Postpartum psychosis is a condition that affects up to two out of every 1,000 women who give birth, soon after delivery. More acute and less common than postpartum depression, it is characterized by a quick and dramatic onset and can include delusions, hallucinations, mania, extreme depression and complete change in personality.
The nature of the condition is complex, and there remains some controversy as to how to categorize the disorder. What is clear is that symptoms of postpartum psychosis have been recorded for more than 2,000 years.
Diagnosis in Ancient Greece
The first record of postpartum psychosis can be attributed to the ancient Greek physician Hippocrates, who wrote in 400 B.C. about a woman suffering from "postpartum delirium" within the first week after giving birth to twins; he described her symptoms as including severe insomnia and restlessness.
In "A Historical Perspective on the Psychiatry of Motherhood," Ian Brockington says similar symptoms are described nearly 2,000 years later by 16th-century Swiss physician Felix Plater, who wrote of a young woman becoming delirious and irate soon after giving birth. In 1797, German obstetrician Friedrich Benjamin Osiander wrote a detailed description of what he termed "puerperal mania," and recognition of the possible connection between childbirth and mental illness grew.
As "Oxford Textbook of Women and Mental Health” illustrates, the term "postpartum psychosis" was included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) II, published in 1968, with some caveats about its application as a last-resort diagnosis. It was excluded from the DSM IV in 2000, where Instead, the symptoms of postpartum psychosis were described in the section on mood disorders, and the condition was categorized as a “postpartum onset specifier” that might occur within the month after birth.
An Ongoing Discussion
Applying postpartum psychosis as a diagnosis is controversial in the modern medical community, where there is some controversy over whether it is, in fact, an independent condition, or if childbirth triggers psychotic episodes in women who were already predisposed.
A 2006 study from medical doctors at the University of Pittsburgh, Western Psychiatric Institute, and the University of Massachusetts Medical School, published in the "Journal of Women's Health," proposed that postpartum psychosis was actually bipolar disorder surfacing due to a drastic change in hormone levels after delivery, quoting data that showed up to 88 percent of postpartum psychosis sufferers could be diagnosed with a bipolar or "schizoaffective" disorder.