While postnatal depression is increasingly well recognised today, other disorders associated with the perinatal period remain poorly understood, frequently underdiagnosed, and consequently inadequately treated. For many reasons (particularly the difficulty of speaking out or the fear of not being heard) many mothers (and sometimes their partners) develop psychological distress that they carry in silence, sometimes for years.
These difficulties can arise following a pregnancy or childbirth experienced as traumatic, but they can also stem from a past trauma reactivated by motherhood. It is essential to highlight that a childbirth deemed 'normal' from a medical perspective can still trigger postpartum post-traumatic stress disorder (PTSD-PP). Indeed, approximately a quarter of mothers exhibit marked symptomatology and 6% develop full-blown PTSD-PP following a birth without any medical complications (Dekel et al., 2017; Cook et al., 2018).
In daily life, these disorders often manifest as difficulties in forming a peaceful bond with one's child, intense anxiety, panic attacks, irritability, intrusive ruminations, as well as the avoidance of anything that might serve as a reminder of the birth (sometimes including the child itself). Without appropriate support, this distress risks becoming ingrained and leading to further complications. Please know, however, that it is never too late to ask for help and begin a path towards recovery.
The information provided above is for guidance purposes only and does not replace a professional diagnosis. If you recognise yourself in this description, a thorough clinical evaluation and an assessment of your personal environment are necessary.
If you would like to discuss your situation or obtain further information, you can use the contact form or reach me directly using the telephone number at the top of the page.
Although it shares several symptoms with postnatal depression—such as heightened anxiety, low mood, or negative thoughts—postpartum post-traumatic stress disorder is distinguished by very specific clinical features. It manifests primarily across three main areas:
- a state of hyperarousal (or emotional numbness): Constant hypervigilance, hyper-reactivity to stress or, conversely, emotional blunting and a feeling of detachment.
- intrusive symptoms: Involuntary re-experiencing, flashbacks, or persistent ruminations constantly bringing the person back to the traumatic event (childbirth or pregnancy).
- avoidance strategies: An active need to avoid anything that might serve as a reminder of the trauma (birth stories, the doctor's surgery, the hospital, and sometimes the baby itself).
Because P-PTSD is frequently intertwined with depression—or can ultimately trigger it if left untreated—it is often overlooked or misdiagnosed as simple postnatal depression. However, obtaining an accurate diagnosis is essential in order to offer genuinely tailored psychotherapeutic support (Grekin & O'Hara, 2014).
(sources: Grekin, R., & O'Hara, M. W. (2014). Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis. Clinical Psychology Review, 34(5), 389–401.)
The postpartum period is accompanied by major emotional and neurobiological changes. This particular vulnerability can trigger Obsessive-Compulsive Disorder (OCD) or exacerbate a pre-existing condition, often plunging the individual into intense distress (Fairbrother et al., 2021). This disorder revolves around two main mechanisms:
- obsessions and intrusive thoughts: the individual is besieged by doubts, worries, or involuntary mental images linked to the concept of danger. In the postpartum context, these ideas may relate to external danger (accidents, germ contamination) or to perceiving oneself as a threat (harm OCD / intrusive thoughts: the irrational and terrifying fear of harming one's child). It is crucial to emphasise that these thoughts are ego-dystonic: they run completely counter to the mother's desires and do not lead to acting upon them.
- compulsions and rituals: in an attempt to neutralise the unbearable anxiety generated by these thoughts, the individual engages in compulsive strategies (repeatedly checking the baby's breathing, excessive washing, avoiding sharp objects or moments of intimacy with the child).
Faced with these manifestations, loved ones' spontaneous reaction is often to try to "reason with" the person by repeating that there is no risk, or to make accusatory remarks out of misunderstanding. These interventions prove unhelpful and counterproductive: they risk fuelling the cycle of anxiety, reinforcing guilt, and driving the mother into silence for fear that her child will be taken away.
With appropriate psychotherapy (particularly Cognitive Behavioural Therapy / CBT), it is entirely possible to break the vicious cycle of OCD, defuse the anxiety surrounding intrusive thoughts, and restore a peaceful relationship with one's child.
(sources: Fairbrother, N., Collardeau, F., Albert, A. Y. K., Challacombe, F. L., Thordarson, D. S., Woody, S. R., & Janssen, P. A. (2021). High prevalence and incidence of Obsessive-Compulsive Disorder among women across pregnancy and the postpartum. The Journal of Clinical Psychiatry, 82(2), 20m13398.)
The arrival of a baby naturally brings worries. However, when these concerns become persistent, uncontrollable, and disproportionate to reality, it may indicate Postpartum Generalised Anxiety Disorder. This disorder can emerge after birth or represent the exacerbation of pre-existing anxiety (Fawcett et al., 2019).
It manifests as a state of continuous tension and a pervasive apprehension regarding everyday events, combining both psychological and physical symptoms:
- hypervigilance and constant restlessness: the brain remains on high alert, continuously anticipating worst-case scenarios regarding the baby or daily life.
- physical exhaustion: anxiety translates physically into severe muscle tension or pain, intense fatigue, and marked sleep disturbances (difficulty falling asleep or anxious awakenings, even when the baby is sleeping peacefully).
- acute manifestations of anxiety: underlying anxiety can peak in the form of panic attacks or severe anxiety attacks.
Unlike OCD, where the individual attempts to neutralise anxiety through specific behaviours or rituals (checking, cleaning), the reaction to anxiety in GAD is more diffuse, vague, and non-ritualised.
When faced with worries often perceived as "excessive", family and friends frequently try to "reason with" the person or play things down. Although well-meaning, these attempts prove ineffective against a clinical anxiety mechanism. They risk increasing feelings of being misunderstood, guilt, and leading to progressive social isolation.
Psychotherapeutic support helps to defuse these worry patterns, learn to regulate the nervous system, and regain a peaceful day-to-day life with one's child.
(sources: Fawcett, E. J., Fairbrother, N., Cox, A. R., White, I. R., & Fawcett, J. M. (2019). The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate hierarchical meta-analysis. The Journal of Clinical Psychiatry, 80(4), 18m12464)
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