Pregnancy and Depression, OCD, Anxiety

Reader’s Question

Last May 2007, I suffered a miscarriage at 5 weeks. I suffered severe anxiety attacks, waking up in a panic often with heart palpitations, which lasted about 2-3 months. Since that time, I fell into a pattern that something was wrong with me, constantly seeking health problems, specifically OB/GYN related. This has escalated into feelings of being attacked (previous rape experience), not realizing if I had a dream or actually drove and attacked someone or someone attacked me (always sexual). This then leads to obsessional thinking and checking and re-checking that everything is OK with me and my family. Recently, my symptoms seemed to decrease, but if stress bubbles up, they come back.

For example, my 1st anniversary of my miscarriage is coming up. Last Saturday I kept thinking something bad was going to happen before I went to bed. I awoke the next morning, and later in the day thought I remembered leaving the house that night and being attacked/having sex. Was it a dream or reality, and on and on it goes. I keep trying to piece events together or flashes of information in my mind, and nothing ever pieces together, like a puzzle that I can’t solve. Which leads to more checking and uncertainty. Any advice? Is it OCD, anxiety, DID? I feel like I’m not in control. I am 14 weeks pregnant now, so I thought this would disappear.

Our Consulting Clinical Psychologist’s Reply

You are describing the symptoms of a depressive disorder following the miscarriage. Depression is thought to be related to low levels of the neurotransmitter Serotonin. Low Serotonin is also linked to obsessive-compulsive behavior. Depression also has a symptom of searching our memory background to find our worst experiences, then bringing those memories to the surface to torment us (sexual assault trauma in your case). To add to the situation, the brain works on Emotional Memory — the memory mechanism that memorizes both the details and the feeling at the time of the traumatic experience.

Here’s the theory (psychologists have a lot of them!). Following your miscarriage you experienced an anxiety and depressive reaction (very common, by the way). The low levels of Serotonin in your depression prompted obsessive-compulsive behaviors to surface — thus the checking and physical preoccupation. The depression also found your history of sexual trauma and brought that to the surface, combining those emotional memories with your obsessive-compulsive behaviors to give you the sense that you may be experiencing sexual trauma again. In OCD behaviors, we are left with the sense that we “don’t know for sure” if there’s been an assault, if we locked the door, if we…etc.

Your symptoms have increased and decreased with your stress level over the past year, something which is also very common. As you now approach the anniversary of the miscarriage, your brain pulls the Emotional Memory of the event — significantly increasing your symptoms and your distress.

In summary, you’re dealing with a depressive disorder that includes components of OCD behaviors and trauma memory. This is not uncommon in clinical practice. I’d recommend:

• Read my article on Chemical Imbalance on my website at www.drjoecarver.com. It will describe how neurotransmitters levels produce specific symptoms.
• Review the article on Emotional Memory. With your history of trauma (sexual assault and miscarriage), you will be dealing with Emotional Memories frequently.
• You may be able to manage your symptoms with a combination of education, understanding the process, and counseling.
• If your symptoms increase (expect an increase around the anniversary) or become unmanageable, consult your OB physician. We have some antidepressant medications that are safe during pregnancy.
• Be alert for depressive and OCD symptoms in the future. Once we become depressed, we are able to identify which memories the depressed brain will use against us. It sounds weird, but those same memories become a warning light in the future. When they resurface, it’s a sign that we are becoming stressed and need to address our situation.
• Recognize that your situation is not uncommon. The symptoms are pretty unusual for you, but not from a clinical perspective.
• As I mention in my Emotional Memory article, the intensity of your reaction and your interpretation of your symptoms will either increase or decrease them. Try to reinterpret your symptoms, viewing the majority of them light-heartedly and as “an adventure in pregnancy”. If you allow the symptoms to pass through, they will decrease.

You are involved in a difficult yet wonderful passage in your life. Your pregnancy has activated many old memories and emotional issues…as pregnancy typically does. On the other side of this passage is your new child. Focus on the arrival of your child and develop a strategy to deal with these additional symptoms just as you tolerate backache, swollen ankles, protruding belly button, food aversions, splotchy skin, and even a dark line from your navel to your lower pelvis. The bottom line…it’s worth it.