Induced abortion is one of the most current problems in social and healthcare sector, it is known as well as deliberate, elective or voluntary abortion. It is a complex issue that adds to its strictly medical side, some other of legal nature, moral, sociological, religious and demographic issues.
Despite the facts that only a few medical issues have such strong social, political and cultural implications as abortion has, there are some difficulties in order to assess properly their psycho-medical and psychopathological effects, among other things, because performing statistical elaboration of data is not simple. (There are barely any systematic medical evaluations of patients after abortion). And because, generally, women who carried out an abortion are not usually favourable to continue interacting with the doctor who has performed the abortion or they do not even want to talk about it. However, after years of underestimating or even denying the psychopathological effects of abortion, the scientific society, in view of the evidence of a variety of disorders, now begins to admit the existence of sequelae after voluntary abortions.
In the present is accepted by the scientific society in general, and personally, I can say after 30 years working as a psychiatrist with this type of patients, that every woman who aborts, even in abortions due to natural causes, is usually more or less profoundly affected. It is a natural response of defense in the face of this stressful event: an anxiety reaction and depression that usually is accompanied by a sense of guilt and the corresponding grieving process. Of course, all of these (feelings of guilt and the grieving process) will be modulated by cultural influences, by personality characteristics and by the previous issues of the person.
It is a Post Traumatic Stress Disorder (PTSD). The symptoms suffered by these women meet diagnostic criteria of the DSM-IV and ICD-10 (International Classifications of Mental Illnesses). In the case of Post Abortion Syndrome (SPA), mandatory sections such as depression, anxiety, and guilt are met. In addition with this, another series of symptoms frequently appear, such as behaviour conduct modifications; drug and alcohol abuse; suicide attempts that according to Rue have 4 times more frequency than in other alterations by post-traumatic stress etc.
All this implies a personal, family and social life deterioration.
As well, among the frequent symptoms in patients with SPA, not mentioned (or less significant) by PTSD, emphasizing their diagnostic and therapeutic importance, the reiterated and persistent dreams and the nightmares related to abortion, the intense feelings of guilt and the “need to repair” that is present in practically all the patients of the study, along with depression and/or anxiety are considered as key point symptoms of this disorder. All of them are, in our opinion, an expression of the special characteristics of abortion, as a traumatic event, which adds to the woman in a psychological conflict difficult to cope with: to be the responsible agent for the traumatic event of which she becomes to be the victim.
On the other hand, dreams and nightmares, in addition of expressing the intensity of the conflict that patients are dealing with, in many cases, the symptom that makes to think, during the anamnesis, of the existence of a possible traumatic antecedent of induced abortion; antecedent that, at the same time, helps to frame the picture (considered unspecific until then) as a SPA.
Definitively, it can take us to reach the conclusion that the post-abortion syndrome is a post-traumatic stress disorder, although, with certain specific symptoms that are very relevant to the patient’s existential understanding and the psychotherapeutic intervention, it would be very useful to provide definitely to the SPA with a categorical entity of PTSD through its inclusion in international classifications.
Dr. Carmen Gómez Lavin
Emerito Spanish Foundation of Psychiatry and Mental Health