Symptoms of Postpartum Posttraumatic Stress Disorder
It may be beneficial to your recovery to understand ways in which to frame your current experience: a biologically-based depression or a trauma-based disorder. If you feel that you relate to many of the symptoms of trauma described below, or you think you may have “Posttraumatic Stress Disorder” (PTSD), your options for recovery may take a new direction. Please use our interview questions to ask a mental health professional to find an appropriate mental health professional to aid in your healing. You may also want to discuss the symptoms you identify here with your current therapist to assist him/her in making an accurate diagnosis. In addition to professional support, you may wish to visit our online community for healing birth trauma to gain peer support and to find many resources for healing.
You may find that you identify with many of the symptoms here, but do not fit the entire criteria for PTSD as laid out in the Diagnostic and Statistical Manual (DSM-5). Many woman with trauma-related symptoms do not meet all the criteria required for the diagnosis of PTSD, however, they do suffer from debilitating traumatic stress. If you feel that you fall into this category, you still deserve health, balance, and a fulfilling experience of mothering. You may want to pursue the same avenues of healing that you would if you had diagnosable PTSD.
From the DSM-5, the criteria for PTSD are as follows:
A. Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse).
Note: Criterion A4 does not apply to exposure through electronic media, television, movies, or pictures, unless this exposure is work related.
B. Presence of one (or more) of the following intrusive symptoms associated with the traumatic event(s), beginning after the traumatic event(s) occurred:
- Recurrent, involuntary, and intrusive distressing memories of the traumatic event(s).
- Recurrent distressing dreams in which the content and/or affect of the dream are related to the traumatic event(s).
- Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring. (such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)
- Intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
- Marked physiological reactions to internal or external cues that symbolize or resemble an aspect of the traumatic event(s).
C. Persistent avoidance of stimuli associated with the traumatic event(s), beginning after the traumatic event(s) occurred, as evidenced by one or both of the following:
- Avoidance of or efforts to avoid distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
- Avoidance of or efforts to avoid external reminders (people, places, conversations, activities, objects, situations) that arouse distressing memories, thoughts, or feelings about or closely associated with the traumatic event(s).
D. Negative alterations in cognitions and mood associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
- Inability to remember an important aspect of the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head injury, alcohol, or drugs).
- Persistent and exaggerated negative beliefs or expectations about oneself, others, or the world (e.g., “I am bad.” “No one can be trusted,” “The world is completely dangerous,” “My whole nervous system is permanently ruined”).
- Persistent, distorted cognitions about the cause or consequences of the traumatic event(s) that lead the individual to blame himself/herself or others.
- Persistent negative emotional state (e.g., fear, horror, anger, guilt, or shame).
- Markedly diminished interest or participation in significant activities.
- Feelings of detachment or estrangement from others.
- Persistent inability to experience positive emotions (e.g., inability to experience happiness, satisfaction, or loving feelings).
E. Marked alterations in arousal and reactivity associated with the traumatic event(s), beginning or worsening after the traumatic event(s) occurred, as evidenced by two (or more) of the following:
- Irritable behavior and angry outbursts (with little or no provocation) typically expressed as verbal or physical aggression toward people or objects.
- Reckless or self-destructive behavior.
- Exaggerated startle response.
- Problems with concentration.
- Sleep disturbance (e.g., difficulty falling or staying asleep or restless sleep).
F. Duration of the disturbance (Criteria B, C, D, and E) is more than 1 month.
G. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
H. The disturbance is not attributable to the physiological effects of a substance (e.g., medication, alcohol) or another medical condition.
With dissociative symptoms: The individual’s symptoms meet the criteria for posttraumatic stress disorder, and in addition, in response to the stressor, the individual experiences persistent or recurrent symptoms of either of the following:
- Depersonalization: Persistent or recurrent experiences of feeling detached from, and as if one were an outside observer of, one’s mental processes or body (e.g., feeling as though one were in a dream; feeling a sense of unreality of self or body or of time moving slowly).
- Derealization: Persistent or recurrent experiences of unreality of surroundings (e.g., the world around the individual is experienced as unreal, dreamlike, distant, or distorted).
Note: To use this subtype, the dissociative symptoms must not be attributable to the physiological effects of a substance (e.g., blackouts, behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
With delayed expression: If the full diagnostic criteria are not met until at least 6 months after the event (although the onset and expression of some symptoms may be immediate).
When should a woman suspect that she has a trauma-based postpartum mood disorder as opposed to postpartum depression? When she:
- experienced an event perceived by her to be traumatic
- experiences flashbacks of the event, with vivid & sudden memories
- has nightmares of the event
- finds an inability to recall an important aspect of the event
- has an exaggerated startle response, constantly living “on edge”
- finds hyper-arousal, always being “on guard,” won’t go away
- is hypervigilant, constantly looking around for trouble or stressors
- notices herself avoiding all reminders of the traumatic event
- experiences intense psychological stress at exposure to events that resemble or remind her of the trauma
- has physiological reactivity on exposure to events resembling the traumatic event, such as panic attacks, sweating, palpitations
- is plagued by fantasies of retaliation
- finds herself to be uncharacteristically experiencing cynicism and distrust of authority figures and public institutions
- may be hypersensitive to injustice
When PTSD goes untreated or persists, one or more of the following cover-up symptoms may develop:
- Alcohol and drug abuse
- Eating disorders: bulimia nervosa, anorexia nervosa, compulsive eating
- Compulsive gambling or compulsive spending
- Psychosomatic problems (body symptoms of an emotional origin)
- Homicidal, suicidal behavior
- Inflicting injury to herself
- Panic disorders
- Depression or depressive symptoms
- Dissociation symptoms
- Fainting spells
While all of these symptoms sound frighteningly severe, and they can be very distressing, they are remarkably direct to treat. Evidence-based treatments for trauma of any source are just as effective in the perinatal period. These treatments may include individual or group psychotherapy, medical and complementary care remedies, EMDR (eye movement desensitization and reprocessing), hypnosis, acupuncture, and more. The key is to find the support that is just right for you. You do not deserve to suffer, and help is available.