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CHAPTER 34 Cheryl Tatano Beck 675

MAJOR CONCEPTS & DEFINITIONS
Beck’s major concepts have undergone refinement baby (and perhaps other children) are in grave dan-
and clarification over years of work on postpartum ger of harm. Although postpartum psychosis often
depression. The first two concepts, postpartum begins to appear during the first week postpartum,
mood disorders and loss of control, were developed it is frequently not detected until serious harm has
utilizing phenomenology and grounded theory occurred.
methods.
Postpartum Obsessive-Compulsive Disorder
Concepts 1 to 2 Only recently identified, the prevalence rates of post-
1. Postpartum Mood Disorders partum obsessive-compulsive disorder have not been
Postpartum depression and maternity blues have reported. Symptoms include repetitive, intrusive
become better delineated over time, as has the un- thoughts of harming the baby, a fear of being left alone
derstanding of postpartum psychosis. Two other with the infant, and hypervigilance in protecting the
perinatal mood disorders, postpartum obsessive- infant.
compulsive disorder and postpartum-onset panic Postpartum-Onset Panic Disorder
disorder, have been identified, as has how these dis-
orders are different and how they are interrelated Postpartum-Onset Panic Disorder has been identified
(Beck, 2002c). only recently and is also without reported prevalence
rates. It is characterized by acute onset of anxiety, fear,
Postpartum Depression rapid breathing, heart palpitations, and a sense of
Postpartum depression is a nonpsychotic major impending doom.
depressive disorder with distinguishing diagnostic
criteria that often begins as early as 4 weeks after 2. Loss of Control
birth. It may also occur anytime within the first year Loss of control was identified as the basic psychoso-
after childbirth. Postpartum depression is not self- cial problem in the 1993 substantive theory of
limiting and is more difficult to treat than simple Beck’s early work. This descriptive theory captured
depression. Prevalence rates are 13% to 25%, with a process women go through with postpartum
more women affected who are poor, live in the inner depression. Loss of control was experienced in all
city, or are adolescents. Approximately 50% of all areas of women’s lives, although the particulars of
women suffering from postpartum depression have the circumstances may be different. The concept of
episodes lasting 6 months or longer. loss of control fit with extant literature and left
women with feelings of “teetering on the edge”
Maternity Blues (Beck, 1993). The process identified consisted of the
Also known as postpartum blues and baby blues, following four stages:
maternity blues is a relatively transient and self- 1. Encountering terror consisted of horrifying anxi-
limited period of melancholy and mood swings ety attacks, enveloping fogginess, and relentless
during the early postpartum period. Maternity blues obsessive thinking.
affects up to 75% of all women in all cultures. 2. Dying of self consisted of alarming unrealness,
contemplating and attempting self-destruction,
Postpartum Psychosis and isolating oneself.
Postpartum Psychosisis a psychotic disorder charac- 3. Struggling to survive consisted of battling the
terized by hallucinations, delusions, agitation, and system, seeking solace at support groups, and
inability to sleep, along with bizarre and irrational praying for relief.
behavior. Although postpartum psychosis is relatively 4. Regaining control consisted of unpredictable
rare (1 to 2 women per 1000 births), it represents a transitioning, guarded recovery, and mourning
true psychiatric emergency because both mother and lost time.

Continued