Typus Melancholicus: Is Personality Type Cause of Postpartum Depression?

Researchers, clinicians and postpartum depression advocates are ALWAYS trying to determine the causes and risk factors of perinatal mood and anxiety disorders.  What we know for sure is that these illness are most likely caused by disruptions and challenges in a mom’s hormones and brain chemistry, sleep patterns, nutrition, and social support.   And we know, of course, that negative thinking patterns (perfectionist thinking, black and white thinking, catastrophic thinking, for example) can also lead a mom toward an increase in depression and anxiety when she is caring for a newborn.  But last week, an article written for health providers in The Journal of Maternal-Fetal and Neonatal Medicine caught my eye.  Is it possible that we can determine the likelihood of an episode of postpartum depression dependent on a mom’s personality?

The article suggests that a personality that they call “Typus melancholicus” is the one most likely to struggle emotionally after her baby comes.  The article attributes the following characteristics to this personality type: orderliness, conscientiousness, hyper-heterononia (I didn’t know what this meant either; it describes someone who obsessively follows social norms), and intolerance of ambiguity (in other words, doesn’t like it when she doesn’t know what to expect).  This personality type that the article refers to as TM, is further characterized by “over-normal behavior, extreme social adjustment and conformism, and a fixation with order at work, in the family, and in interpersonal relationships, in an attempt to meet the expectations of significant others.”

Moms with this personality type are, apparently, hypersensitive to expectations during pregnancy and are the moms who follow recommendations to a tee.  They are also the moms who are unable to delegate childcare tasks to anyone else once the baby comes.  The article describes having a child and becoming a parent as a “crises” because it forces women to suddenly manage the conflict that occurs instantaneously between the roles of woman, wife/partner, mother, and worker.  The TM personality struggles with creatively managing the conflict that occurs between these roles as her need to meet expectation of others makes this virtually impossible to do without flaw.  And these moms don’t tolerate flaw easily.

So, I wondered back … does this match up with the women who I have seen in my office for the treatment of postpartum depression and anxiety?  Can I fit the moms who I have seen into this category and personality type?  Is it even fair to do so?  This last question has literally kept me up at night (yes, even I need to practice my breathing when trying to sleep).  I get uncomfortable when trying to fit women with postpartum depression into a box, especially because much of the work that I do revolves around helping women see that PPD is NOT a character flaw.  So, is it helpful to use this understanding of personality in identifying women who may be at risk, or is it somewhat like a personality form of racial profiling?

I write this post today because I am eager to hear from all of you.  If you are someone who has struggled postpartum, do these characteristics resonate with your sense of self?  Does it feel helpful to have OBGYNs, pediatricians, and nurses looking for this personality type when mindfully and intentionally trying to identify the women who may be at risk of developing a postpartum mood or anxiety disorder?

Let’s get this conversation started…

Kate Kripke, LCSW

Editor’s Note: Hey y’all.  This is Katherine.  I’m really looking forward to your feedback on this as well.  If I’m being honest, I’m very much someone along the conscientiousness, intolerance of ambiguity, unable to delegate childcare tasks to anyone else type.  How about you? How does this make you feel either way?

About Katherine Stone

is the creator of this blog, and the founder and executive director of Postpartum Progress. She has been named a WebMD Health Hero, one of the fiercest women in America by More magazine, and one of the 15 most influential patient advocates to follow. She is a survivor of postpartum OCD.

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Comments

  1. Laura Doyle says:

    What a fascinating post! I think I have some tendencies towards this TM personality type. I love order, definitely have an intolerance for ambiguity and do follow social norms. (in fact, I'm struggling with that right now in my search for a convertible car seat….) I have no problem allowing others care for my daughter, but have had major conflict trying to reconcile my new, different roles.

    I think anything OBs, pedis, nurses, etc. can do to help identify people at risk for PPD would be beneficial. But if it is meant to identify it before it happens, it needs to happen early in pregnancy, or at least sometime before admittance to L&D.

  2. I'm pretty much the opposite of this personality type. Though I am a wee tad OCD/anxiety, I am also about the most cheerful, optimistic, go-with-the-flow, silver-lining type people out there. At any rate, I got slammed with PPD after #3 (and really? After all 3, looking back). So, maybe it is more the pre-existing anxiety/OCD, than a melancholic personality.

  3. I think some of those character traits do resonate with me. But I think that EVERY pregnant and postpartum women should still be aggressively screened, because it's easy to "fake" your true self to a medical professional!

  4. Yep that's me, as much as I dislike some of the descriptive words used and think they are a bit too at the far end of the spectrum for me I can see myself in this description. I am a perfectionist, a planner (I like to know the ins and outs of something before I embark on it), I'm a good organiser, I hate to fail and I like order/routine (however I don't have OCD). Funnily enough I work for the police which I thought was quite revealing reading these traits. I refused to hand over my kids to anyone when they were born, even daddy so I could have a break as I felt that if I couldn't cope with them how could anyone else and I felt i had to prove myself to everyone despite nobody running me down, I had big expectations of myself and couldn't deviate from what the books told me made a good mum! I was destined to fall when you read this!!

  5. Wow. That does not describe me AT ALL, and yet I was hit with PPD twice. Again, with the lack of acknowledgement to the chemical side of it! Helloooo, has anyone heard of hormones?! I'm beginning to doubt that the so-called 'experts' really know what they are talking about at all.

  6. It certainly describes me well. My life is one long essay on how things SHOULD be and proving that I didn't need anyone to help me through. I had a terrible time asking for help, accepting help when it was offered, and not criticising the help I did get. For example, I wouldn't let my parents come out to visit when I first had my son. I felt that I needed to learn how to be a mother perfectly before they could come and visit us. When they did come, I was reluctant to let them take care of the baby and when they did I would panic, either overtly or have the ticker of panic running through my head. My poor husband, who now wants to divorce me, was also a victim of this mentalityl; he was nervous about his role when the baby first came home and then I set about punishing him when he finally was able to pitch in.

    And guess what, when I finished breastfeeding and all my feel good hormones finally left I wound up with serious post partum depression, that wasn't treated here in the US, but when I went back to my country of origin. My medical care here was laughable as compared to my homeland.

    I don't think that the research is trying to fit anyone in a box, or define them. My opinion, having lived through an absolutely hellish couple of years and finally emerging on the other side is that there's no one cause for PPD. I was at risk – I had previous and family history of depression, I lacked support of family and friends, I had been through IVF and had experienced the unbearable stress of TTC for 3 years. And yes, I have a personality that is prone to the kind of rigidity and demanding nature described here.

    The conversation about PPD is so underdeveloped in the US. There's not automatic screening at well-baby visits and there should be. There's a way too high emphasison PPD as something that happens immediately following birth or within the first few months. But for me it was the end of breastfeeding that was the trigger. I had read nothing (and I read and educated myself substantially on PPD) on that topic and I was so happy after I made it through 4 months with no signs of depression that to be walloped with it at 8.5 months post partum was a nasty, nasty surprise.

  7. This personality describes me. I didn't think so until I had perinatal and postpartum anxiety/ depression. Then some of these characteristics punched me in the face. But I didn't have PPD and anxiety until my 3rd baby so….. what was the difference? I think the characteristics might be a piece to some mom's PPD, but not the direct cause.

  8. Personally, most of these traits fit me –but only when I am battling and suffering with my PPD /PP-PTSD. It seems my personality, life outlook, and character traits morph into someone else's when I've just had a baby. It's such a scary struggle to not really know yourself or to be able to predict your reactions to normal events–let alone stressful situations.

  9. Natalie Walls Adams says:

    This was not/is not my personality type. I believe we all like a certain degree of "order" in our lives. I was beaten with PPD/A about two months after giving birth. I continued to breastfeed until month 4, but had to stop due to the wretchedness of this illness, and the medications I was put on. I do not think it's fair to say that a certain personality type is more prone to a perinatal mood disorder. That, to me, is the same as saying your personality type can predispose you to cancer, or any other physical problem/illness. Every woman is DIFFERENT, and can be hit with this for numerous reasons…or no reason at all. It does not discriminate. Hormones absolutely play a role in this, and what woman do you know that does not have hormones? I think it's worth checking into, but really I believe the OB's should consider themselves socially and emotionally immoral if they don't start educating their patients BEFORE hand. The reality is, it can and does happen to woman who have all personality types.

  10. Yes, I do agree with this article. I have suffered from depression since I was a teenager and have since realised that my mother and I share some anxious traits. However, I didn't have postnatal anxiety with my first baby, but did with my second. And it came exactly three days after birth. So there must be some sort of hormonal/personality nexus.

  11. I think that "risk factor" is unambiguous enough that it doesn't bug me to consider a 'personality' type. There are many different things that contribute to many different diseases. People with high cholesterol are at a greater risk for a heart attack, but not all of them have heart attacks. People who smoke are at a greater risk for cancer and heart disease, but not all of them experience that. On the flip side, people who don't have high cholesterol or smoke also sometimes have heart attacks and cancer. The risk factors weren't there, but it still happened.

    I think this personality sounds a lot like me and a lot of that part of my personality played right into my PPD. The guilt of not doing it 'right' and the worry that I still struggle with about what other people think. This resonates with all of that. It's not the nicest description that I've ever read, but I do find truth in it.

    My thought was–don't most Moms feel some/all of these right after a baby? Or… Is the fact that I think that indicative of my temperment?

  12. I can see and understand that this personality trait fits with some people with PPD, but I think there is so much more to play with it. I had PPD after both of my children, Yet both times were very different. I was more relaxed with my second pregnancy and child yet it felt like a smack in the face with balancing it all. I have had depression issues in the past, and I do think this connects to having PPD. I do not think you can at all put those people with PPD into a personality "box". Your hormone level changes so much after having a child and your worries/anxieties are effected by so MANY things. I felt this was a great article though trying to open up people to another factor in a reason why certain women might have PPD.

  13. Wow- as always I so much appreciate all of your thoughts, insight, and experience. And, as a clinician who trains doctors, midwives, and nurses in identifying moms at risk for PMADs, I truly appreciate your individual takes on this. Val- your connection to correlations between risk factors and other diseases makes sense to me- I think that we are always trying to help those in the medical field look out- ahead of time- for women who may develop PPD/PPA at some point. But, of course, those women who have some of the personality traits mentioned will never develop a perinatal mood or anxiety disorder. So, let me ask you all a follow-up question- if you weren't suffering and your doctor suggested that you might because of your particular personality type, would this bother you?

  14. POD (Plain ol' depression!) and PPD mama right here…so I read that second paragraph and thought you were describing me. Fits me to the tee. Though I do agree that we shouldn't all be put in a box, I can definitely see this type of personality (labeled or otherwise) as at least a possible risk factor for PPD.

  15. Robin | Farewell, St says:

    I don't see myself in this either. To some degree, sure, but not really. This comes across as a very extreme personality type, and I'm definitely not that much this way. I can see how it would contribute to PPD, but I think for me it was other factors.

  16. I see many of my own traits here: "orderliness, conscientiousness, intolerance of ambiguity (in other words, doesn’t like it when she doesn’t know what to expect), a fixation with order, not able to tolerate flaws (of my own).” I didn't have a problem letting others help with childcare per say, in that I felt like pretty much anyone could certainly do a far better job than I was doing. But I also felt like I should be able to handle it — and that it wasn't anyone else's responsibility to help me. This is my kid — my responsibility. So I wasn't comfortable asking for help.

    After reading quite a bit about common personality traits found in PPD moms, I was/am a dead-on fit. Wish I (my husband) had known this ahead of time. We could have been better prepared for the shitstorm that was coming. (Although, honestly, I probably wouldn't have believed it would really happen to me. I'd hope my husband might have seen it differently.)

  17. I think this description is unfair. It's condescending. They even gave this stereotype they created a Latin name, like they are the zoologist naming some sort of exotic animal. It also comes across as blaming. Like "You should have seen it coming, 'cause you are so incredibly uptight".

    How about this narative instead: "Sometimes the personality traits that serve us well in one area of life can cause us to suffer in other areas of life. Being super conscientious can be great on the job. It can also exhaust us in the round-the-clock job of being a mother. Orderliness is wonderful for creating a stable home that can help kids feel secure. At times (especially with babies) striving for order can be impossible. Caring about social norms helps us all get along and have a functioning society. But trying to live up to "normal" can hurt us during situations like pregnancy, birth and postpartum because these vary so much from person to person. Caring that we please people is an important trait for being a good friend or spouse. At the same time, we need to make sure that their wants, needs and opinions don't drown out our own. Independence is a great trait and a sign of strength…and so is knowing how to ask for help.

    I think striking the right balance is tough for most of us, not just for "Typus melancholicus” whoever she is.

  18. This article describes my personality to a T. It's almost scary how well I fit into the mold. That said, it sounds like from the comments that a lot of women don't fit this personality type. So where does that leave us? If personality type is not predictive of PPD, perhaps the treatment or therapy would at least differ based on personality type?

    • Truthfully, the treatment for PPD varies on the individual- based on what works best and resonates for her. Where I think this article is important, is in its efforts to try and identify women at risk early so that they can be supported early if they are to suffer. As a therapist, I know that with many of the women who I see (most, really), working with belief systems, expectations, identity, and sense of self is a very important part of recovery… and women who fit the personality description above do, often, benefit from learning ways to re-set their expectations of themselves, work through self judgment and the fear of being judged by others, and learning to trust their internal sense of what works and doesn't work for them and their children regardless of expectations and "norms"- these tasks are especially difficult for someone who resonates with these personality traits…. but ones that are imperative in her recovery…

      Of course, we know that any PMAD is initially triggered by hormonal shifts that impact brain chemistry and, in turn, lead to a decrease in mom's emotional resilience. And women who tend to "need things just so" have an extra hard time with the challenges that come with being less resilient and less in control than she is used to. So, often, physiology and "personality" work together to create a perfect storm, so to speak…

  19. I felt like this article was written about ME!! I like order, dont delegate well, dont tolerate flaws, am very conscientious and dont enjoy not knowing what to expect. And I get very anxious when things do go as planned…

  20. This here describes me to the Tee, after my baby was born, before developing ppd, I would not let a single person help me….and when I look back, I've always been that way….I want to do everything myself, perfectly. Suprises are just not me, my poor husband knows that….I plan things way in advance cos I hate not knowing what to expect……..

  21. Katherine Stone says:

    What's interesting to me is the idea that the personality type might be somehow to "blame" for PPD, yet they don't ask whether there is something underlying the personality type? For instance, in my case I had some pretty serious childhood trauma. That trauma led me to have certain coping mechanisms around rigidity and order and control. So it would seem to me that the trauma is the risk factor and/or potential cause, not the personality type. Does that make any sense?

    • Yes. Completely. When we experience trauma as children, we adapt accordingly and, often, traits that serve us when we are young (these are coping mechanisms, usually) no longer serve us when we "grow up" and become parents ourselves… and this is when "personality type" can lead us to challenges. The catch is that many women who fit this type of personality may not have experienced trauma in childhood…. they may have adapted tendencies from their own parents or, simply, found ways of existing that have worked for them. I think when we look at risk factors, it is nearly impossible to separate the many different contributing factors: early trauma, family of origin conflict, personality type, biochemistry, lacking social support, birth trauma, other psycho-social stressors etc all play a role- for most women.

      And, I must add, that I did not read the article as saying that this personality was to ":blame" but, rather, that it may be a risk factor…. I am interested in the fact that many readers read it that way- did I miss something?

      This is all such amazing food for thought!!

  22. I'm still struggling with PPA/OCD and that doesn't describe me. I'll admit I like order, though it's not on my mind every moment. But I'm quite anti-conformism. To me, tradition is a dirty word, but I look at traditions now and research them before categorically dismissing them. And I wasn't worried about everyone else's perception of me, it was much more my perception and expectations of me. One problem in my case was that there was a family history on both sides and I didn't know until it was almost too late. And my therapist agreed that even if she had known about my history, she would have taken a different approach.

    I'm also not against any research that can help women with this horrific illness. I can see how this type would be prone to PPD, because so many women who don't get help early end up acting like this anyway. Either way, I say do research, be honest, and get help. You will be a much better person for it.

  23. In a nutshell, my belief is that statistics are great for science, but don't work out much for getting to the truth. PPMD is lit up in shades of grey and no matter how hard "specialists" try, they will never make it a black and white illness.

    Goodness knows, I tried, and tried and tried! As far as the article goes, I like order, but am messy when I want to be. I had a traumatic childhood, but a wonderful pregnancy. I love to analyze and research and would say that I am in my mind a lot; a thinker.

    There are similarities that Postpartum Women share but each experience is completely unique. When you start to categorize Women by personality type, judgement steps in and compassion is thrown out the window.

    I could go on and on. To your question if Doctor's should be looking for personality types, my answer is is a resounding NO!

    The struggles we go through with STIGMA is enough to keep us hidden in closets, silent and suffering.

    Help these Women Heal with Compassion and accept that not everything can fit into a BOX.

    I am a volunteer for the Region of Peel Peer Advocate Program for raising awareness of PPMD to help reduce stigma and get all the support these women need.

    I also have a blog containing information for women, as I strongly believe that resources are vital to expedite recovery.

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