Postpartum Psychosis Risk Factors: Exploring Causes Of This Mental Health Disorder

The period following childbirth is often marked by new experiences, emotional fluctuations, and difficult adjustments. In rare cases, though, a birthing parent can experience more severe mental health challenges, including hallucinations, delusions, and other psychotic symptoms. Postpartum psychosis is a severe mental health condition that can significantly affect the lives of a birthing parent and their newborn. Learning about potential contributors to postpartum psychosis can help expectant parents evaluate the likelihood that they will develop it and avoid exacerbating those risks. In this article, we’re providing an overview of postpartum psychosis, discussing its various risk factors, and outlining options for treating this challenging disorder. 

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What is postpartum psychosis (PPP)?

Also called puerperal psychosis or peripartum psychosis, postpartum psychosis (PPP) is a serious mental illness characterized by hallucinations, delusions, and other psychotic symptoms. Postpartum psychosis is one of several postpartum psychiatric disorders, which also include postpartum depression, postpartum blues, and postpartum anxiety. Symptoms of PPP typically develop within two to four weeks of birth. 

Though it is a widely acknowledged condition, postpartum psychosis is not listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, it may be diagnosed as postpartum depression with psychotic features, bipolar disorder with postpartum onset, or a similar condition. Many experts consider postpartum psychosis to be a bipolar spectrum disorder due to the overlap in symptoms and causes between PPP and bipolar I. 

As described in a study published in the Archives of Women’s Mental Health, postpartum psychosis is “the rarest and arguably most severe of the postpartum mood disorders” (Arch Womens Ment Health 2020). Often requiring hospitalization due to its severity, postpartum psychosis is typically treated with medication and psychotherapy.

Because of the potential effects of PPP and other postpartum disorders, birthing parents are often urged to work with a mental health nurse or another provider following childbirth. Consulting with a maternal mental health professional can help new parents identify symptoms of postpartum psychosis and avoid exacerbating them. 

Symptoms of a postpartum psychotic episode

As with other forms of psychosis, postpartum psychosis (PPP) is primarily characterized by a disconnection from reality. Individuals with PPP may experience hallucinations, delusions, confusion, impaired functioning, and disorganized behavior. Other symptoms may include mood swings, sleep disruptions, and appetite changes. 

• Hallucinations – Hallucinations are sensory perceptions of nonexistent stimuli—often sights or sounds. Individuals with PPP may see visions or hear voices related to their newborn. 
• Delusions – Delusions are persistent beliefs that aren’t grounded in reality. Common forms of these thought patterns are control delusions (irrational beliefs that one is being manipulated by external forces), persecutory delusions (irrational beliefs that one is being oppressed or mistreated), and delusions of grandeur (irrational beliefs regarding one’s importance or abilities). 
• Disorganized thinking and speech – The manifestation of disorganized thinking as disorganized speech can involve confused, pressured, or nonsensical communication patterns. Common examples include speaking in “word salad,” making loose associations, and creating new words or phrases.  

Subtypes of postpartum psychosis

There are three subtypes of postpartum psychosis: depressive, manic, and atypical. Depressive postpartum psychosis is thought to be the subtype in which the most severe symptoms tend to occur. In this form of PPP—the most common of the three—psychotic symptoms are accompanied by low mood, fatigue, and lack of motivation. Delusions and hallucinations during depressive postpartum psychosis may reinforce feelings of sadness or hopelessness. For example, an individual may believe that certain forces are conspiring to take their child away due to neglect, despite evidence to the contrary. 

Manic postpartum psychosis typically involves an elevated mood, heightened energy levels, increased activity, and delusions of grandeur. The second most common subtype, this form of PPP can cause an individual to exhibit pressured speech, irritability, and risk-taking behaviors. Psychotic symptoms may reflect this manic state. For example, a birthing parent may see visions that suggest their baby was chosen by a divine power. 

Atypical postpartum psychosis, the least common subtype, may involve both manic and depressive symptoms. Individuals with this subtype may exhibit severe disorientation. They may also experience depersonalization and derealization, which involve a sense of disconnection from one’s body.

History of bipolar disorder, sleep disruptions, etc.: Postpartum psychosis risk factors

Experts still do not know the exact causes of postpartum psychosis. However, several risk factors have been identified. A personal or family history of bipolar disorder, psychosis, or a related mental illness is the most common indicator of postpartum psychosis. It is estimated that half of people who experience PPP have a history of mental health challenges. 

Below are some of the most common psychological, biological, and environmental risk factors for postpartum psychosis. 

History of bipolar disorder, depression, and other mood disorders

Other mood disorders, such as depression, can also increase one’s risk of developing postpartum psychosis. In one study, researchers found that 10% of women with a history of major depressive disorder developed psychotic symptoms after pregnancy. 

History of psychosis

Having a personal history of psychotic illness is another strong risk factor for psychosis during the postpartum period. Birthing parents who have previously experienced PPP are at increased risk of developing it again. A history of schizoaffective disorder, which closely resembles postpartum psychosis, is also thought to be a significant contributor to the condition. 

Changes in hormone levels

Women who have just given birth typically experience a significant reduction in progesterone and estrogen. These changes in hormone levels can cause alterations in brain function due to disruptions to certain neurotransmitters, such as dopamine. There is also evidence that increases in free thyroxine 4 (FT4), a thyroid hormone, can contribute to psychosis after birth. 

Lack of sleep

Sleep disruptions are closely linked to an increased risk of psychotic symptoms. A lack of sleep is a common concern for new parents due to erratic sleep schedules, physical health concerns, and mental health challenges. PPP has also been connected to sleep disorders, such as insomnia. 

Birth complications and trauma

Labor and delivery can be challenging for birthing parents, potentially leading to various physical and psychological concerns. Cesarean sections, postpartum hemorrhage, eclampsia, birth canal injuries, and uterine rupture are some of the birth complications and traumatic events that have been linked to postpartum psychosis. 

Other postpartum psychosis risk factors

There are several other factors that can increase one’s risk of developing PPP. Being a first-time parent is a widely cited risk factor. There is also evidence that stress is a contributor to postpartum psychosis, with research showing that higher cortisol levels are associated with the condition. Additionally, research suggests that the use of stimulant drugs, such as amphetamines, can contribute to psychosis in birthing parents. 

Studies also show that adverse events in childhood and adulthood can lead to a higher chance of experiencing PPP. These events can include childhood neglect, trauma, financial strain, and placement in foster care. Such factors may increase the likelihood of psychosis for someone who is already at risk of experiencing PPP. 

Mental health treatment for postpartum psychosis

Treatment for postpartum psychosis typically involves emergency care through a psychiatric hospital or similar inpatient setting. Various medications may be prescribed, and the exact course of medication may depend on whether depressive, manic, or atypical PPP are present. Always consult with a healthcare professional prior to starting or stopping any medication. 

Psychotherapy can also help individuals address the symptoms of PPP. A therapist can provide emotional support, help clients develop coping strategies, and address potential comorbidities, like anxiety and depression. Cognitive behavioral therapy and interpersonal therapy are common psychotherapeutic modalities for PPP. 

In severe cases, electroconvulsive therapy (ECT) may be utilized. ECT involves the activation of certain brain regions through electric currents. Research suggests that ECT can reduce symptoms of both postpartum psychosis and depression. 

How online therapy can help new parents

Online therapy is a flexible and affordable method of addressing mental health challenges associated with parenting, psychiatric disorders, and related concerns.  

The benefits of mental health treatment through online therapy

With an online therapy platform like BetterHelp, you can be matched with a therapist from a huge team of mental health professionals, providing you with the opportunity to work with someone who can address your specific parenting-related concerns. Your therapist can also connect you with useful resources, such as informational content on mental health risk factors or psychotic symptoms.

The efficacy of online therapy for postpartum depression

Research suggests that online therapy can help individuals living with mental health disorders following childbirth. For example, in one randomized controlled trial, researchers found that an online therapy intervention led to significant reductions in symptoms of postpartum depression. Additionally, participants experienced decreases in mental health symptoms that can be risk factors for postpartum psychosis, including stress and anxiety, as well as improvements in psychological and environmental quality of life. Please note that online therapy is not a suitable treatment option for postpartum psychosis.