Hello Darkness, My Old Friend— Navigating Postpartum Psychosis & Postpartum OCD with Psychotherapist Trinity Toft

In honor of Maternal Mental Health Month, we asked Portland-based psychotherapist Trinity Toft to share her perspective on two huge unmentionables in women's health that can impact the Fourth Trimester: Postpartum Psychosis and Postpartum OCD. Trinity’s professional work with women suffering from perinatal mood disorders, and her own personal experience with postpartum depression and anxiety, inspired her to create her practice, The Mother Birth. Trinity is a Licensed Clinical Social Worker and holds certification in Maternal Mental Health from Postpartum Support International.
"While Postpartum Depression and Postpartum Anxiety (PPD and PPA, respectively) are common for 1 in 5 women (and really because of underreporting it's more like 1 in 3) we don't always put a lot of focus on their not-so-common sisters: Postpartum Psychosis (PPP) and Postpartum OCD (PPOCD). These are the scarier, uglier, more brutal Perinatal Mood and Anxiety Disorders (or PMADS -so many acronyms!) that most people would just rather not discuss.  As a therapist that focuses on PMADS and the transition to motherhood, I'm kind of a fan of getting messy and seeing what is under the surface.  So let's dive in.
The first time I saw a woman with PPP it was after she had been recently released from an inpatient program at a hospital.  Unlike PPA, where most thoughts stay thoughts, but don't usually lead to detrimental actions, a woman with PPP is having a psychotic break and needs professional help.  Someone experiencing Postpartum Psychosis may have symptoms like:
  • Delusions or strange beliefs that feel real
  • Hallucinations (seeing or hearing things that aren’t there)
  • Feeling confused
  • Feeling disconnected from reality
  • Decreased need for or inability to sleep
  • Paranoia and suspiciousness
  • Difficulty communicating at times*
Most women who experience PPP have prior risk factors such as personal or family history, Bipolar Disorder (diagnosed or undiagnosed) or a prior psychotic break.  For some women the abrupt shift in hormones can cause a first-time psychotic break.  You should always get your thyroid tested before or during pregnancy to see if there is a co-occurring issue.
I had never seen a true state of catatonia before, but that is what happened to this mother of three.  She entered into the partial-hospitalization program I was working for at the time.  For at least a week she would sit in the groups and just stare off at something only she could see.  She wasn't able to engage with the information that her peers or the therapists were sharing.  She wasn't able to answer questions or have much comprehension of what was going on around her.  It seemed like we couldn't reach her.  But slowly, ever so slowly, she started to receive the care that was being offered to her and she started to come back to life.  That is the thing about all PMADS: recovery is possible, it is available, and you deserve to feel better.
After about eight weeks, with a combination of medication, a mix of Cognitive Behavioral Therapy and Dialectical Behavioral Therapy, and some new plans for self-care, this mother was able to express herself, smile and laugh, and begin to engage in some deeper work.  The color came back to her skin.  The light came back into her eyes.  It was really like that.  Like watching someone come back from a terrible journey only they could go on.  This is what I love about the work I do.  I often say I'm just a guide, the client already knows the answers.  As care providers, we will walk with you along the path.  It takes a village to raise a mother too.
Let's talk recovery.  I am a HUGE proponent of setting up your Postpartum Care Team exactly the same way you might handpick the items for your Baby Shower registry.  This might look like a mental health therapist, a massage therapist that specializes in postpartum massage, an acupuncturist, a naturopath, a postpartum doula, a chiropractor, a gym membership (or a walking buddy!) or whatever you feel like might help you ease into the transition of motherhood.  Cause it's a beautiful, messy, wild ride.  And you don't have to do it alone, even if you want to."
If you, or someone you know, shows signs of PPP they should go to the hospital immediately or call 911.