# 225 - 6E20 Mental and behavioural disorders associa

# 6E20 Mental and behavioural disorders associated with pregnancy, childbirth or the ...

Clinical Descriptions and Diagnostic Requirements for ICD-11 Mental, Behavioural or Neurodevelopmental Disorders
Mental and behavioural disorders associated with pregnancy, 
childbirth or the puerperium, without psychotic symptoms
Essential (required) features
• Onset of a syndrome involving significant mental and behavioural features occurring 
during pregnancy or the puerperium (i.e. up to about 6 weeks following delivery) is 
required for diagnosis.
• The syndrome does not include delusions, hallucinations or other psychotic symptoms.
• The symptoms are not a manifestation of another medical condition (e.g. a brain tumour), 
and are not due to the effects of a substance or medication on the central nervous system 
(e.g. benzodiazepines), including withdrawal effects (e.g. from stimulants).
• The disturbance results in significant impairment in personal, family, social, educational, 
occupational or other important areas of functioning. If functioning is maintained, it is 
only through significant additional effort.
Note: if the symptoms meet the diagnostic requirements for a specific mental disorder (e.g. a 
mood disorder, an anxiety or fear-related disorder, obsessive-compulsive disorder, adjustment 
disorder), that diagnosis should also be assigned. If the symptoms do not meet the diagnostic 
requirements for a specific mental disorder, the presentation can be described using codes from 
the section on mental or behavioural symptoms, signs or clinical findings (p. 677).
Additional clinical features
• This diagnosis may be assigned regardless of whether biological factors related pregnancy, 
childbirth or the puerperium are known to be etiologically related to the syndrome.
• Common presentations of mental and behavioural disorders associated with pregnancy, 
childbirth or the puerperium, without psychotic symptoms, include the following.
Depressive symptoms
These may include depressed mood, excessive crying; difficulty bonding with the baby; 
withdrawing from family and friends; loss of appetite or eating much more than usual; inability to 
sleep (insomnia) or sleeping too much; overwhelming fatigue or loss of energy; reduced interest 
and pleasure in usually enjoyable activities, intense irritability and anger; fears of not being a good 
mother, feelings of worthlessness, shame, guilt or inadequacy; diminished ability to think clearly, 
concentrate or make decisions; thoughts of harming oneself or the baby.
Anxiety symptoms
These may include excessive worry, general apprehensiveness not restricted to any particular 
environmental stimulus, phobic responses (e.g. related to dirt or germs) and panic attacks.
Mental and behavioural disorders associated with pregnancy, childbirth or the puerperium
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Mental and behavioural disorders associated with pregnancy, childbirth or the puerperium
Obsessions and compulsions
Obsessions are repetitive and persistent thoughts, images or impulses/urges that are experienced 
as intrusive and unwanted, and are commonly associated with anxiety. Compulsions are repetitive 
behaviours or rituals, including repetitive mental acts, that the individual feels driven to perform 
in response to an obsession. Obsessions and compulsions typically focus on the newborn or 
unborn infant (e.g. obsessions about the baby getting hurt, contaminated or lost; compulsive 
rituals involving checking, mental rituals and seeking reassurance). Unwanted sexual obsessions 
may also be present. There may also be excessive avoidance, such as avoiding bathing or holding 
the baby, in response to the obsessions.
Boundary with normality (threshold)
• This diagnosis should not be used to describe mild and transient depressive symptoms that 
do not meet the diagnostic requirements for a depressive episode, which may occur soon 
after delivery (so-called “postpartum blues” or “baby blues”).
• Postpartum depression may be mistaken for baby blues at first, but the signs and symptoms 
are more intense, last longer, and interfere with functioning, including the ability to care 
for the baby. If the diagnostic requirements are met for a depressive episode, a diagnosis of 
single episode depressive disorder or recurrent depressive disorder should also be assigned.
• Worries and fears about the baby during pregnancy and after childbirth and some degree 
of intrusive thoughts about possible harms are common, and should not be diagnosed 
as mental and behavioural disorders associated with pregnancy, childbirth or the 
puerperium unless they are persistent, associated with substantial distress, and interfere 
with functioning, including the ability to care for the baby.
Boundaries with other disorders and conditions (differential diagnosis)
• This diagnosis may be assigned even if the syndrome represents a recurrence or exacerbation 
of a pre-existing disorder (e.g. a mood disorder).
Mental and behavioural disorders associated with pregnancy, childbirth or the puerperium