Therapy • Coaching • Courses • Retreats


Perinatal Psychosis: When Intrusive Thoughts Become a Medical Emergency

Last week, I shared information about intrusive thoughts and Perinatal OCD (When "What If" Creates Anxiety, Ask Yourself "What Is.")

Today I wanted to talk about Perinatal Psychosis and shed some light on the differences between the two very different, but sometimes confused, perinatal disorders. 

Both perinatal (meaning during pregnancy or postpartum) disorders can involve scary thinking but there are distinct differences between the nature of the thoughts, the level of anxiety they create, and the types of treatment necessary. 


Perinatal OCD

Perinatal OCD involves intrusive and often relentless scary thoughts, typically regarding harm to the self or baby: “What if I drop the baby?” “What if we get in a car crash?” “What if I accidentally harm my baby?” “What if I don’t really love my baby because I’m having these awful thoughts?” “What if I’m not cut out to be a mom?” “Maybe my baby would be better off without me.” 

These thoughts are simply anxious thoughts. They create a high level of anxiety in moms, making them feel out-of-control or guilty for thinking this way. Moms with Perinatal OCD may avoid certain situations, such as giving the baby a bath, driving, or cooking with knives.  

Perinatal OCD is an anxiety disorder and something treatable through therapy. Often, education and some cognitive-behavioral tools are enough to help moms cope with this disorder. Sometimes medication (SSRIs/antidepressants) are used to decrease anxious thinking. 

Moms experiencing postpartum anxiety/OCD are not a threat to their babies and they are not at risk for acting on scary thoughts. They do not need to be hospitalized, nor separated from their babies. Rather, they need reassurance from a professional well-trained in perinatal mental health who knows that what they are experiencing is common and treatable. 


Perinatal Psychosis

Perinatal Psychosis, on the other hand, is a temporary psychotic experience and a medical emergency. 

It involves delusional thinking and hallucinations that are disconnected from reality and often of a demonic, persecutory, or possessed nature. For example, believing the baby is possessed by a demon, feeling controlled by an evil force, seeing the devil’s face instead of the baby’s, or hearing commands to harm the baby for his/her protection. 

They can also include delusions of grandiosity, or a sense of artificial importance, such as being called upon by God to save the baby from demons: “My baby is not safe in this evil world. God is counting on me to save him.” “I see the devil's eyes when I look at my baby. She is possessed by a demon.” “I see bugs and blood all over my baby.”

Moms in a psychotic state generally fail to recognize their thoughts are not grounded in reality. Their thinking seems reasonable and they feel compelled to take measures to protect their children. There is a decrease in anxiety when indulging in behaviors related to their delusions, even when their actions could cause serious harm.


Perinatal Psychosis is a Medical Emergency

Perinatal psychoses tends to come on quickly and is reported to carry a serious risk of suicide (5%) and infanticide (4.5%) due to the nature of psychotic thoughts. 

Moms who experience Perinatal Psychosis are not inherently dangerous or flawed. They are not operating out of place of malintent. Rather, they are experiencing a neurochemical event and are in a temporary state of being disconnected from reality. When harm occurs, moms truly believe that they are acting in the best interest of their children.


Perinatal Psychosis Stats & Symptoms

Perinatal Psychosis is less common than other Perinatal Mood & Anxiety Disorders, but it does occur in approximately 1-2 out of every 1,000 births. It can co-occur with other experiences of perinatal depression or anxiety, and can happen any time during pregnancy or postpartum. Most typically, it occurs within the first several weeks following birth. 

Perinatal psychosis is treatable but it is a medical emergency that requires immediate attention and often hospitalization or a period of separation from the baby until mom is stable.

The symptoms of perinatal psychosis often wax and wane, causing a woman to feel like she’s operating in two different realities. She may alternate between psychotic episodes and periods of lucidity, where she can recognize something is wrong. She may be inclined to reach out for help in between psychotic episodes, but often, delusions create shame that make it difficult for women to confide in others. 

Women are more vulnerable to psychoses post-birth than at any other time during their lives, likely due to biochemical changes in the brain during pregnancy and a sharp decrease in hormones post delivery. 

50% of those who develop perinatal psychosis have no history of psychoses. Stress, past trauma, depleted nutrition, thyroid dysfunction, mineral deficiencies, elevated levels of copper, and sleep deprivation can also play a role. 


Symptoms can include:

  • Delusions and hallucinations 
  • Insomnia
  • Rapid mood swings (depression, agitation, hyperactivity, emotional distancing, aloofness, dysphoria, etc.) 
  • Paranoia
  • Confusion
  • Disorientation
  • Poor concentration
  • Disorganization
  • Rambling ideas and thoughts


Prevention & Awareness

Adequate sleep is vital for new moms and may help prevent Perinatal Psychosis and the worsening of symptoms. Pregnant women with any personal or family history of bipolar disorder, schizophrenia, or psychotic episodes should speak with their providers regarding their increased risk so they can be carefully monitored during pregnancy and postpartum. Those with a personal history of Postpartum Psychosis are often advised to begin prophylactic treatment at birth in subsequent pregnancies as a preventative measure.

Awareness is key. Because women who are in a delusional state are not aware that what they are experiencing is problematic, partners, friends, and family members need to be mindful of the potential for these symptoms, especially in first-time moms, those who have had OB complications, or anyone with a personal or family history of psychotic episodes. 

Too often, the struggle with psychotic thinking is a very internal experience for moms, until it’s too late and harm has occurred. It’s vital for providers and family members to be well versed in this disorder and to be careful not to dismiss confusing symptoms because moms have returned to a period of lucidity. The more aware family members are of the potential for this diagnosis, the quicker they can intervene.


Some signs others may notice include:

  • Irritability
  • Irrational or uncharacteristic behaviors
  • Talking to herself
  • Not making sense, disjointed thoughts, or strange statements
  • Sounding inarticulate, dazed, or confused 
  • Acting suspicious, paranoid, or accusatory 
  • An inability to read words
  • Difficulty processing information, for example following the plot of a movie or show
  • Sudden religious preoccupations 


While Perinatal Psychosis feels very scary and worrisome, it is treatable. With intervention and the right antipsychotic medication, moms can fully recover. 


For more information, check out Episode 119 on the Finding Your Village Podcast where Amanda Gorman and I speak about Perinatal Psychosis. 

If you have questions regarding perinatal psychosis, need help differentiating it from perinatal anxiety/ocd, or are looking for resources, get in touch!