The DSM-5 peripartum specifier: prospects and pitfalls

The addition of the "with peripartum onset" specifier for mood episodes in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, and broadening the scope of the specifier to include hypomanic episodes, are welcome changes. However, the peripartum onset specifier, by failing to distinguish between "prepartum" onset and "postpartum" onset, obfuscates important differences in mood episodes that might have distinct etiologies, clinical profiles, and responses to treatment. In addition, restricting the specifier to a period of 4 weeks postpartum potentially excludes many mood episodes that are associated with a postpartum onset. We argue that the specifier should be modified to distinguish between episodes with prepartum and postpartum onset, and that the time frame for the specifier should be increased from 4 weeks to 6 months.