The perinatal period is a time of particularly high risk for several psychiatric disorders. Most of the attention has been directed towards postpartum mood disorders with less attention being given to anxiety disorders. This keynote address focuses on anxiety in pregnancy and in the postpartum period. Panic disorder and obsessive-compulsive disorder during pregnancy are discussed with emphasis on the effect of pregnancy on the course of these pre-existing anxiety disorders. Postpartum anxiety disorders that are addressed in this keynote include postpartum panic disorder, postpartum obsessive-compulsive disorder, and post traumatic stress syndrome after childbirth. Results of a qualitative study on postpartum onset of panic disorder are described. In this study six women who had experienced their initial onset of panic disorder during the postpartum period were interviewed. The following six themes emerged which described the essence of their experiences:

The terrifying physical and emotional components of panic paralyzed women, leaving them feeling totally out of control.

During panic attacks, women's cognitive functioning abruptly diminished while between these attacks women experienced a more insidious decrease in their cognitive functioning.

During the panic attacks, women feverishly struggled to maintain their composure, leading to exhaustion.

Because of the terrifying nature of panic, preventing further panic attacks was paramount in the lives of the women.

As a result of recurring panic attacks, negative changes in women's lifestyles ensued-lowering their self-esteem and leaving them to bear the burden of disappointing not only themselves but also their families.

Mothers were haunted by the prospect that their panic could have residual effects on themselves and their families.

Implications for clinical practice with mothers suffering from postpartum panic disorder can be derived from each theme.