When most people think of postpartum depression, they think of a lethargic new mother, hardly able to function, with possible thoughts of harming herself or her baby. While this can occur in a rare, but serious condition called postpartum psychosis occurring in approximately 0.089-2.6 of births in the United States, the majority of women experiencing postpartum depression typically present with more anxious symptoms. If these symptoms persist beyond two weeks postpartum, a period commonly referred to as the “baby blues,” postpartum depression must be ruled out.

The majority of new mothers that come to my practice present with difficulty sleeping (even when the baby is sleeping), crying easily, irritability, loss of interest, and being extremely concerned with being a “perfect” mother. Furthermore, anxious, looping thoughts are common as well as a constant feeling of being overwhelmed.

Some women are embarrassed or afraid of their intrusive thoughts and feel troubled by them, especially if they are experiencing scary thoughts about something bad happening to their baby. Many women fear that if they speak up about these thoughts, their baby will be taken from them even though they would never do anything to want to harm their baby. In fact, the desire to do everything so well, is creating its own anxiety.

Obsessions and compulsions can develop around housework, schedules and caring for the baby. Sadly, these mothers can greatly benefit from treatment for postpartum depression, but instead they suffer in silence, often experiencing a worsening of symptoms.

It is important to understand the difference between postpartum depression and postpartum psychosis. Women experiencing postpartum psychosis typically present with auditory or visual hallucinations, delusions, mania, insomnia, agitation, disorganized thinking, a flat affect, a detachment from reality.

Thoughts of self-harm and harm to the newborn can occur. Additionally, women who have a history of bipolar disorder, a major depressive disorder or schizophrenia are at a greater risk of developing postpartum psychosis. For this reason, it is imperative that women with a personal or family history of one of these conditions discuss a prevention plan with their doctor prior to giving birth.

There is good news and bad news. Unfortunately, because most women don’t realize that what they are experiencing classifies as postpartum depression, they do not seek help and therefore do not get treatment for it. The good news is that once postpartum depression is treated, symptoms typically improve relatively quickly.

Symptoms of postpartum depression include, but are not limited to:

• anger, irritability and mood swings
• loss of interest
• hopelessness
• anxiety
• restlessness
• panic attacks
• difficulty sleeping
• fatigue
• lack of concentration
• unwanted thoughts/repetitive thoughts

If you or someone you love is experiencing any of these symptoms, please know that good help is available. You cannot “think” your way out of postpartum depression and the longer it is left untreated, the worse the symptoms typically get.

This is especially the case when there is a chronic lack of sleep. Postpartum depression is not a weakness, a failure or a character flaw. It does not make someone a bad mother. Postpartum depression occurs for a variety of reasons that are well beyond a woman’s control. Most women report wishing they had sought treatment sooner once they began to feel better and more like themselves again.

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Since it’s pretty unrealistic (although sometimes quite appealing) to live your life in solitary confinement, it’s vital to know how to work through some of these feelings of extreme mistrust. The following three steps are essential if you want to not only protect yourself, but also reclaim a healthy social life.

1. Educate Yourself- The most important thing you can do to protect yourself from getting into future destructive relationships is to educate yourself about unhealthy patterns. And not just obvious markers. You need to be attuned to the subtle nuances that often get overlooked. Knowledge is power. You need to know what to watch out for like the back of your hand. Once you familiarize yourself with early warning signs of abuse and classic red flags, you can move forward with confidence in your relationships, knowing that you can accurately identify worrisome behavior early on in the relationship and walk away.

2. Practice, Practice, Practice Setting and Maintaining Boundaries- If you’ve been in an unhealthy relationship, there is no question that you’ve struggled to maintain boundaries. A manipulator will use all types of tactics to push, blur or collapse your boundaries including mockery, manipulation, playing the victim, intimidating or threatening you. As your will to maintain your boundary increases, the punishment for doing so escalates, likely causing you to fold eventually.

This abusive conditioning might leave you fearful of setting any type of boundary moving forward and doing so will likely cause you discomfort. Do it anyway. Learning to tune into what you really want or need and ensuring that it happens, while also protecting yourself from mistreatment, is a necessary skill if you are going to have a healthy life. It’s like riding a bike; awkward at first, but once you get the hang of it, you’ll never look back.

3. Trust Yourself – One of the most challenging pieces of recovery is recognizing that the lack of trust in others is really about the lack of trust in yourself. It’s easy to lose faith in your “gut feeling” if you feel it has led you astray in the past. Your sense of helplessness feels like something beyond your control, something that happens to you, which you are powerless to stop. But let’s break it down.

• Did your intuition fail you or did you choose to ignore it?
• Did you decide to look the other way because it was easier than confronting what you didn’t want to believe?
• Did you tolerate mistreatment because you just wanted to be loved?

These are tough questions to confront, but remember, this is not about blaming yourself, it is about knowing yourself and your tendencies in relationships. This is extremely valuable information so that you can trust yourself to know the warning signs, set boundaries and end mistreatment if it arises in your future.

Trusting others, and yourself, is arguably the hardest part of recovering from an unhealthy relationship. It may feel practically impossible to get to a trusting place again. You can do it. You have knowledge and the beautiful gift of intuition. Listen to it and set healthy boundaries by honoring what it says. As you practice this, you will see your fear of relationships dissolve and the quality of your relationships flourish.

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