Should Postpartum Psychosis Be Included in the DSM?

Mena Mirhom, MD, FAPA, a board-certified psychiatrist and Psychiatric Times section editor, argued that postpartum psychosis should be considered for inclusion in the next iteration or update of the DSM. He said the Lindsay Clancy case and the national conversation around it raise the question for good reason.

The DSM-5-TR does not list postpartum psychosis as its own diagnosis. Clinicians instead apply a peripartum-onset specifier to mood disorders, or a postpartum-onset specifier to brief psychotic disorder. Both cover onset during pregnancy or within 4 weeks after delivery.¹ Mirhom said the current evidence supports a more specific approach.

The Case for Inclusion

Mirhom cited 3 lines of evidence. The first is the nature of the condition itself, which presents in a nuanced and distinct way. The second is the growing research literature on postpartum psychosis. Researchers have described features that set it apart from other psychotic illnesses, including rapid onset in the early postpartum weeks, a strong link to bipolar disorder, and fluctuating, sometimes delirium-like symptoms.²

The third is clinical expertise. Mirhom pointed to fellowships focused on peripartum care for women as evidence that the field already recognizes a specific body of knowledge. He said this expertise shows the need for a specifier and a defined approach to how clinicians study, treat, and work together to understand and support women with postpartum depression and postpartum psychosis.

A Public Health Perspective

Mirhom said formal recognition in the DSM matters beyond classification. “Being able to put this on paper in our DSM facilitates [and] opens a door for us to be able to better study a subject, better address it as a psychiatric community,” he said. That recognition would support research, academic, and clinical work alike.

For these reasons, Mirhom said, the psychiatric community should consider advocating for postpartum psychosis to be included in the DSM. He described this as an important public health priority.

Dr Mirhom is past president of the New York County Psychiatric Society, an assistant professor of psychiatry at Columbia University, a Forbes contributor, and chief wellbeing officer at Athletes for Hope.

References

1. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, text revision. American Psychiatric Association Publishing; 2022.

2. Bergink V, Rasgon N, Wisner KL. Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry. 2016;173(12):1179-1188.