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News|Articles|November 8, 2025

Experts recommend postpartum psychosis be classified as its own disorder

An international panel of women’s mental health specialists urges the DSM to recognize postpartum psychosis as a distinct condition.

Key takeaways:

  1. Experts are calling for postpartum psychosis (PP) to be recognized as its own diagnostic category in the DSM due to its distinct onset and clinical profile.
  1. PP affects 0.1% to 0.2% of women without prior mental illness and carries significantly increased risks of suicide and infanticide.
  1. The condition is often missed because symptoms begin after childbirth, when patients are at home and undergoing major psychosocial changes.
  1. Evidence shows PP requires specific, urgent treatment, with inpatient care and stepwise therapy—including benzodiazepines, antipsychotics, and lithium—achieving a 98% remission rate.
  1. Recognizing PP as a separate disorder could improve prevention and early intervention, especially for women with known risk factors such as prior bipolar disorder or previous PP.

Postpartum psychosis (PP) should be reclassified as its own category of mental illness to improve care, according to a recent consensus statement published in Biological Psychiatry.1

This call came from an international panel of leading women’s mental health experts. Despite being one of the most recognizable mental illnesses in women because of rapid onset and distinctive symptoms, PP remains unrecognized in the Diagnostic and Statistical Manual (DSM) and the International Classification of Diseases.

“Postpartum psychosis is a very rare and serious psychiatric illness which requires a specific treatment approach,” said Jennifer Payne, MD, senior author and expert in reproductive psychiatry at UVA Health.

Challenges in timely diagnosis

According to authors, 0.1% to 0.2% of women without a prior mental health diagnosis experience PP, significantly increasing the risks of suicide and infanticide.2 Additionally, the odds of psychosis are increased 10-fold during the first few weeks postpartum vs any other time in women’s lives.

Authors also noted that clinicians working with patients to provide a clear understanding of PP risk and phenomenology is key for timely diagnosis. However, women at home during symptom onset and when undergoing psychosocial and physical adjustments are more likely to have their signs missed or normalized by health care providers.

While a peripartum specifier has been implemented for mood disorders in the DSM, this period referrers to the time during pregnancy and up to 4 weeks postpartum. In comparison, PP only occurs after childbirth, with no data indicating mania or bipolar recurrence during pregnancy.

Distinct treatment needs

Additionally, PP has unique treatment approaches when compared with other psychiatric disorders. As it is classified as a psychiatric emergency, experts recommend inpatient admission to evaluate and treat patients with PP.

Patients with PP should have the current episode immediately treated, after which steps should be taken to prevent recurrence in the postpartum period and beyond. A goal of full recovery within the first year postpartum should also be set.

In the largest study to date, a 98% remission rate was reported in patients hospitalized with PP receiving a stepwise sequence of short-term benzodiazepines, antipsychotics, and lithium. Lithium alone was also highlighted as protective against relapse within 1 year.

Lactation considerations and the need for maternal sleep preservation are also key aspects of PP management. There is also an increased risk of mastitis following skipped or infrequent feedings, and mood is often impacted by fatigue, stress, and sleep disruption.

Severe risks associated with postpartum psychosis

Authors highlighted the severe consequences of PP, with suicide being the leading cause of maternal mortality. According to US maternal mortality review committees, these deaths are all preventable, and PP leads to the greatest risk.

Infanticide has also been indicated as an outcome of PP, regardless of other risk factors such as childhood sexual abuse and a family history of violent death. Finally, out-of-home displacement was noted to be nearly as likely in children of mothers with new-onset mental illness postpartum vs those with a long-standing mental illness.

According to authors, this unique prognosis highlights the need for PP to be considered a distinct disorder in the DSM. This can allow PP to be prevented in women with traditional risk factors such as:

  • Prior bipolar disorder with a risk of 17%
  • Prior PP with a risk of 29%

“Due to the risks to self and the infant, the rapid escalation of severity, and its fulminant course, it is imperative that [PP] is recognized, diagnosed, and treated as early as possible,” wrote investigators.

References

  1. Postpartum psychosis: International experts seek to save lives of mothers, babies. University of Virginia Health System. November 3, 2025. Accessed November 7, 2025. https://www.eurekalert.org/news-releases/1104187
  2. Bergink V, Akbarian S, Byatt N, et al. Postpartum psychosis and bipolar disorder: Review of neurobiology and expert consensus statement on classification. Biological Psychiatry. Published online October 22, 2025. doi:10.1016/j.biopsych.2025.10.016

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