First, postpartum depression came out of the shadows. Now, it’s postpartum anxiety’s turn. The American Pregnancy Association has estimated approximately 10 percent of new mothers are estimated to develop postpartum anxiety, but other studies say the number may be even higher — perhaps even three to four times more common than postpartum depression.

What Does Postpartum Anxiety Feel Like?

Concern about the new life you are now responsible for is normal, but postpartum anxiety is a different animal. It’s characterized by intense and persistent worry and it gets in the way of your life.

“You constantly feel worried and on edge,” Sarah Gottfried, M.D., author of The Hormone Cure explained. “I think of postpartum anxiety as the loss of the normal sense of balance and calm, and postpartum depression as a loss of heart.”

So how do you know if your anxiety is normal and healthy for a new mom, and when it’s out of whack?

“It has to do with the amount of anxiety, the intensity of it, and how distressed they are by it — that’s what defines a disorder versus normal anxious feelings,” Catherine Birndorf, clinical associate professor of psychiatry and obstetrics/gynecology, and the founding director of the Payne Whitney Women’s Program at the New York-Presbyterian Hospital told Goop. “It becomes a problem when it’s interfering with their life and causing them a great deal of distress.”

Birndorf uses an easy diagnostic tool to gauge the anxiety levels of new moms. She asks if they’re able to sleep or rest when the baby is asleep or safely in someone else’s hands.

“When a mother answers that she can’t relax because she’s watching the baby, worrying about the baby, or generally too amped even when the baby is totally safe, then I know the line has probably been crossed and it’s interfering with her life.”

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Symptoms of Postpartum Anxiety

For the majority of women, symptoms kick in between the baby’s birth and first birthday. For some, the anxiety kicks in even earlier. “Twenty-five to 35 percent of postpartum anxiety cases begin during pregnancy,” says Ann Smith, CNM and President of Postpartum Support International.

Postpartum anxiety has physical as well as psychological symptoms. Some of the psychological symptoms include racing thoughts that you can’t control; an impending fear that something bad is going to happen, constant worry, and trouble focusing. Physical symptoms include changes in eating and sleeping, a racing heart rate, dizziness, hot flashes, and nausea. You may also feel restless, unable to sit still or focus.

Michael Silverman, PhD, a psychologist and assistant professor at the Icahn School of Medicine at Mount Sinai in New York City, told The Bump that postpartum anxiety tends to manifest in two different forms: fear of “contaminating” your baby (worrying that he’s going to eat something he shouldn’t), and fear of accidentally causing harm to your child (like dropping your baby or rolling over him in the night).

Why Does Postpartum Anxiety Happen?

There’s a variety of causes for postpartum anxiety, but consider first biological factors of pregnancy and birth.

“There’s a huge hormonal shift,” Elizabeth Fitelson, M.D., director of the Women’s Program at the Columbia University Department of Psychiatry told Parents. “Estrogen and progesterone levels increase 10- to 100-fold during pregnancy, then fall to essentially zero within 24 hours of delivery.”

Levels of oxytocin rise during pregnancy. The hormone promotes bonding, and triggers heightened levels of activity in the areas of the brain associated with empathy, but also with anxiety. Neurologically, those changes can continue to affect the brain long after the postpartum period has passed, according to a study in Nature Neuroscience.

You may be particularly at risk for postpartum anxiety if you have a personal experience with — or family history of — anxiety or depression. If you tend to get especially weepy or irritated during PMS, have had an eating disorder, or obsessive-compulsive disorder, you’re especially vulnerable to postpartum anxiety.

If you’ve had a healthy delivery following a previous miscarriage or stillbirth, you’re also more susceptible to postpartum anxiety. This is due to an increasing worry that something else might go wrong, according to a study done by the University of Rochester Medical Center.

Personality might also play a part; moms who identify as Type A, are sensitive, or frequently worry are more likely to develop postpartum anxiety.

Treatment of Postpartum Anxiety

Like other forms of anxiety, postpartum anxiety can be treated in the form of psychotherapy, medication, or through several natural and alternative modalities, including meditation and mindfulness. Should you pursue medication, be sure to talk to a knowledgeable health care provider — such as a reproductive psychiatrist — who can advise about what medication will be best during this time.

It can be hard to admit you’re struggling during the time that most think is the happiest of your life, but know that you’re not alone. Postpartum anxiety is common and treatment is readily available and effective.