APA Expert Opinion
An APA Expert answers common questions regarding women's mental health

This month's expert is, Catherine Birndorf, M.D., assistant professor of Psychiatry and Obstetrics & Gynecology at The New York Presbyterian Hospital, Weill Cornell Medical Center. Dr. Birndorf is also the Program Director of the Payne Whitney Women’s Program, a program designed to evaluate and treat women with emotional distress and psychiatric illness throughout the life cycle. 

My boyfriend has never hit me but he screams at me all the time.  Since I am not being hit, his screaming is not abuse, right?

Abusers use many ways to isolate, intimidate and control their partner, which does not always include physical abuse. It starts insidiously and may be difficult to recognize. Early on, your partner may seem attentive, generous and protective in ways that later turn out to be frightening and controlling. Initially the abuse is isolated incidents for which your partner expresses remorse and promises never to do again or rationalizes as being due to stress or caused by something you did or didn’t do.

While you cannot stop your partner’s abuse—only they can do that—you can find help and support for yourself.

•     Talk with someone you trust: a friend or relative, a neighbor, coworker or religious or spiritual advisor.

•     Tell your physician, nurse, psychiatrist or therapist about the abuse.

•     Call the National Domestic Violence Hotline [1-800-799-SAFE (7233)], your state domestic violence coalition, and/or a local domestic violence agency.

•     Call the police if you are in danger.

•     Remember, you know your situation better than anyone else. Don’t let someone talk you into doing something that isn’t right for you.

I had my baby a couple of months ago and still feel overwhelmed. Could I have postpartum depression?  

As many as 90 percent of new mothers have a brief episode of heightened emotions within a few days of birth.  This is called ‘baby blues,’ and it generally goes away within a couple of weeks without treatment.  Postpartum depression on the other hand, is clinical depression occurring within the first year after childbirth.  It is experienced by as many as 10 - 15 percent of new mothers, regardless of socioeconomic factors. 

The symptoms of postpartum depression can include:

• Sadness or irritability
• Anxiety or worry related to the baby’s safety
• Feelings of hopelessness and helplessness
• Disturbances in appetite and sleep
• Confusion
• Loss of energy
• Inability to enjoy things
• Lack of interest in the baby
• Fear of harming the baby or oneself

The symptoms, and their severity, vary from woman to woman. Because new motherhood is supposed to be a happy time, women experiencing these symptoms often feel isolated, guilty and ashamed. Women who have postpartum depression love their children but may be convinced that they're not able to be good mothers. Women with a personal or family history of a mood disorder are at an increased risk of postpartum depression.

Postpartum depression deprives the mother and baby of emotional interactions that are vital to the baby’s development.  It is important for spouses, family members and friends to watch for symptoms, to urge the new mother to seek medical attention, and to support her during treatment, which is much like the treatment for depression at any other time of life.  Friends and relatives should reinforce the mother’s self-confidence with the baby and help in anyway they can.

Can I keep taking my antidepressant while I am pregnant or trying to get pregnant?

If you have been diagnosed with depression, or another illness, it's important to work with your physician before stopping any medication. In general, symptoms don't take a break and neither should effective treatment. Women who discontinue medication during pregnancy are very likely to suffer a return of the symptoms of depression. 
Untreated depression can have negative effects on the pregnancy as well.  There have been a number of reports of complications for the babies of mothers who take antidepressants during pregnancy.  Therefore treatment decisions have to be made by you and your physician on an individual basis, depending on the severity and frequency of depressive episodes you have experienced and the ease or difficulty you have had in finding the most effective treatment.  One possibility is to reduce medication gradually, under medical supervision and increase psychotherapy for the duration of the pregnancy.

What exactly is an eating disorder?

Eating disorders are serious, but treatable illnesses. Those suffering from eating disorders typically become preoccupied with food and their body weight. Eating disorders affect some several million people at any given time, most often women between the ages of 12 and 35. There are two main types of eating disorders, anorexia nervosa and bulimia nervosa.

Anorexia nervosa afflicts as many as one in every 100 girls and young women. It is usually diagnosed when patients weigh at least 15 percent less than the normal healthy weight expected for their height. People with anorexia nervosa don't maintain a normal weight because they refuse to eat enough, often exercise obsessively, and sometimes force themselves to vomit or use laxatives to lose weight. Girls and women with anorexia nervosa usually lose their menstrual periods.

Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa can be slightly underweight, normal weight, overweight or even obese. But, they are rarely as underweight as anorexia nervosa sufferers. Patients with bulimia nervosa binge eat frequently, and during these times sufferers may eat an astounding amount of food in a short time, often consuming thousands of calories that are high in carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it. Their binges often end only when they are interrupted by another person, they fall asleep, or their stomach hurts from being stretched beyond normal capacity. During an eating binge, sufferers feel out of control. After a binge, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative. This cycle is usually repeated at least several times a week or, in more serious cases, several times a day.

I feel nervous all the time.  Do I need treatment?

Anxiety disorders are the most common of emotional disorders, affecting 19 million Americans; women twice as often as men. Anxiety disorders differ from normal feelings of nervousness. If you feel worried nearly all the time, and realize that your anxiety is out of proportion to your life situation, you may have generalized anxiety disorder (GAD).  If you have episodes of severe anxiety, your heart is pounding, you are perspiring, you feel you can’t breathe, and you are convinced you are in danger of dying, you may have panic disorder.  Untreated anxiety disorders can push people into avoiding situations that trigger or worsen their symptoms. People with anxiety disorders are likely to also suffer from depression, and may abuse alcohol and other drugs in an effort to gain relief from their symptoms. Job performance, school work, and personal relationships are affected.

The first step towards getting relief from anxiety symptoms is a thorough medical evaluation.  Some general medical conditions, such as an overactive thyroid, can mimic anxiety symptoms. If an anxiety disorder is diagnosed, there are several effective forms of therapy, including psychotherapy and medication. Signs of effective treatment can take several weeks; patients should have close medical supervision during that time.

Unfortunately, many people with anxiety disorders don’t seek help. They don’t realize that they have real, treatable illnesses. Other people fear their family, friends or coworkers might criticize them if they get help. It is important not to discount your feelings and to consult a psychiatrist or other mental health professional for a thorough examination.

Page created March 5, 2007