors (for example lack of family support). It is treatable and it is important to remember that recovery is possible with the right supports in place.

Symptoms

An episode of perinatal depression and anxiety can be mild, moderate or severe. It is diagnosed when several of the following symptoms occur for more than two weeks causing significant distress or impairment:

• Depressed mood including feeling sad, empty or hopeless.
• Crying for no apparent reason.
• Loss of interest or pleasure in life.
• Physical symptoms: (changes in appetite, headaches, sweaty palms, heart racing).
• Insomnia or excessive sleep.
• Moving more slowly or finding it harder to slow down.
• Loss of energy or fatigue.
• Not feeling attached or bonded with your baby.
• Feelings of worthlessness, guilt, feeling trapped.
• Impaired concentration or indecisiveness.
• Thoughts of death, self-harm or a suicide attempt.

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Clinical Definition of Perinatal Anxiety

Pregnancy and the first year after birth (the perinatal period) involve uncertainty, upheaval and change. In an environment where people try to retain as much control as possible over their lives, these new challenges are often anxiety-inducing.

It is expected and common for new parents to experience some worries and concerns. But if worries and fears start to feel overwhelming, or if they interfere significantly with daily life, a parent may be developing some perinatal anxiety symptoms.

When examining statistics, some studies have found up to one in five women are affected by perinatal anxiety. Although perinatal anxiety in dads or partners is not as well-researched, similar rates are estimated for men.

Anxiety tends to fluctuate more frequently and deteriorate more rapidly in the perinatal period compared with other times. There are many reasons for this.

Triggers for perinatal anxiety can include biological factors (for example hormonal changes); psychological factors (for example negative thinking or the desire to be a “perfect” parent); and social factors (for example loss of financial independence for a stay-at-home parent; no family support). Although it is common, perinatal anxiety is treatable – early intervention helps and recovery is possible.

Perinatal anxiety is commonly diagnosed by medical professionals using criteria applied to other anxiety disorders.

Symptoms

If a parent experiences several of the following symptoms for two weeks or more and they cause significant distress or impairment, an anxiety diagnosis may be given:

• Difficulty concentrating or focussing.
• Feeling unusually restless.
• Fear that something awful might happen.
• Excessive and generalised worry.
• Irritability.
• Panic attacks.
• Muscle tension.
• Sleep disturbance.
• Appetite disturbance.
• Obsessive or compulsive behaviours.
• Other physical symptoms such as heart palpitations, sweaty hands, stomach complaints.

In addition, many parents have repetitive, negative, intrusive thoughts or images about their baby’s health or safety. The repetitive intrusive images and thoughts are very frightening and can feel like they come ‘out of the blue’. Research has shown that these images are anxious in nature not delusional and have very low risk of being acted upon.

These include sudden thoughts (for example “what if I drop the baby on the stairs?”) or sudden images (for example picturing the baby falling off the changing table).

They can be associated with Obsessive-Compulsive Disorder (OCD), which is a specific diagnosis. However, if these intrusive thoughts or images are not linked to repetitive, behavioural urges or compulsions, they may be diagnosed as an anxiety symptom only. They occur in approximately 80% of new parents. It is a common manifestation of anxiety. It is not about who you are as a parent.

Parents are encouraged to disclose these thoughts and fears to their health practitioners so they can understand them to receive supportive care and treatment.

Depression, anxiety, OCD, stressor and trauma-related disorders frequently occur together.

“You can be scared and still take care of your baby. You can be uncertain and still do things that help you feel more in control. You can have scary thoughts and be a wonderful mother. You can be anxious beyond belief and still experience joy.”
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Karen Kleiman, MSW
Founder and Director, The Postpartum Stress Centre)

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Clinical Definition of Perinatal OCD

Obsessive-Compulsive Disorder (OCD) is related to but no longer classified with the anxiety disorders. It is disturbing and distressing for the person experiencing it and can significantly affect their capacity to cope during early parenthood. It is a treatable condition and benefits from an experienced GP and/or psychiatrist/psychologist or other health professional who can help with strategies and treatments to manage the distress.

OCD is defined as repetitive, disturbing thoughts or images (obsessions) that cause anxiety and stress. These are commonly followed by thoughts or actions (compulsions) a person keeps repeating to try and reduce the anxiety.

In the perinatal period, these behaviours often revolve around the baby’s safety but may also show up in other ways. The cycles can become overwhelming and dominate a person’s day, stopping them from being able to do other things. The cycles may be accompanied by feelings of frustration, guilt and shame.

Many people are familiar with stereotypical compulsive behaviours such as repetitive handwashing, which may temporarily relieve fears about germs and illness. However, OCD can emerge in many different ways.

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.

OCD in the perinatal period has not been extensively researched. Research on OCD during pregnancy or among men is even more limited. Some studies estimate that after birth, OCD rates among new mums are very high.

Symptoms

Some of the followings are common but not exclusive ways that OCD may show up during the perinatal period.

• Fear around a baby being harmed by germs or dirt.
• Worries about something a parent did or didn’t do to keep their baby safe.
• An image (a picture that flashes into a person’s mind) or a thought of harming a baby, either accidentally or deliberately. These can include sexual or violent thoughts, which can be very distressing for a parent.

Some of the behaviours that may follow to alleviate anxiety:

• Rituals such as washing, cleaning or sterilising repetitively and excessively.
• Checking a baby’s breathing repeatedly when he/she is sleeping to the point where it interferes with the parent’s own sleep.
• Seeking repeated reassurance from others that everything is OK.
• Correcting obsessional thoughts by counting, praying or repeating a special word.
• Avoiding feared situations or activities for example avoiding nappy changing or taking a baby out in public because of germs.

Although perinatal OCD can be scary to experience, medical professionals understand that it does not involve any intention to harm a baby, that it is a mental health issue and does not define the parent as bad or unable to care for their baby. Actual harm to the baby is very rare. It is important to seek professional help in order to recover from perinatal OCD.

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Date of Last Review: April 2021