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On the last track, we discussed obsessive-compulsive disorder. This included prenatal and postpartum OCD and preventing potential dangers of prenatal and postpartum OCD.
Do you have a client whose childbirth or pregnancy brings up traumatic memories for her?
If fear and embarrassment are two factors contributing to women’s reluctance to confide their symptoms of OCD to their doctors, the fear created from a third form of anxiety, post-traumatic stress disorder, or PTSD, can be even more isolating and distressing. As you may know, PTSD is characterized by the intrusive re-experiencing of a past traumatic event, avoiding close connections with family and friends, emotional numbing, and finally, chronic hyper-arousal.
Intrusive symptoms generally involve terribly nightmares or sudden, painful flashbacks that are sometimes so vivid the person actually feels that he or she is going through the trauma again. In order not to relive that pain, the person with PTSD may become emotionally numb, go about daily life in a dull, mechanical way, becomes more and more isolated, and generally tries to avoid contact with people or situations that are reminders of the trauma.
PTSD and Pregnancy
When Veronica, age 27, came to see me several years ago in just the second month of her pregnancy, she was requesting a psychiatric evaluation in order to have a cesarean section. At the time, C-sections were performed only if necessary for medical or obstetrical reasons, and if a woman wanted to have one for purely psychological reasons, she was forced to go through rigorous and often embarrassing questioning.
Although I knew immediately that Veronica was struggling emotionally, I didn’t know the cause of her struggle at the time. In compliance with hospital policy, I had to refer Veronica to the ethics committee, which ultimately denied her request. Since she’d refused to provide any reason for her wanting a C-section, their decision didn’t come as much of a surprise to me.
It took many sessions before Veronica trusted me enough to feel safe confiding her long-guarded secret. What she then told me was that she’s been awakening in the night seeing the image of a man wearing green coveralls and a green cap that were similar to the scrubs doctors wear in the operating room. As I continued to gently encourage Veronica to divulge, she further confessed that this green-clad figure was actually her uncle, who had molested her repeatedly when she was a child.
Years after these incidents but also many years before her pregnancy, when Veronica was having her first pelvic examination, she experienced her first flashback to the molestation, and ever since that time she’d avoided anyone’s touching her genitals or doing intrusive examinations, which was why she’d been so desperate to deliver her baby by cesarean section. Veronica further confided that even sexual intimacy with her husband had been traumatic, although she’d never allowed him to know it.
Have you found, as I have, that women with a history of sexual abuse tend to prefer female health care providers, particularly when they undergo physical examinations?
Childbirth and PTSD
Delia was carrying twins when...in the third trimester of her pregnancy, she developed a serious complication that resulted in the death of one of the babies. After that, Delia became acutely anxious and angry with her doctors. During Delia’s first visit with me, it became clear that she blamed the health care system and believed that she hadn’t received proper treatment in the hospital.
When a woman is so focused on her pregnancy going as planned, as Delia was on having twins, it can be difficult for her to come to terms with any deviation from that plan. Angela, for example, had been determined to give birth at home and had hired a midwife to oversee the delivery.
PTSD may actually be associated with an increased risk of obstetrical complications. As with any form of untreated depression or anxiety, the baby as well as the mother is at risk. All the more reason, then, for clinicians to be vigilant in looking for symptoms of PTSD in their clients, looking for any history of molestation, abuse or violence, as well as any symptoms that the women may be experiencing or have experienced in the past.
Do you have a Veronica or a Delia who might benefit from hearing this track?
On the next track, we will discuss Eating Disorders and Postpartum. This will include pregnancy and the course of the eating disorder and the eating disorder and the baby.
Online Continuing Education QUESTION 11
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