Postpartum Psychosis: Symptoms, Causes, And Treatments

Reviewed by Whitney White, MS CMHC, NCC., LPC

Published 12/09/2020

Most people imagine pleasant times with their newborn baby. They may recognize that dealing with an infant involves sleepless nights, the weight of responsibility, a little chaos, and sometimes utter exhaustion. Iconic images in art and depictions of motherhood in popular culture don’t show the whole story. For 1 to 2 in 1000 women, being a new mother comes with postpartum depression.

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What Is Postpartum Psychosis?

Several psychiatric conditions might happen after a woman gives birth. They include postpartum depression, obsessive and compulsive symptoms, and postpartum psychosis. Psychosis is the most severe of the three.

So, what is a good postpartum psychosis definition? The first thing to know is that it happens after a woman has a baby. It usually begins within the first two weeks after birth. The other part of the definition is the psychosis part. The psychosis can include either hallucinations, delusions, or both. It represents a break with reality.Postpartum psychosis doesn’t always lead to more mental health problems. Sometimes, with treatment, it can go away and never come back or be part of a longer-term mental health issue.

Puerperal Vs. Prenatal Psychosis

You may have heard of puerperal psychosis or prenatal psychosis. Puerperal psychosis is just another term used for postpartum psychosis. Prenatal psychosis is different in that it happens before you give birth. Because you are still pregnant when it happens, your doctor will have to consider the effects of medication on the unborn baby. So, treatment might be a little different than for postpartum psychosis.

Postpartum Psychosis and Depression

Postpartum psychosis, depression, and other mental illnesses sometimes happen after childbirth. Postpartum depression is more common than psychosis. In fact, about 1 in 8 women have symptoms of postpartum depression. Symptoms include excessive crying, anxiety, anger, and feeling numb or unattached to the new baby. The depression can be bad enough that you think of hurting yourself or your baby.

You might not have symptoms you recognize as postpartum depression until weeks or even months after giving birth. Postpartum psychosis usually comes on very suddenly. It happens within the first two to four weeks after giving birth. While there may be a mood element that includes mood swings, the primary problem is the psychotic symptoms.

Postpartum Psychosis Symptoms

Postpartum psychosis, of course, has symptoms in common with psychosis that doesn’t happen after childbirth. The main two symptoms are hallucinations and delusions, but when they occur after birth, they often take on a different flavor.

Early Signs of Postpartum Psychosis

Most people don’t have a lot of warning that they are about to have postpartum psychosis. It tends to come on very suddenly. However, there are a few early signs of this disorder that you might be able to recognize. If you do, you can seek help and possibly avoid worse problems. Early symptoms include:

  • Extreme and rapidly changing moods
  • Being confused
  • Being disoriented as to time or place
  • Erratic behavior
  • Disorganized speech and behaviors

Hallucinations in Postpartum Psychosis

The word “hallucinations” refers to sensory experiences that aren’t based on reality. You may hear, see, taste, smell, or feel things that aren’t actually there. Auditory hallucinations are common and usually include voices that tell the mother something distressing.

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Delusions in Postpartum Psychosis

Delusions are a classic sign of psychosis whenever it happens. Delusions are beliefs that can’t possibly be true or that don’t match what is really happening. During postpartum psychosis, these false beliefs may have something to do with the baby or the woman as a mother.

Other Symptoms

Although hallucinations and delusions are the main symptoms that define postpartum psychosis, other types of symptoms can be just as severe and distressing. These signs of psychosis include thoughts, emotions, and behaviors like the following.

Violent Thoughts

Often, women with this condition have violent thoughts. They think about hurting themselves or their baby. If you notice these thoughts or someone you care about is talking about them, seek help right away.

Obsessive Thoughts

Sometimes, a woman has obsessive thoughts about her baby. Her mind may get stuck on little details about the child. She finds it hard to let go of these thoughts or stop worrying about them. What starts as a small concern can grow into an overwhelming idea that something is seriously wrong with the baby.

Rapidly Changing Moods

Postpartum psychosis is not primarily a mood disorder, but moods can play a part. When she’s in a psychotic state, the mother may bounce back and forth between elation and despair. The moods not only change quickly, but each mood is extreme.

Sleep Disturbances

One sign of this type of psychosis relates to sleep. The mother typically doesn’t sleep well. She may have insomnia. Her sleep may be disrupted by terrifying dreams or intrusive thoughts. This feature of the condition is both a symptom and possibly a partial cause of postpartum psychosis.

Excessive Energy or Agitation

Women with psychosis following a birth sometimes have boundless energy. That energy often shows up as agitation. Agitation means an increased activity that serves no purpose or is repetitive. If you have postpartum psychosis, you might feel like you’re hurrying to get things done but not accomplishing anything.

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Paranoia

Paranoia means you’re extraordinarily suspicious or distrustful of others. In postpartum psychosis, this distrust usually has to do with the baby or your role as a mother. You may believe that the father or another of the child’s caregivers will harm the baby, or you might think someone outside your family is tracking your movements as you care for the baby.

Disorientation

Disorientation can be an early sign of psychosis, but it usually continues and may worsen over time. You might not know where you are or even what year it is.

Irrational Behaviors

If you have psychosis after pregnancy, you might behave in irrational ways. What you’re doing might or might not make sense to you, but others find your behaviors odd or even bizarre.

Trouble Concentrating or Remembering

You’ll probably have a hard time controlling your thoughts during a psychotic episode. It’s difficult to concentrate on real issues and responsibilities when you’re hallucinating or when your mind is full of delusions. You may also have trouble remembering ordinary or recent things.

Sudden Anger or Aggression

Your anger might flare up quickly during postpartum psychosis. You may have angry outbursts. You may even become aggressive with others around you.

Postpartum Psychosis Risk Factors

Why do some women have postpartum psychosis while others don’t? There’s still a need for more research, but scientists have identified several possible risk factors. You’re more likely to experience this syndrome if:

  • You have bipolar disorder
  • You had postpartum psychosis after an earlier birth
  • You have schizophrenia or schizoaffective disorder
  • Someone in your family had postpartum psychosis or bipolar disorder
  • It’s your first pregnancy
  • You stopped taking psychiatric meds when you became pregnant

What Causes Postpartum Psychosis?

No one knows precisely what causes this mental problem, but it might have a lot to do with the drastic drop in hormone levels that happens right after a woman gives birth. The hormonal changes can make mood and behavior unstable.

The increased demands and responsibilities of motherhood can cause excessive stress. This extreme stress may trigger symptoms of psychosis. Not taking good care of your physical health nearly always makes mental problems worse. So, when a new mother can’t get enough sleep or take care of her other physical needs, she may begin to have psychotic symptoms.

Treatments for Postpartum Psychosis

Treatment for this condition is almost always necessary. Someone with severe symptoms of postpartum psychosis may need to be hospitalized until she can be stabilized. This is a way of protecting her, her baby, and others while she gets the treatment she needs.

Medications for this condition include antipsychotic meds, mood stabilizers, or sedatives. Psychotherapy with a counselor can help her express and deal with her feelings and thoughts. With the combination of meds and therapy, many women can completely recover from postpartum psychosis.

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What to Do About Postpartum Psychosis

Maybe you’re a new mother who’s recognized signs of psychosis in yourself. If so, getting help right away is important.If a new mother in your life seems to be having psychotic symptoms, encourage her to seek help. If the situation becomes dangerous, contacting emergency services is an important step to take.

Conclusion

Postpartum psychosis is the most severe psychiatric problem related to childbirth. If you recognize the symptoms and get help, you can keep the mother and baby safe. With treatments like meds and psychotherapy, women with this syndrome can recover fully.