Is it PPD or PTSD?

by Joyelle Brandt

Mom_and_baby (1 of 1)

I stood in front of a room of strangers with kind eyes, and announced:

“I have been struggling with postpartum depression.”

Somehow it was easier to admit this to strangers than to my husband and friends, yet there it was. Since early in my pregnancy with my second child, I had struggled with my mental health. But it would take me years to realize that what I had was not postpartum depression, but a particularly acute flair up of the undiagnosed post traumatic stress disorder (PTSD) I had lived with most of my life.

Having children brought up memories of childhood sexual abuse that I thought I had dealt with. But often these weren’t actually mental memories, but physical sensations paired with an emotion, usually fear. I have since learned that these body memories are common for people like me, who are survivors of childhood trauma. While I was pregnant with my second child, these body memories became so intrusive that I was plunged into a depression that felt like drowning. I felt swept away by uncontrollable thoughts and fears. I didn’t know what else to call this, so I called it postpartum depression. But that wasn’t it, really. What I was experiencing was a more intense version of the PTSD flashbacks and dissociation that I had lived with my whole life. But despite many visits to various therapists over the years, no one had ever suggested that I might have PTSD. Turns out, I’m not alone.

Looking back, I can see that I have had all of the symptoms for most of my life. It was misdiagnosed many times over. As depression when I was a kid, as bipolar disorder a few years ago, postpartum depression… I only got the PTSD diagnosis about 6 months ago. I still thought it was anxiety and depression, partly because I have bought in to the stigmatizing belief that only veterans can have post traumatic stress.” -Cherie

Many trauma survivors are living with un-diagnosed PTSD that becomes un-manageable when they have kids of their own. Prior to having kids, most of us found ways to avoid our triggers. This is a natural human instinct, to avoid painful experiences. When we couldn’t avoid it, we dissociated, or numbed. But once we have children, we can’t just walk away or check out. We have to be present. All. The. Time. Even when we are reliving our worst traumatic experiences. Even when we feel like we want to crawl out of our skin.

You might be wondering why it is a problem to receive a diagnosis of PPD instead of PTSD. I see two concerns here. One is that PPD is assumed to be a temporary issue of adjustment to a new phase of life, that is assumed will ease as the child grows out of the demanding infant and toddler phases. For parents with PTSD or Complex PTSD related to trauma, their symptoms will not ease off as the child  grows up. As I have read essays written by parents with PTSD, they have shared that each stage in their child’s development brings new triggers.

The second concern is that a woman being referred for PPD most likely will not be sent to a therapist with a trauma informed practice. If the therapy is focused only on what the new mom is experiencing right now, without addressing the original trauma, the issues will not be resolved. In the words of trauma researcher Bessel van der Kolk:

“Traumatized people chronically feel unsafe inside their bodies: The past is alive in the form of gnawing interior discomfort. Their bodies are constantly bombarded by visceral warning signs, and, in an attempt to control these processes, they often become expert at ignoring their gut feelings and in numbing awareness of what is played out inside.”

Therapists who have specialized training in the area of trauma will be able to identify and address the trauma reactions that their patients are struggling with, and choose therapies to address those issues.

So how can we identify whether a distressed new mom is suffering from PPD or PTSD related to childhood trauma, or other traumas? We need to ask more questions, and uncover women’s trauma histories in our medical intake forms. We need to know if she is a survivor of childhood physical abuse or if she was raped when she was 20. These experiences are important to understand her risk level not just for depression and anxiety, but for additional physical complications in her pregnancy, delivery and recovery.

One tool that therapists (and survivors themselves) can use to learn to identify whether they might have PTSD is the Adverse Childhood Experiences Study. Researchers found that the higher the ACE Score, the greater the risk of experiencing poor physical and mental health, and negative social consequences later in life. Dr. Anda created an ACE Score Calculator 10-qacecalc.pdf  which allows individuals to calculate their own ACE Scores, based on the original scoring criteria of the ACE Study.  To use this survey, participants add up all of the YES responses to 10 questions.  The sum is the ACE Score.  The ACE Score can range from “0”, meaning no exposure to the ten categories of child abuse and trauma investigated by the Study, to “10”, meaning exposure to all ten categories.

What I have found personally is that learning about the impact of trauma on the mind and body has given me so much. I get it now, when I am have a trauma response. I can label and identify what is happening inside of me instead of berating myself for not “having it together” or being able to “suck it up.” I have more compassion for myself. I can also explain to my husband in the moment what is happening instead of shutting down or lashing out. I wish I could have sat down with my midwives and shown them my ACE score. It would have meant all the difference in how I saw myself, and in how my husband understood what was happening with me. I know it’s just a label, but having the right label makes all the difference.


Authors Note: This article does not address new mothers’ PTSD from traumatic childbirth experiences, as that subject has already been covered in other articles, which can be found here and here.


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