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A 32-year-old woman attends the child health clinic six weeks after an uncomplicated birth. For a month she has felt flat throughout the day, has taken no pleasure in the baby, wakes at 4 am even when he is asleep, and tells the nurse she is a useless mother. She describes unwanted images of the baby being harmed that horrify her; she recognises them as her own thoughts, has no wish to act on them, and has asked her partner to do the bathing. She is fully orientated with no delusions or hallucinations. Which one of the following best explains her presentation?
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