An international consortium of leading experts in women’s mental health has issued a pioneering consensus statement advocating for the formal recognition of postpartum psychosis as a distinct psychiatric diagnosis. This recommendation challenges the current frameworks used in psychiatric classification, urging revisions within both the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD) to include postpartum psychosis as a unique category, distinct from existing mood and psychotic disorders.
Postpartum psychosis is characterized by an abrupt onset of severe psychiatric symptoms occurring within weeks of childbirth. This condition manifests through a spectrum of affective and psychotic symptoms including mania, depressive episodes with psychosis, hallucinations, delusions, and disorganized cognitive processes. Its clinical presentation often involves profound disruptions in mood, cognition, and behavior, resulting in a psychiatric emergency that commonly necessitates inpatient psychiatric care due to acute risks including suicide and, in some cases, infanticide. Timely diagnosis and management drastically improve outcomes, allowing many women to regain their pre-illness level of function.
Despite clinical distinctiveness and severity, postpartum psychosis currently lacks a standalone diagnostic classification in DSM-5 and ICD codes, typically being subsumed under broader mood or psychotic disorder categories armed only with a specifier “with peripartum onset.” The expert panel argues that this imprecise classification hampers both clinical recognition and treatment efficacy, ultimately contributing to elevated morbidity and mortality. They propose that postpartum psychosis deserves a classification within the bipolar disorder chapter, reflecting its overlapping yet unique neurobiological and clinical features.
The scientific rationale for treating postpartum psychosis as a discrete entity rests on compelling neurobiological and epidemiological evidence. The postpartum period encompasses profound physiological changes in the brain’s endocrine, immune, and neuroanatomical systems, providing a biological substrate that predisposes to this illness. Genetic analyses indicate a distinctive risk architecture for postpartum psychosis that partially overlaps with bipolar disorder but remains genetically distinguishable, underscoring the syndrome’s unique etiological underpinnings.
Clinically, the phenomenology of postpartum psychosis aligns strongly with affective symptoms typical of bipolar disorder—mania, mixed mood states, and psychotic depression. Moreover, treatment responses align with bipolar disorder protocols; lithium and electroconvulsive therapy (ECT) have demonstrated substantial efficacy. Follow-up longitudinal studies reveal that women who experience postpartum psychosis face approximately a 50% risk of subsequent bipolar disorder development, while the risk of schizophrenia does not appear elevated, further reinforcing the nosological linkage to bipolar spectrum disorders rather than primary psychotic disorders.
This consensus reflects a collaborative effort among clinicians, researchers, and patient advocacy groups aimed at enhancing early detection and evidence-based interventions. The urgency is driven by the rapid clinical deterioration characteristic of postpartum psychosis and the attendant risks to maternal and infant health. The panel’s diagnostic criteria emphasize symptom onset within 12 weeks postpartum, persistence or severe intensity of psychotic or manic symptoms, notable changes in functioning uncharacteristic of the typical postpartum period, observable disturbances by others, and significant impairment necessitating hospitalization or intensive care.
The need for a dedicated diagnostic category stems from the failure of existing classifications to adequately capture the onset timing and symptom constellation. The current “peripartum onset” specifier is deemed insufficient, as it neither fully reflects the timing specificity nor the distinct clinical trajectory of postpartum psychosis. The proposed classification framework will enable clinicians to apply precise diagnostic labels, facilitate targeted treatment pathways, and improve healthcare systems’ coding and billing infrastructures to better serve affected women.
Mount Sinai’s Women’s Mental Health Center, led by Dr. Veerle Bergink, spearheaded this initiative, with longstanding efforts engaging the American Psychiatric Association and DSM steering committees since 2020. The collaboration underscores a commitment to reduce tragic outcomes historically linked to postpartum psychosis, such as maternal suicide and infanticide, through improved diagnostic clarity and intervention strategies. The panel highlights that advancing neurobiological research in conjunction with clinical expertise is essential to fully understand the pathophysiology and optimize therapeutic approaches.
Beyond immediate clinical implications, this reclassification holds broad public health significance. Postpartum psychosis affects 1-2 per 1000 childbirths—far rarer than postpartum depression, yet far more severe. Recognition as a discrete disorder enhances awareness, reduces stigma, and promotes allocation of research funding for specialized treatment modalities and prevention strategies. In doing so, it aligns psychiatric nosology with the clinical realities faced by women and healthcare providers during the vulnerable postpartum period.
By integrating postpartum psychosis into the bipolar disorder spectrum, psychiatric practice acknowledges the condition’s unique neurobiological identity while leveraging existing bipolar disorder management frameworks. It also opens avenues for personalized medicine approaches informed by genetic, hormonal, and neuroimaging data collected during this critical window of brain plasticity. These advances promise to revolutionize care and improve prognosis for countless women worldwide.
Ultimately, redefining postpartum psychosis as a distinct diagnostic entity represents a paradigm shift in psychiatry—one that honors the complex interplay of biological, psychological, and social factors in maternal mental health. The expert consensus delivers a scientifically grounded and clinically pragmatic blueprint to transform diagnostic systems, catalyze research innovation, and save lives by ensuring mothers receive timely, appropriate, and effective psychiatric care.
Subject of Research: People
Article Title: Postpartum Psychosis and Bipolar Disorder: Review of Neurobiology and Expert Consensus Statement on classification
News Publication Date: 22-Oct-2025
Web References:
https://www.mountsinai.org
https://www.biologicalpsychiatryjournal.com/article/S0006-3223(25)01536-7/fulltext
References:
DOI: 10.1016/j.biopsych.2025.10.016
Image Credits: Mount Sinai Health System
Keywords: Psychiatric disorders, Pregnancy, Bipolar disorder, Depression, Psychosis
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