Everyone wants to know, “Why me?” Why did I get this? What did I do wrong?
You didn’t do anything wrong. Lots of women get postpartum depression, postpartum anxiety, depression or anxiety during pregnancy, postpartum OCD, postpartum PTSD, postpartum psychosis, and related illnesses. And there’s very likely more than just one reason why they do.
What are the postpartum depression risk factors?
What causes postpartum anxiety and the like?
Perinatal mood and anxiety disorders may be caused by a combination of nature and nurture. Yes, there is likely something going on inside your body—with your brain processing or your DNA—that makes you more likely to get PPD, PPA, PPOCD, etc. than the girl standing next to you. For instance, you might have a family history of mental illness that makes you genetically susceptible. Or there’s something about how your body works that makes you more sensitive to hormonal changes, makes you more vulnerable. This is the “physical” part of what may be making you sick that you hear people talking about—actual things and processes that you could see in a microscope or test for; brain chemistry and all that.
Why is it, though, that you can have two women who both have family histories of mental illness and only one of them gets PPD and the other one doesn’t? Why doesn’t every mom who has the “wrong” gene or set of genes, or who is more vulnerable, get sick?
That’s where the nurture—what has happened or is happening to you in your life outside of the realm of your neurotransmitters and the confines of your skull—part comes in. What is or has happened in your life, believe it or not, can turn your possibility of getting PPD into actually getting PPD, turn your susceptibility into fact. These are the things that are going on outside your body that raise your risk as well.
First, a definition of the term risk factor: A risk factor is any attribute, characteristic, or exposure of an individual that increases the likelihood of developing a disease or illness.
If you have experienced a period of or been diagnosed with depression, anxiety, OCD, bipolar disorder, eating disorders, or other such illness in your life, then you clearly have a higher risk for getting a perinatal mood or anxiety disorder like PPD. But there are many risk factors for these illnesses besides having a family member that has a psychiatric disorder or episode or having a history of one yourself—things that most moms don’t know about.
These risk factors include:
A traumatic pregnancy or birth: Did you or do you have hyperemesis gravidarum? Were you or are you on bed rest? Did you have an emergency c-section or other complications during delivery? Was your baby in the NICU? Did something that you found very frightening happen to either you or your baby during pregnancy, during birth, or after the birth?
An experience with emotionally painful or stressful experiences around pregnancy, childbirth and/or early parenting: Did you struggle with and/or were you treated for infertility? Have you suffered a previous miscarriage or other pregnancy loss? Did you just deliver multiples? Do you have a special needs baby? Does your baby have colic or a difficult temperament? Have you had difficulty with feeding your baby?
A traumatic childhood: Did you have a traumatic childhood? Did you lose a parent? Did you have a troubling relationship with your own mother? Trauma as a child can have a VERY big impact on your emotional health as an adult, even if you think you’re “over it” and it’s “in the past.”
Stress: This is such a big one, and it surprises people, because everyone has stress right? But there are major stressors that can tip your brain over the proverbial edge. These include the loss of someone close to you, a job loss, financial hardship, divorce or strain in your relationship with your partner, and even a house move. Big changes in your life can have a big impact on your emotional health.
Lack of social support: Do you feel alone and as though you have no one to help you? Do you live far from your family and close friends? Do you feel like when you need help there is absolutely no one to ask? Are you a military wife whose partner is deployed?
- Personality: Are you a perfectionist? Do you have a controlling personality? Do you have low self-esteem? This is not so much a risk factor but studies are showing there is, as Karen Kleiman calls it, a “clinically relevant” relationship between this type of personality and having PPD or anxiety.
Here were my risk factors, none of which I had any awareness of when I had my first child and ended up with postpartum OCD:
- family history of mental illness
- baby with colic
- traumatic delivery
- traumatic childhood/traumatic relationship with mother
- perfectionist personality and likely had always had OCD but just didn’t know it
Any of these things can mean you are more likely to get PPD or a related illness than the mom next to you. They’re not a guarantee, but they raise your risk. And someone should tell you that. You should know about that.
You should know about postpartum depression risk factors. You should know that bipolar episodes raise your risk of postpartum psychosis. You should know whether you might end up having postpartum OCD and intrusive thoughts.
Because if you and every other mom knows, then she can be prepared. She can be read to learn what the symptoms are and identify them in herself. She can know that she needs to reach out for help and figure out who might be able to help her in her town. She can make sure her family or friends or someone in the community who cares are at the ready.