Psychological risk factors for perinatal depression and anxiety
Pregnancy is a time of great change and adjustment, and mental health issues can emerge. Read on to learn more about psychological risk factors for perinatal depression and anxiety.
PSYCHOLOGICAL RISK FACTORS FOR PERINATAL DEPRESSION + ANXIETY
By Joyce Chong (updated 26 April 2018)
Pregnancy and parenthood are times of great change and, with that, adjustment beckons. From changes to your body, your health, finances, potentially house/city/country, shifts to family dynamics, and also changing identity, it's no wonder that difficulties adjusting to this period of change may emerge. It's also during this time that we may see anxiety and depression emerge, or intensify should these be pre-existing conditions.
In our work as clinical psychologists with pregnant women and new mothers, we thought we'd highlight some of the psychological risk factors we often see that can negative affect mental health.
1. A history of depression or anxiety
Having a pre-existing history of depression or anxiety can make you more susceptible to developing perinatal depression or anxiety. It's therefore especially important to working on boosting your wellbeing and mental health as early on as possible so that you're prepared for the changes that lie ahead.
2. Negative thinking styles
We're all prone to negative thinking styles at any stage of our lives. During pregnancy and following birth, some common ones we see include:
Emotional reasoning (e.g. “If I feel anxious it must mean that I’m not that confident.”),
Black and white thinking (e.g. believing it’s either perfect or completely ruined),
Catastrophising (e.g. believing that forgetting one thing will lead to a disastrous impact on your unborn child), and
Mind reading (e.g. “They will think I’m so incompetent!”).
3. Perfectionism
Perfectionism can rear its ugly head at any time in the pregnancy, birthing, and parenting process, and it can make it difficult to adjust to change. From having the perfect pregnancy, to the perfect birth plan, to being the perfect parent with the perfect baby...are you putting too much pressure on things that are likely beyond your control?
4. A tendency to engage in social comparison
A tendency to engage in social comparison. We’ve previously blogged here about how social comparisons can hurt your self esteem and pregnancy and parenthood provides a new arena for social comparison.
From comparing your pregnancy body to what you see on Instagram, to assessing your parenting skills against those of other new mums, to gauging your child's milestones against others in playgroup - the potential for feeling anxious and depressed is heightened.
5. Unrealistic expectations
Unrealistic expectations present challenges for pregnancy and parenthood, and they underpin problematic (clinical) perfectionism. Examples of where unrealistic expectations trip us up include:
Expecting to glow throughout pregnancy with only a tiny bump, when the reality is that you're ridden with nausea and swollen ankles for much of the pregnancy.
Expecting to instinctively know what to do after you've given birth, when it's only your first time holding an infant.
Expecting things to go according to your birth plan, only to end up with a completely opposite experience due to complications.
Expecting to breastfeed when, in reality it isn’t possible due to problems latching, or illness.
With such unrealistic and potentially unattainable expectations, is it any wonder that your mind sets yourself up to feel like a failure?
6. Difficulties adjusting to change
Pregnancy and becoming a parent is a time of great change, and with that comes adjustment. It helps to adjust expectations regarding how much disruption there will be to life and to routines, how significant an impact it will have on productivity levels, and how it will impact on stress and mood levels.
For example, if you're used to ticking of item after item on your To Do list and streamlining your workflow, it may come as a rude shock to discover your main achievement for the day becomes leaving the house before lunchtime.
Do the above signs look familiar?
Not sure if you or someone might need help? A useful screening tool used by many health professionals is the Edinburgh Postnatal Depression Scale which you can take it here.
Much can be done to support expectant or new mums with Perinatal Depression and Anxiety, but things can't change unless the first step is taken. A good starting point is to talk to your GP, obstetrician, or psychologist. If you'd like to work with us to build skills to help navigate this period of significant change, then contact us to make an individual appointment.
Excellent resources can also be found at Beyond Blue and also Perinatal Depression and Anxiety Australia.
What about fathers and partners?
Perhaps it is telling that we don’t see as many expectant or new fathers in comparison to expectant mothers because it is the mothers who experience the more visible changes.
However, first-time fathers are also going through a period of great change, moving from what was once a nice twosome shifts to the focus being solely on a third new little being. Whilst this can be an absolutely joyous event, there's no denying that there may be financial stress, a diminished social life, impacted relationships, changes to quality of life, and even importance for fathers in ranking within the household.
Men can also experience Perinatal Depression and Anxiety, with similar risk factors as those for women. Perinatal Depression and Anxiety Australia has put together an excellent resource which you can find here, as has Beyond Blue here.
It may also be helpful for expectant fathers to talk to others who have been through the same process to understand what emotional changes may occur. For first-hand accounts of other fathers’ experiences, have a look at the Black Dog Institute here.
Alternatively, consider speaking to a mental health professional (like us!) about preparing psychologically for the upcoming changes, particularly if the psychological risk factors are present.
A primer on perfectionism
Here’s a quick guide on what you need to know about perfectionism.
A PRIMER ON PERFECTIONISM
By Joyce Chong
It’s easy to think of perfectionism as one overall category in which you’re driven to achieve exceedingly high standards, and attaining the standard is like climbing to the peak of a mountain. But perfectionism is so much more complex and diverse than that. Today, we’re taking a closer look at the different ways in which we can think about perfectionism.
WHERE DOES PERFECTIONISM COMES FROM?
The cause of perfectionism is thought to be varied. [1] Genes potentially make a contribution, as suggested by studies of identical twins raised together versus those raised apart, as do parental expectations. It’s also thought that we can ‘learn’ perfectionism through mechanisms such as observation, reward (e.g. getting praised for doing well), and punishment (e.g. getting punished for failing to meet others’ expectations).
ABOUT PERFECTIONISTIC STANDARDS
We often think of perfectionism as something that is driven from within, influenced by our own high standards and driving our own behaviour. However perfectionism isn’t necessarily directed at ourselves.[2]
Perfectionism can be directed at others wherein you expect others to adhere to the high standards that you expect of them. Thus, you may expect:
Your partner to do housework a particular way;
Your family to conform to your idealised vision of how family members should relate to each other
Your friends to act in a particular way
Your children to behave how they ‘should’
In each of these situations it’s easy to see that disappointment, hurt, and anger may follow when others don’t meet your expectations.
There is also something that we call socially prescribed perfectionism, wherein we believe that others hold high expectations that we must meet. Not surprisingly, it’s been shown to be linked to a fear of negative evaluation, loneliness and shyness, lower levels of social self-esteem[3]. It has also been linked to a tendency to be perfectionistic when it comes to how one presents oneself (perfectionistic self-presentation), the perception of having received social feedback that is negative in nature, to ruminate more about having (potentially) offended others, and also feelings of depression and social anxiety.[4]
HOW IS YOUR PERFECTIONISM MANIFEST?
Perfectionism can be manifest in different ways in different domains of our lives. For instance you may see perfectionism:
Within the home, with lawns meticulously manicured, the interior and exterior cleaned spotlessly, and objects arranged ‘just so’. There may be daily, weekly, monthly, and seasonal cleaning routines that must be rigidly adhered to.
At work where you pore over every detail of every project, find it hard to delegate tasks, and set extremely high targets that you ‘must’ achieve at all costs. Long hours are typically involved in getting outcomes that meet your exacting standards.
At school or at university, where you aim for extremely high marks, relentlessly study or research to ensure that you have all the answers readily available and that you avoid making any mistakes. Your assignments keep getting reworked until they feel ‘just right’.
In hobbies, where there are multiple attempts are made to get something ‘just so’. If cooking is your thing, then it may be attempting to replicate a dish so that it looks exactly like it does in a magazine.
In sport/exercise, and not just at the lofty levels of competition. There may be multiple attempts to achieve a textbook yoga pose, or overtraining against a coach’s advice because of a desire to perfect techniques.
In self-presentation…how you speak, dress, your level of grooming, your lifestyle choices, your body weight and shape. Throw in the heightened scrutiny of social media to this mix and it’s easy to see how perfectionism can take over in a bid to maintain a perfect image.
HOW IS PERFECTIONISM MAINTAINED?
How do perfectionistic standards continue to persist given they are often unrealistically high and therefore at times unlikely to be met?
One factor is the thought process or interpretation – that a failure to meet these standards are not a reflection of the unrealistic nature of the standards themselves, but rather a reflection on your own failures. Or, if the standard is somehow achieved, then it may be discounted as being too easy and attainable by all.
Perfectionistic behaviours also reinforce the problem, as you increase your efforts to achieve the unrealistic standards. While it may pay off, it’s important to recognise that this level of effort is often difficult to sustain in the longer term.
Interestingly, procrastination also plays a part for some dealing with perfectionism. By ‘opting out’, or perhaps completing the work with insufficient time to do a decent job, the ‘blow’ of being unable to meet the unrealistic standard becomes far easier to handle.
THE IMPACT OF PERFECTIONISM
Critically, what is the impact of perfectionism? Is it something that motivates you, spurring you on to strive for excellence? When that excellence is achieved do you feel a sense of contentment and satisfaction?
Or, is perfectionism more like a rod of punishment, where you feel pressured to reach a particular standard, your motivation is driven by a fear of failure, or where achievements are quickly dismissed as being too easy and replaced by even loftier goals?
Give that perfectionism can have very different effects, the big question is what differentiates adaptive perfectionism from maladaptive – or clinical – perfectionism?
A key factor to look at is how much 'wiggle room' we give ourselves when it comes to our standards. When perfectionism is adaptive we tend to see the goals as guidelines to work tirelessly towards, however we can show some degree of flexibility when it comes to the goal that is set, whether the goals are realistic, and whether there is flexibility in the time frame within which it is to be achieved.
In contrast, when clinical perfectionism is at play goals are set unrealistically high (typically setting us up for failure), however in typical black and white thinking any deviation from the goal is viewed as failure. Clinical perfectionism leaves us constantly feeling that we’re not good enough, leading us to set even loftier goals that we are unlikely to meet. With this type of mindset is it any wonder that clinical perfectionism is linked with burnout, psychological distress, depression, and other mental health disorders?[5] To learn more about this, see our Tip Sheet in our FREE Resource Library on When Perfectionism Harms your Wellbeing.
When considering the effects of clinical perfectionism, the big question to ask yourself is…Is it really worth it?
REFERENCES
[1] Antony, M.M., & Swinson, R.P. (1998). When perfect isn’t good enough: Strategies for coping with perfectionism. Oakland: New Harbinger.
[2] Hewitt, P.L., Flett, G.L., Turnbull-Donovan, W., & Mikail, S.F. (1991). The Multidimensional Perfectionism Scale: Reliability, validity, and psychometric properties in psychiatric samples. Psychological Assessment, 3, 464-468.
[3] Flett, G.L., Hewitt, P.L., & De Rosa, T. (1996). Dimensions of perfectionism, psychosocial adjustment, and social skills. Personality and Individual Differences, 20, 143-150.
[4] Nepon, T., Flett, G.L, Hewitt, P.L., & Molnar, D.S. (2011). Perfectionism, negative social feedback, and interpersonal rumination in depression and social anxiety. Canadian Journal of Behavioural Science, 43, 297-308.
[5] Egan, S.J., Wade, T.D., Shafran, R., & Antony, M.M. (2014). Cognitive-behavioral treatment of perfectionism. New York: The Guilford Press.
How are self-esteem, body image, and eating disorders related?