Post-abortion syndrome

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Post-abortion syndrome (PAS), post-traumatic abortion syndrome and abortion trauma syndrome, are terms used to describe a proposed diagnosis of psychopathological characteristics which may be observed in some women following an elective abortion.[1]

In common usage, PAS is often used to describe any negative emotional responses to abortion. As defined by mental health experts who are proponents of the PAS diagnosis, the proper definition is limited only to those traumatic reactions associated with post-traumatic stress disorder (PTSD). These include only symptoms related to intrusion, hyperarousal, avoidance and dissociation, wherein the stressor causing the trauma is either the abortion, the abortion decision, or the circumstances surrounding the decision to abort.

Post-abortion syndrome is not recognized as a subset of PTSD either the American Psychological Association or the American Psychiatric Association. Specifically, it is not included in Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. Prior to 1994, however, the (DSM III-R) did list abortion as a "psychosocial stressor" capable of producing some or all of the symptoms of PTSD. Specifically, in Chapter Two, page 20 of that edition, a psychosocial stressor was described to include a "Physical illness or injury: e.g., illness, accident, surgery, abortion."

The term post-abortion syndrome was first proposed as a variant of PTSD in 1981 by psychotherapist Vincent Rue.[2] PTSD had only been accepted as an official diagnosis by theAmerican Psychiatric Association in the prior year, 1980. As a trauma specialist, Rue believed that many of the women he was treating for post-abortion reactions were experiencing a constellation of symptoms similar to that of many Viet Nam vets under his care.

Rue's proposal was immediately controversial. He was quickly put on notice by the general counsel of the APA that he would be subjected to legal action if any notes he published making reference to abortion induced PTSD did not include a specific disclaimer stating that the APA denies there is "any clinical evidence for the basis of the diagnosis of ‘post-abortion syndrome.'"[3] In 1994, the word abortion was excised from the description of psychosocial stressors included in the APA's diagnostic manual.

Some mental health experts argue that abortion is a benign experience and that PAS is a myth perpetuated by opponents of abortion for purely political purposes.[4]

Contents

[edit] PAS Specific Studies

Currently, there are only three studies have been published looking specifically for PTSD symptoms arising directly from the abortion experience.

The first, involved a followup study of women two years after their abortion and concluded that 1.4 percent of the women had all the symptoms of PTSD and each symptom was attributable to their abortions rather than another cause.[5]

The second PAS specific study surveyed 217 American women who had a history of abortion and queried them about symptoms they attributed to their abortions. Slightly over 14 percent had all the symptoms of PTSD which they attributed to their abortions, and over half reported at least some of the symptoms.[6]

The third study examined ten cases of alleged PAS and reported that the criteria for PTSD were met in all ten.[1] Apart from the PTSD-specific symptoms, other symptoms noted in these studies were "repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the 'need to repair'."[1]

The U.S. Surgeon General, C Everett Koop, conducted a review in 1989 of over 250 studies pertaining to the psychological impact of abortion, but wrote that it was not possible to reach any conclusions, and recommended setting up a five-year longitudinal study, tracking thousands of women, which would cost $100 million.[7] The study was never funded, however, so most studies on psychological reactions to abortion rely on relatively small samples.

[edit] Reactions to abortion which may be part of PAS

The list below is representative of negative reactions to abortion found in some women who have had abortions.[8] Not all of these reactions are specific to traumatic reactions.

Post-abortion syndrome is commonly thought of as a reaction that women may have following an abortion, but some abortion counseling professionals[24] believe that in some cases it may also be experienced by the father, grandparents and siblings.

[edit] Recent research and APA's Response

A longitudinal study of 630 young women in New Zealand,[15] published in 2006, found that women who had an abortion between the ages of 15 and 25 were significantly more likely to develop mental health problems post-abortion, including depression, suicidal behaviors and substance use disorders. This was the case even when accounting for confounding variables, including pre-existing psychological conditions.

Fergusson, a self-described "pro-choice atheist", criticized the American Psychological Association (APA) for publishing reports that he says indicate little or no psychological harm associated with abortion while omitting references to studies which contradicted their official position in favor of abortion.[15] In responding to this charge, Dr. Nancy Russo, who was referred to a Washington Time's reporter by the APA, explained that the APA's official position on abortion developed from the viewpoint that abortion is a civil right. According to the article, Russo states that "pre-existing mental health problems, relationship quality, and whether the pregnancy was wanted or unwanted are key factors determining postabortion mental distress, not the abortion itself".[25] Shortly thereafter, the APA removed its favorable summary of research on abortion that had previously been posted on their web site,[26] but it is still available through web.archive.org.

[edit] Risk factors for post-abortion psychological problems

Some empirical research suggests that some women are more likely than others to develop post-abortion psychological problems.[27] The risk-factors found in some clinical studies include:

  • Low self-efficacy for coping with the abortion[28]
  • Low self-esteem[29]
  • External locus of control[30]
  • Difficulty with the decision to have an abortion[31][32]
  • When there is emotional investment in the pregnancy [33][34]
  • Perceptions of one's partner, family members, or friends as non-supportive[35][36]
  • Timing during adolescence, being unmarried, or poor[37][38][39][40][41]
  • Pre-existing emotional problems or unresolved traumatization[42]
  • A poor or insecure attachment relationship with one's mother or a childhood history of separation from one's mother for a year or more before age 16[43][44][45]
  • Involvement in violent relationships[46][47]
  • Traditional sex-role orientations[48]
  • Conservative views of abortion and/or religious affiliation[49][50][51]
  • When a pregnancy is initially intended[52][53][54][55][56]
  • Abortion during the second trimester[57]
  • When the woman is in an unstable partner relationship[58][59]
  • Being forced into abortion by one's partner, others, or by life circumstances[60]

[edit] References

  1. ^ a b c d Gomez, Lavin C & Zapata, Garcia R. "Diagnostic categorization of post-abortion syndrome", Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.
  2. ^ Vincent Rue, “Abortion and Family Relations,” testimony before the Subcommittee on the Constitution of the US Senate Judiciary Committee, U.S. Senate, 97th Congress, Washington, DC (1981).
  3. ^ Theresa Burke and David C. Reardon.Forbidden Grief: The Unspoken Pain of Abortion. Acorn Books. 2002. See Appendix A.
  4. ^ Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
  5. ^ Pro-Choice Researchers Recognize PAS: Half a Million Women May Suffer From Post-Abortion Syndrome. The Post Abortion Review 8(3), July-Sept. 2000, citing Major, B., Cozzarelli, C., Cooper M.L., Zubek, J., Richards, C., Wilhite, M., Gramzow, R.H. (2000). Psychological responses of women after first-trimester abortion. Arch Gen Psychiatry. 57(8):777-84.
  6. ^ Rue VM, Coleman PK, Rue JJ, Reardon DC. Induced abortion and traumatic stress: A preliminary comparison of American and Russian women. Med Sci Monit, 2004 10(10): SR5-16.
  7. ^ Koop CE. Post abortion syndrome: myth or reality? Health Matrix. 1989 Summer;7(2):42-4. PMID 10294679.
  8. ^ [1]
  9. ^ a b [2]
  10. ^ a b [3]
  11. ^ a b [4]
  12. ^ [5]
  13. ^ a b c [6]
  14. ^ a b c d e [7]
  15. ^ a b c d e f Fergusson, D.M., Horwood, L.J., & Ridden, E.M. (2006. Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47(1), 16-24.
  16. ^ [8]
  17. ^ [9]
  18. ^ [10]
  19. ^ [11]
  20. ^ [12]
  21. ^ a b [13]
  22. ^ a b [14]
  23. ^ a b [15]
  24. ^ [16]
  25. ^ Warren Throckmorton. "Abortion and mental health." Washington Times. January 21, 2005.
  26. ^ American Psychological Association. (2005)"APA Briefing Paper on The Impact of Abortion on Women", retrieved January 15, 2006.
  27. ^ Coleman, P.K., Reardon, D.C., & Strahan, T. (2005). The psychology of abortion: A review and suggestions for future research. Psychology and Health, 20(2), 237-271.
  28. ^ Major, B., Cozzarelli, C., Sciacchitano, A.M., Cooper, M.L., Testa, M., & Mueller, P.M. (1990). Perceived social support, self-efficacy, and adjustment to abortion. Journal of Personality and Social Psychology, 59, 186-197.
  29. ^ Cozzarelli, C., Karrasch, A., Sumer, N., & Major, B. (1994). The meaning and impact of partner's accompaniment on women's adjustment to abortion. Journal of Applied Social Psychology, 24, 2028-2056.
  30. ^ Cozzarelli, C. (1993). Personality and self-efficacy as predictors of coping with abortion. Journal of Personality and Social Psychology, 65, 1224-1236.
  31. ^ Bracken, M.B. (1978). A causal model of psychosomatic reactions to vacuum aspiration abortion. Social Psychiatry, 13, 135-145.
  32. ^ Osofsky, J.D., & Osofsky, H.J. (1972). The psychological reaction of patients to legalized abortion. American Journal of Orthopsychiatry, 42, 48-60.
  33. ^ Lyndon, J., Dunkel-Schetter, C., Cohan, C.L., & Pierce, T. (1996). Pregnancy decision making as a significant life event: A commitment approach. Journal of Personality and Social Psychology, 71, 141-151.
  34. ^ Remennick, L.I., & Segal, R. (2001). Sociocultural context and women's experiences of abortion: Israeli women and Russian immigrants compared. Culture, Health, and Sexuality, 3, 49-66.
  35. ^ Major et al. (1990).
  36. ^ Major, B., & Cozzarelli, C. (1992). Psychological predictors of adjustment to abortion. Journal of Social Issues, 48, 121-142.
  37. ^ Adler, N.E. (1975). Emotional responses of women following therapeutic abortion: How great a problem? Journal of Applied Social Psychology, 6, 240-259.
  38. ^ Bracken, M.B., Hachamovitch, M., & Grossman, G. (1974). The decision to abort and psychological sequelae. Journal of Nervous and Mental Disease, 158, 155-161.
  39. ^ Campbell, N., Franco, K., & Jurs, S. (1988). Abortion in adolescence. Adolescence, 23, 813-823.
  40. ^ Franz, W., & Reardon, D. (1992). Differential impact of abortion on adolescents and adults. Adolescence, 27, 161-172.
  41. ^ Osofsky & Osofsky (1972)
  42. ^ Speckhard, A., & Rue, V. (1992). Postabortion syndrome: An emerging public health concern. Journal of Social Issues, 48, 95-119.
  43. ^ Cozzarelli, C., Sumer, N., & Major, B. (1998). Mental models of attachment and coping with abortion. Journal of Personality and Social Psychology, 74, 453-467.
  44. ^ Kitamura, T., Toda, M.A., Shima, S., & Sugawara, M. (1998). Single and repeated elective abortions in Japan: A psychosocial study. Psychosomatic Obstetrics and Gynecology, 19, 126-134.
  45. ^ Payne, E., Kravitz, A., Notman, M., & Anderson, J. (1976). Outcome following therapeutic abortion. Archives of General Psychiatry, 33, 725-733.
  46. ^ Allanson, S., & Astbury, J. (2001). Attachment style and broken attachments: Violence, pregnancy, and abortion. Australian Journal of Psychology, 53, 146-151.
  47. ^ Russo, N., & Denious, J.E. (2001). Violence in the lives of women having abortions: Implications for policy and practice. Professional Psychology Research and Practice, 32, 142-150.
  48. ^ Gold, D., Berger, C., & Andres, D. (1979). The abortion choice: Psychological determinants and consequences. Concordia University, Department of Psychology, Montreal.
  49. ^ Bogen, I. (1974). Attitudes of women who have had abortions. Journal of Sex Research, 10, 97-109.
  50. ^ Osofsky & Osofsky (1972)
  51. ^ Soderberg, H., Janzon, L., & Slosberg, N.-O. (1998). Emotional distress following induced abortion: A study of its incidence and determinants among adoptees in Malmo, Sweden. European Journal of Obstetrics, Gynecology, and Reproductive Biology, 79, 173-178.
  52. ^ Ashton, J. (1980). The psychosocial outcome of induced abortion. British Journal of Obstetrics and Gynecology, 87, 1115-1122.
  53. ^ Friedman, C., Greenspan, R., & Mittleman, F. (1974). The decision-making process and the outcome of therapeutic abortion. American Journal of Psychiatry, 131, 1332-1337.
  54. ^ Lazarus, A. (1985). Psychiatric sequelae of legalized first trimester abortion. Journal of Psychosomatic Obstetrics and Gynecology, 4, 141-150.
  55. ^ Major, B., Mueller, P., & Hildebrandt, K. (1985). Attributions, expectations, and coping with abortion. Journal of Personality and Social Psychology, 48, 585-599.
  56. ^ Miller, W.B. (1992). An empirical study of the psychological antecedents and consequenes of induced abortion. Journal of Social Issues, 48, 67-93.
  57. ^ Anthanasiou, R., Oppel, W., Michelson, L., Unger, T., & Yager, M. (1973). Psychiatric sequelae to term birth and induced early and late abortion: A longitudinal study. Family Planning Perspectives, 5, 227-231.
  58. ^ Llewellyn, S.P., & Pytches, R. (1988). An investigation of anxiety following termination of pregnancy. Journal of Advanced Nursing, 51, 468-471.
  59. ^ Soderberg, H., Andersson, C., Janzon, L., & Slosberg, N.-O. (1997). Continued pregnancy among abortion applicants. A study of women having a change of mind. Act Obstetrica Gynecologica Scandinavia, 76, 942-947.
  60. ^ Friedman, et. al (1974)

[edit] External links

Articles from non-aligned sites

Articles from pro-choice sites

Articles from pro-life sites

Post-abortion support sites & organizations

  • Backline toll free, national talk line to women and men wanting to discuss feelings both before and after abortion.
  • Abortion Conversation Project handouts and training materials on Healthy Coping After an Abortion.
  • Exhale: U.S. post-abortion counselling hotline.
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