Postpartum Depression: Case Presentation
Marisol is a twenty-seven-year-old Latina woman of Honduran origin, who currently lives in the United States with her husband and infant son. She presents with a depressed mood, reporting feeling “totally empty,” and became tearful when describing her last few months during which she experienced a substantial impairment in her social and occupational functioning, leading her to question if she was experiencing postpartum depression.
Symptoms affecting Marisol’s current functioning are indicative of a mood disorder. She reports that she previously enjoyed working as a seamstress but has not been able to make anything for months. In addition to a lack of enjoyment in her work, Marisol reported that she no longer enjoys music and is not interested in talking to her friends. This information illustrates that Marisol no longer enjoys activities that she used to find pleasure in – a sign of anhedonia.
Related Reading: Social Work Specialization in Mental Health
Additional Symptoms of Postpartum Depression
Marisol also exhibits several somatic symptoms, including sleeplessness and headaches. Due to her inability to sleep at night, she reports feeling exhausted and appears drained and tired. Marisol reports that the simplest tasks seem to take “everything I have.” Based on this information, Marisol’s somatic symptoms amount to insomnia, fatigue, and loss of energy, and psychomotor retardation nearly every day. Additionally, Marisol reports that she can no longer taste food, signifying a change in appetite.
It is important to note that the onset of Marisol’s symptoms and a decline in functioning occurred one month after the birth of her first child, and have persisted for four months. Marisol reported that the first month of motherhood was “lovely,” but she subsequently began to worry about her baby’s health, obsessing about cleanliness and germs.
Marisol was so anxious about her child’s health that she would stay up to ensure he was breathing as he slept, or would stay up at night worrying. She is no longer able to breastfeed her child because she reports “it was sucking the life out of me!” Marisol feels excessive guilt about her current state and inability to nurse, calling herself a “horrible mother.”
Marisol also expresses feelings of guilt about relying on her husband to accompany her to appointments and calling him “all day,” and feels guilty about the gang-related death of her brother in Honduras just after she immigrated to the United States.
Related Reading: Social Work Specialization in Women
Postpartum Depression Diagnostic Criteria
From the information that is currently known about Marisol’s symptoms, level of functioning, and behavior, the following multi-axial DSM1 diagnosis has been given:
- Axis I 296.23 Major Mood Disorder, Single Episode, Severe without Psychotic Features, with Postpartum Onset
- Axis II V71.09 (no diagnosis)
- Axis III Childbirth
- Axis IV Immigration, marital tension, death of brother, physical separation from family
- Axis V GAF = 37 (on admission)
Based on the interview with Marisol, the clinician has been able to determine that Marisol meets the criteria for a Major Depressive Episode.
To competently make this assessment, the clinician had to ascertain that Marisol experienced at least five of the symptoms for a Major Depressive Episode, with at least one of the symptoms being depressed mood or loss of interest or pleasure. Additionally, the five or more symptoms must have been present during the same 2-week period, at a minimum, and the presence of the symptoms must represent a change from Marisol’s previous level of functioning.
Establishing the Diagnosis
To make this diagnosis of postpartum depression, the clinician first established that Marisol was experiencing either depressed mood or loss of interest or pleasure. Marisol has experienced both of these symptoms on a daily basis for the past four months.
The persistence and duration of her depressed mood is particularly important in differentiating between a depressive disorder and normal moodiness or periods of sadness; as Zide and Gray2 articulate, “the depressed mood is not temporary or easily shaken off, and it typically persists for weeks, months, or years.” Thus, it becomes clear that Marisol’s depressed mood is characteristic of clinical depression.
Based on information available about Marisol, she has been shown to meet the preliminary criterion for a Major Depressive Episode, since depressed mood and loss of interest or pleasure have both been present (constituting 2 symptoms), in addition to five other symptoms – decrease in appetite, insomnia, psychomotor retardation, fatigue or loss of energy, and feelings of excessive guilt – for a total of seven symptoms, all of which she experiences nearly every day and all of which have been present during the same 2 week period.
All of these symptoms also illustrate a substantial change from previous to current functioning.
The specification of “single episode” has been diagnosed because Marisol has no history of major depressive episodes, nor any experience of manic or hypomanic episodes.
Because Marisol’s episode does not include any psychotic features, such as hallucinations or delusions, but she does exhibit most of the possible criteria symptoms of the Major Depressive Episode, the Major Depressive Episode has been specified as Severe without Psychotic Features. This level of severity was determined because the combination of Marisol’s symptoms results in a clear impairment of social and occupational functioning,
The final specifier of Postpartum Onset is especially salient, as the onset of all of Marisol’s symptoms occurred approximately four weeks after the birth of her first child. Marisol exhibits behavior common in postpartum-onset episodes – “preoccupation with infant well-being” – in her obsession with the baby’s cleanliness and health that causes her to stay up at night worrying or watch her son sleep to make sure he is breathing1.
Findings suggest that postpartum mood episodes “may be more common in primiparous women1” like Marisol. Unlike the transient “baby blues,” Marisol’s symptoms have persisted well beyond ten days postpartum and have acutely impaired her functioning, confirming the diagnosis of a Major Depressive Episode with Postpartum Onset.
Further Diagnosis of Postpartum Depression
Because Marisol does not exhibit any symptoms or behavior of a personality disorder or mental retardation, no diagnosis has been given for Axis II. The medical condition of Childbirth has been given for Axis III, to allow any clinician working with Marisol to understand the biological changes and affects that her recent childbirth has had.
Axis IV has given consideration to Marisol’s social environment, acknowledging Marisol’s immigration to the United States, the reported marital tension with her husband, the death of her brother, and the physical separation from Marisol’s parents and siblings who still reside in Honduras.
A Global Assessment of Functioning score of 37 was given due to Marisol’s major impairment in social and occupational functioning, family relations, and mood.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington (DC): American Psychiatric Association; 2000.
- Zide, M, Gray, S. Psychopathology: A competency-based assessment model for social workers (2nd ed.). Belmont (CA): Wadsworth/Thomson Learning; 2007.
- Gabbard, G. Psychodynamic psychiatry in clinical practice (4th ed.). Washington (DC): American Psychiatric Press; 2005.
- Newman, B, Newman, P. Development through life: a psychosocial approach. Belmont (CA): Wadsworth Cengage Learning; 2009.