Post-abortion syndrome

Post-abortion syndrome (PAS), also known as post-traumatic abortion syndrome and abortion trauma syndrome, is a term used to describe a set of psychopathological characteristics that have been observed in women following an elective abortion. Gomez, Lavin C & Zapata, Garcia R. "Diagnostic categorization of post-abortion syndrome", Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72. There is no agreement within the medical community as to whether these characteristics constitute a separate nosological category. Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747. PAS is not included in the DSM-IV-TR or ICD-10 list of psychiatric conditions.

Although no formal definition exists, PAS is characterized as being similar to post-traumatic stress disorder (PTSD). The term "abortion trauma syndrome" has been used by abortion opponents to imply that connection. A 2005 study showed that the criteria for PTSD were met in all ten cases of alleged PAS that were looked at. Apart from the PTSD-specific symptoms, other symptoms noted were "repeated and persistent dreams and nightmares related with the abortion, intense feelings of guilt and the 'need to repair'."

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, $100 million study. Koop CE. Post abortion syndrome: myth or reality? Health Matrix. 1989 Summer;7(2):42-4. PMID 10294679. __TOC__

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According to a 2005 report of the American Psychological Association (APA), prior research indicated that adverse emotional reactions to the procedure are most strongly influenced by pre-existing psychological conditions and other negative factors. American Psychological Association. (2005). "APA Briefing Paper on The Impact of Abortion on Women", retrieved January 15, 2006.

A recent longitudinal study of 630 young women in New Zealand 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. found results that conflict with the conclusions of the 2005 APA report. 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.

Empirical research suggests that some women are more likely than others to develop post-abortion psychological problems. 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. The risk-factors include:

low self-efficacy for coping with the abortion 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.
low self-esteem 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.
external locus of control Cozzarelli, C. (1993). Personality and self-efficacy as predictors of coping with abortion. Journal of Personality and Social Psychology, 65, 1224-1236.
difficulty with the decision Bracken, M.B. (1978). A causal model of psychosomatic reactions to vacuum aspiration abortion. Social Psychiatry, 13, 135-145.Osofsky, J.D., & Osofsky, H.J. (1972). The psychological reaction of patients to legalized abortion. American Journal of Orthopsychiatry, 42, 48-60.
when there is emotional investment in the pregnancy 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.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.
perceptions of one's partner, family members, or friends as non-supportive Major et al. (1990).Major, B., & Cozzarelli, C. (1992). Psychological predictors of adjustment to abortion. Journal of Social Issues, 48, 121-142.
timing during adolescence, being unmarried, or poor Adler, N.E. (1975). Emotional responses of women following therapeutic abortion: How great a problem? Journal of Applied Social Psychology, 6, 240-259.Bracken, M.B., Hachamovitch, M., & Grossman, G. (1974). The decision to abort and psychological sequelae. Journal of Nervous and Mental Disease, 158, 155-161.Campbell, N., Franco, K., & Jurs, S. (1988). Abortion in adolescence. Adolescence, 23, 813-823.Franz, W., & Reardon, D. (1992). Differential impact of abortion on adolescents and adults. Adolescence, 27, 161-172.Osofsky & Osofsky (1972)
pre-existing emotional problems or unresolved traumatization Speckhard, A., & Rue, V. (1992). Postabortion syndrome: An emerging public health concern. Journal of Social Issues, 48, 95-119.
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 Cozzarelli, C., Sumer, N., & Major, B. (1998). Mental models of attachment and coping with abortion. Journal of Personality and Social Psychology, 74, 453-467.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.Payne, E., Kravitz, A., Notman, M., & Anderson, J. (1976). Outcome following therapeutic abortion. Archives of General Psychiatry, 33, 725-733.
involvement in violent relationships Allanson, S., & Astbury, J. (2001). Attachment style and broken attachments: Violence, pregnancy, and abortion. Australian Journal of Psychology, 53, 146-151.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.
traditional sex-role orientations Gold, D., Berger, C., & Andres, D. (1979). The abortion choice: Psychological determinants and consequences. Concordia University, Department of Psychology, Montreal.
conservative views of abortion and/or religious affiliation Bogen, I. (1974). Attitudes of women who have had abortions. Journal of Sex Research, 10, 97-109.Osofsky & Osofsky (1972)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.
when a pregnancy is initially intended Ashton, J. (1980). The psychosocial outcome of induced abortion. British Journal of Obstetrics and Gynecology, 87, 1115-1122.Friedman, C., Greenspan, R., & Mittleman, F. (1974). The decision-making process and the outcome of therapeutic abortion. American Journal of Psychiatry, 131, 1332-1337.Lazarus, A. (1985). Psychiatric sequelae of legalized first trimester abortion. Journal of Psychosomatic Obstetrics and Gynecology, 4, 141-150.Major, B., Mueller, P., & Hildebrandt, K. (1985). Attributions, expectations, and coping with abortion. Journal of Personality and Social Psychology, 48, 585-599.Miller, W.B. (1992). An empirical study of the psychological antecedents and consequenes of induced abortion. Journal of Social Issues, 48, 67-93.
abortion during the second trimester 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.
when woman is in an unstable partner relationship Llewellyn, S.P., & Pytches, R. (1988). An investigation of anxiety following termination of pregnancy. Journal of Advanced Nursing, 51, 468-471.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.
being forced into abortion by one's partner, others, or by life circumstances Friedman, et. al (1974)

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