Miscarriage and Anxiety Disorder

Serious mental disorder is more common than depression

Anxiety disorders common following a miscarriage.
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After experiencing a miscarriage or a stillbirth, it is not uncommon for parents to develop symptoms of depression or anxiety. While many of us have a pretty good understanding of what depression is, anxiety is something that many people assume to mean "being on edge."

But it is actually more than that. Like depression, anxiety can severely interfere with a person's ability to function and often requires treatment and counseling to fully resolve the underlying trauma.

In fact, most research suggests that anxiety disorders are a more common condition following pregnancy loss than even depression.

Understanding Anxiety Disorders

Anxiety disorders are serious mental illnesses that cause significant worry or fear that doesn't go away and can even worsen over time. Anxiety disorders come in different forms, each with distinct features and treatment goals.

The types more commonly seen after pregnancy are generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), acute stress disorder (ASD), and post-traumatic stress disorder (PTSD).

Women tend to experience anxiety disorders more than men.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder, despite its name, is very specific in how and to what degree it can affect an individual. By definition, GAD is a persistent, excessive, and intrusive worry which occurs on most days and last for more than six months.

In women who have experienced a pregnancy loss, GAD may begin with fears about medical complications following a dilation and evacuation (D&E) procedure, worries about repeated miscarriage, or concerns as to whether an underlying medical or genetic condition may have contributed to the loss. Those fears are only compounded by the feelings of grief and loss that a woman may naturally feel.

GAD is difficult to control and may manifest with an array of symptoms, including:

Obsessive-Compulsive Disorder (OCD)

Interestingly enough, obsessive-compulsive disorder is commonly seen during pregnancy, a conditions scientists believe may be related to hormones. On the flip side, women who have experienced a pregnancy loss are eight times more likely to be diagnosed with OCD than those who haven't.

OCD is characterized by excessive thoughts (obsessions) that lead to repetitive behaviors (compulsions). Symptoms are best characterized as follows:

  • Persistent thoughts of a disturbing nature
  • Use of rituals to control or distract from the upsetting thoughts
  • Rituals and/or the thoughts that are disruptive to the person's daily life

The disturbing thoughts may be violent or overtly sexual, both of which may further fuel the underlying anxiety.

Acute Stress Disorder (ASD)

Acute stress disorder is believed to affect one of every 10 women who has experienced a pregnancy loss. ASD is directly associated with a traumatic event and can manifest within hours of the event.

Contrary to what some might assume, ASD is not directly related to the timing of the miscarriage or stillbirth. More often than not, it occurs in women who have experienced a loss before the 20th week of gestation, not after.

Symptoms of ASD may include:

  • A sense of numbness or lack of emotional responsiveness
  • Feeling dazed or outside of oneself
  • Inability to recall aspects of the trauma
  • Reliving the event through recurrent thoughts, dreams, or flashbacks
  • Avoiding anything that are reminders of the miscarriage
  • Persistent edginess and/or distress

ASD is similar to PTSD but lasts for at least two days but no longer than four weeks.

Post-Traumatic Stress Disorder (PTSD)

Research has long suggested that around one percent of women with ASD will progress to post-traumatic stress disorder following a miscarriage. The symptoms of PTSD are essentially the same as ASD but are defined as lasting longer than a month.

However, recent research paints a somewhat different picture, suggesting that rates of PTSD may be far higher. According to a study from the Imperial College in London, among 186 women who experienced an early pregnancy loss, 28 percent met the criteria for probable PTSD after three months of follow-up.

Moreover, the severity of the PTSD symptom had no association to the severity or type of miscarriage experienced. On the plus side, symptoms tended to wane after the second month.

What to Do If You Experience Persistent Anxiety

If you feel a persistent anxiety following the loss of your pregnancy, you are not alone. Most research suggests that it's a more common experience than one might imagine.

A 2011 study involving 13,000 women who had experienced miscarriage showed that 15 percent had clinically significant anxiety and/or depression which persisted for as long as three years. What this should tell us that any such symptoms, however small, should never be ignored.

We are fortunate today to have effective treatments for these disorders. By working with a qualified mental health professional, you can begin to come to terms with your fears and regain some of the control you may have lost.

Healing does not mean forgetting. Communicate with others, find support groups, allow yourself to grieve, and don't be afraid to reach out for professional help.

Sources:

Bergner, A.; Beyer, R.; Klapp, B.; and M. Rauchfuss. "Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology, and coping." Journal of Psychosomatic Obstetrics and Gynecology. 2008; 29(2):105-13.

Blackmore, E.; Cote-Arsenault, D.; Tang, W. et al. "Previous Prenatal Loss as a Predictor of Perinatal Depression and Anxiety." British Journal of Psychiatry. 2011; 198(5):373-378.

Daugirdaite, V.; van den Akker, O.; and S. Purewal. "Posttraumatic Stress and Posttraumatic Stress Disorder after Termination of Pregnancy and Reproductive Loss: A Systematic Review." Journal of Pregnancy. 2015: 646345.

Farren, J.; Jalmbrant, M.; Arneye, L. et al. "Post-traumatic stress, anxiety, and depression following miscarriage or ectopic pregnancy: a prospective cohort study." BMJ. 2016; 6e011864.

Gold, K.; Boggs, M.; Muzik, M.; and A. Sen. "Anxiety Disorders and Obsessive Compulsive Disorder 9 Months After Perinatal Loss." General Hospital Psychiatry. 2014; 36(6):650-4.

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