A  Trauma-­‐Informed  Understanding  of  

Postpartum  Psychosis  in  Forensic  Settings  

Diana  Lynn  Barnes,  Psy.D  

The  Center  for  Postpartum  Health  

A  trauma-­‐informed  understanding  of  

postpartum  psychosis  in  forensic  settings  

THERE  ARE  NO  FINANCIAL  DISCLOSURES  

OBJECTIVES  

1.  identify  5  symptoms  of  postpartum  psychosis  

2.  describe  the  connection  between  complex  trauma  and  mental  illness  

3.  list  3  risk  factors  for  postpartum  psychosis  

4.  explain  how  the  legal  definition  of  insanity  creates  difficulty  in  the  courtroom  

5.  name  3  types  of  pregnancy  denial  

What  is  Postpartum  Psychosis  

� Mania  

�  Thought  disorder  �  Cognitive  confusion  �  Delusions    �  hallucinations  �  Sleep  disturbance  �  Amnesia  

�  Agitation  �  Severe  mood  fluctuations  

�  Depersonalization  �  Dissociation  � Waxing  and  waning  

risk  factors  for  postpartum  psychosis  

v Personal/family  hx  of  bipolar  disorder,  schizophrenia,  schizoaffective  disorder,  major  depressive  disorder  with  psychotic  features  

v Complex  trauma  in  childhood  

v Death  of  one’s  mother  when  <  5  yrs  old  (suicide)  

postpartum  psychosis  is  NOT  severe  

postpartum  depression  

What  is  Altruistic  Filicide?  

WHAT  DOES  IT  MEAN  TO  FEEL  SAFE  WHEN  YOU  HAVE  NEVER  

FELT  SAFE?  

What  does  it  mean  to  be  legally  insane?  

WHO  WAS  DANIEL  M’NAUGHTEN?  

what  is  pregnancy  denial  

� Affective  denial  � Psychotic  denial  � Pervasive  denial  

 risk  factors  for  pregnancy  denial  

�  <  age  25  � Women  of  minority  

�  Childhood  trauma    

�  Family  hx  of  substance  abuse  

�  dependent  on  family  for  economic  survival  

�  Poor  problem  solving  skills  

characteristics  of  pervasive  pregnancy  denial  

� Pregnancy  related  symptoms  are  misinterpreted  

� Onset  of  labor  is  not  recognized  � Babies  almost  always  born  in  the  bathroom  � Dissociation  during  labor  � Families  collude  with  the  denial  

 

“Iatrogenic  participation”  

WHAT  DOES  THE  DSM  

HAVE  TO  DO  WITH  IT?  

The  DSM  V  has    No  diagnosis  for  postpartum  psychosis    No  diagnosis  for  pregnancy  denial    

The  Neurobiology  of  Trauma  

 

 

 

HPA  Axis  over-­‐reactivity  and  dysregulation    Elevations  in  cortisol  preceding  psychosis  onset    Reduced  gray  matter  in  the  frontal  lobe    Changes  in  the  hippocampus      

 

 

 

 

Read,  J.,  Bentall,  R.  P.,  &  Fosse,  R.  (2009).  Time  to  abandon  the  bio-­‐bio-­‐bio  model  of  psychosis:  exploring  the  epigenetic  and  psychological  mechanisms  by  which  adverse  life  events  lead  to  psychotic  symptoms.  Epidemiologia  e  psichiatria  sociale,  18(04),  299-­‐310  

 

traumatic  information  is  

stored  

Ø CORTEX  –  cognitive  memory  

Ø LIMBIC  –  emotional  memory  

Ø MIDBRAIN/CEREBELLUM  –  vestibular  memory  

Ø BRAINSTEM  –  state  memory  

types  of  trauma  

� ACUTE  

� CHRONIC  

� COMPLEX  

differential  responses  to  

threat  

Sympathetic  N.S.  

�  Reactive  �  Hypervigilant  �  Scanning  the  environment  

�  >heart  rate,  blood  pressure  �  Alarm  response  

�  Anxious  �  Flight  �  Panic,  impulsivity  

Parasympathetic  N.S.  

�  Detachment  

�  Numbing  

�  Dissociation  �  Derealization  �  Compliant  

�  Suspension  in  time  

�  Atypical  psychotic  reaction  

requirements    for  attachment  

security  

   

Ø Proximity  

Ø Separation  distress  

Ø Safe  haven  

Ø Secure  base  

Adverse  Childhood  Experiences  

Study  

               disrupted  neurodevelopment            social  emotional  and  cognitive  impairment  

     adoption  of  health  risk  behaviors  

     disease,  emotional  disturbances  

     early  mortality  

     

Anda,  R.F.,  Felitti,  V.J.  &  Bremer,  D.J.  (2006).  The  enduring  effects  of  abuse  and  related  adverse  experiences  in  childhood.  European  Archives  of  Psychiatry  and  Clinical  Neuroscience,  256(4).256-­‐263  

 

 

what  is  a  delusion?  

A  fixed  and  rigid  belief  that  cannot  be  willed  away  despite  any  rational  evidence  

to  the  contrary.  

altruistic  filicide?  

Can  we  call  it  an  act  of  love?  

In  the  courtroom  -­‐  

mistaken  ideas  about  

postpartum  psychosis  

� Mothers  with  postpartum  psychosis  are  “bad”  mothers  

�  If  you  have  postpartum  psychosis,  you  intended  to  kill  your  child  (premeditation)  

�  You  can  tell  a  woman  has  postpartum  psychosis  just  by  looking  at  her  

�  A  woman  with  postpartum  psychosis  is  a  danger  to  society  

�  Once  psychotic,  always  psychotic  

In  the  courtroom  –  what  to  teach  

about  postpartum  psychosis    

�  postpartum  psychosis  is  the  perpetrator  

�  The  mother  is  also  a  victim  

�  Postpartum  psychosis  by  its  very  nature  renders  a  woman  insane  

�  In  the  midst  of  a  postpartum  psychotic  episode,  there  is  an  absence  of  psychological  thought  making  it  impossible  to  determine  right  from  wrong.  

�  Delusions  cannot  be  willed  away  or  confronted  

�  Hearing  voices  is  not  a  confirmation  of  premeditation  

�  Infanticide  is  frequently  altruistic  

THE  GOOD  NEWS  

POSTPARTUM  PSYCHOSIS  IS  TREATABLE!  

REFERENCES  

�  Barnes,  D.L.  ed.  (2014).  Women’s  reproductive  mental  health  across  the  lifespan.  New  York:  Springer  Publishing  

� Meyer,  C.L.  &  Oberman,  M.  (2001).  Mothers  who  kill  their  children:  Understanding  the  acts  of  moms  from  Susan  Smith  to  the  “prom  mom”.  New  York:  New  York  University  Press.  

� Moskowitz,  A.  Schäfer,  I.  &  Dorahy,  M.J.  (2008).  Psychosis,  trauma  &  dissociation:  Emerging  perspectives  on  severe  psychopathology.  Oxford:  Wiley-­‐Blackwell  

�  Spinelli,  M.G.  ed.  (2003).  Infanticide:  Psychosocial  &  legal  perspectives  on  mothers  who  kill.  Washington,  D.C.:  American  Psychiatric  Publishing.  

The  Center  for  Postpartum  Health  

Diana  Lynn  Barnes,  Psy.D  

818.887.1312.                Sherman  Oaks,  CA