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Prim Care Companion CNS Disord. 2018 Sep 27;20(5). pii: 18m02322. doi: 10.4088/PCC.18m02322.

Examining Symptom Clusters of Childbirth-Related Posttraumatic Stress Disorder.

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Department of Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA.
University of Groningen, Grote Kruisstraat 2/1, Groningen, Netherlands.
Interdisciplinary Center (IDC), Herzliya, Israel.
Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Charlestown Navy Yard, 120 2nd Ave, Charlestown, MA 02129.
Harvard Medical School, Harvard University, Boston, Massachusetts, USA.



Recent studies document posttraumatic stress disorder (PTSD) symptoms in women following at-term deliveries with health baby outcomes. However, the notion that childbirth can trigger PTSD remains controversial, and the symptom clusters are mostly unknown. The objective of this study was to examine the clustering of childbirth-induced postpartum PTSD (PP-PTSD) symptoms in comparison to DSM-5 clusters.


We examined the symptom presentation of childbirth-related postpartum PTSD (PP-PTSD) in a sample of 685 women. The majority of these women delivered at term. Peritraumatic stress reactions to childbirth and PP-PTSD symptoms were assessed approximately 3 months after delivery. A hierarchical cluster analysis was used to detect grouping of the PP-PTSD symptoms.


Childbirth-related peritraumatic stress was strongly and positively associated with PP-PTSD symptom severity. Cluster modeling revealed 4 distinguished symptom groups: reliving (some reexperiencing symptoms), namely nightmares and flashbacks; avoidance coupled with unwanted memories (other reexperiencing symptoms); negative cognitions and mood; and hyperarousal reactivity.


Our findings show that the representation of symptoms of PTSD that develops following a stressogenic childbirth experience appears, for the most part, to resemble DSM-5 symptom clusters. More research integrating descriptive symptom assessment with biological measures is warranted to better characterize the symptom presentation of this neglected posttraumatic stress syndrome.

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