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How to recognize the signs of postpartum anxiety

Woman sitting on bed, looking stressed out1

May 21, 2019

Reviewed by Julie Ciecior, LPC, NCC

Sleepless nights, always worrying about how your baby is doing, and feeling like you just can’t relax. That all sounds normal for new parents. And it is… until it isn’t. Perinatal anxiety and panic disorders are very common, with prevalence estimates as high as 20% for postpartum anxiety. The most common form is generalized anxiety disorder (GAD), with symptoms like agitation, irritability, difficulty falling or staying asleep, rapid weight loss, racing thoughts, constant worry, and high alert.

One of the difficulties around postpartum anxiety is figuring out when it’s a symptom and not just a normal part of having a newborn (or something else, like postpartum thyroiditis). For example, how do you define agitation? You probably are a little grumpy because you haven’t gotten more than 3 hours of sleep in a row, and you have a piranha attached to your nipples all day and night. What about constant worry? Of course you’re worried, you’ve never had a baby before and she didn’t exactly come with an instruction manual. So when is it normal and when is it anxiety?

Unfortunately, there’s not always a clear line between normal new parent emotions and GAD. But some of the more specific forms of anxiety, like postpartum panic disorder and postpartum OCD, have more obvious symptoms.

Postpartum panic disorder is characterized by episodes of extreme anxiety or nervousness, or panic attacks, which come and go in waves. During a panic attack, the sufferer may experience shortness of breath, chest pain, rapid heartbeat, dizziness, and other symptoms of anxiety. After the panic attack, there may be excessive worry about having another attack, losing control, going crazy, or dying.

Postpartum Obsessive-Compulsive Disorder (OCD) can manifest as symptoms of obsessions, compulsions, or both, and often interferes with daily life.

Obsessions are also called intrusive thoughts, and usually of harm coming to the baby. They are usually accompanied by guilt, shame, horror, and hypervigilance. It's important to note that these thoughts do not indicate intent, and if the mother is horrified by these thoughts, she is in touch with reality, which is a distinction from psychosis.

Compulsions are repetitive behaviors that are done in response to obsessions, and can include: cleaning, checking on things or the baby, counting, and putting things in order.

The Edinburgh Postnatal Depression Scale (EPDS) can be used to screen for anxiety as well as depression, but it does not diagnose. It’s designed to be administered by a clinician, although it’s self-reporting (you fill out the answers by yourself and a trained professional discusses the results and next steps with you). So the only way to know for sure if you have anxiety is to talk to a mental health professional.

Generalized anxiety disorder, panic disorder, and OCD are all treatable. There are medications that have been shown to be effective and safe for breastfeeding, and there are different kinds of therapy available. Even if your symptoms are mild, therapy can be helpful (and has been shown to prevent PPD in moms with risk factors), so call your insurance company and check if you have in-network benefits.

If your symptoms are mild and you’re looking for things you can do on your own to feel better, you can start with prioritizing sleep, drinking more water, eating nutritious food, and getting some light exercise each day. If you’ve tried these things and are still struggling, please talk to a doctor or therapist and get help.


Julie Ciecior, LPC, NCC is a psychotherapist at the Postpartum Wellness Center of Boulder. She has received training in perinatal mood disorders through Postpartum Support International, along with extensive training in trauma and sexual abuse. She received her Bachelor of Arts from the University of Colorado at Boulder and her Masters in Counseling from Regis University.

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