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Post-abortion syndrome (PAS), post-traumatic abortion syndrome and abortion trauma syndrome, are terms used by opponents of abortion to describe a proposed diagnosis of psychopathological characteristics which are proposed to occur in some women following a induced abortion.

PAS is not a medically recognized syndrome. The American Psychological Association and the American Psychiatric Association do not recognize PAS. PAS is not included in Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR or ICD-10 list of psychiatric conditions. It has been argued that PAS is a myth created by opponents of abortion for political purposes.

Academic research

A number of studies have examined the relationship between abortion and depression or other negative psychological symptoms. While several studies have found an statistical association between abortion and depression, no academic study to date has established a causal relationship.

Neutral and positive effects of abortion

Some studies have indicated that women who have undergone abortion have experienced positive or no change to their mental health and well-being. A 1989 study of teenagers who sought pregnancy tests found that counting from the beginning of pregnancy until two years later, the level of stress and anxiety of those who had an abortion did not differ from that of those who had not been pregnant or who had carried their pregnancy to term. Another study in 1992 found that having one abortion was positively associated with higher global self-esteem, particularly feelings of self-worth, capableness, and not feeling one is a failure. It also noted that adverse emotional reactions to the abortion are influenced by pre-existing psychological conditions and other negative factors and, furthermore, that women's well-being was separately and positively related to employment, income, and education, but negatively related to total number of children. Abortion, as compared to completion, of an undesired first pregnancy was not found to directly pose the risk of significant depression in a 2005 study.

Studies on abortion and depression or stress

In 1989, the American Psychological Association (APA) convened a panel of psychologists with extensive experience in this field to review the data available to determine the existence of "post-abortion syndrome". The panel concluded that "research with diverse samples, different measures of response, and different times of assessment have come to similar conclusions. The time of greatest distress is likely to be before the abortion. Severe negative reactions after abortions are rare and can best be understood in the framework of coping with normal life stress."

Denmark

A study conducted at University of Copenhagen has shown legal abortion is associated with few adverse effects on sexual function among women in Denmark. The study was conducted among 941 women who chose elective abortion. Among the many statistics of note, the authors wrote, "Diminished libido was experienced by 15.3% at 8 weeks follow-up, and 6.0% experienced diminished orgasm ability (self-rated changes). Libido was unchanged in 72.4% of the women, 69.7% had no change in orgasm ability and 3.3% had never experienced orgasm." The study concluded that "Overall, 51.0% of the women recommenced coitus within 2 weeks after TOP (Termination of Pregnancy). This figure was significantly higher among women aged 18–24 years (60.6%) than among women in higher age groups (41.7–47.8%)."

Finland

A Finnish study has shown a correlation between miscarriage (or spontaneous abortion) with depression and suicide, as well as between medically induced abortion with depression and suicide among women in Finland. The study found that among 8,980 women, "In total, 30 suicides were committed after women gave birth (42% ), 29 after an abortion (40%), and 14 after a miscarriage (19%), of which two were after an extrauterine pregnancy." The study was unable to establish a causal link between abortion and suicide because it was not clear if abortion causes depression and suicide, or if women who are depressed and suicidal are more likely to elect to have an abortion. The article concludes that an "explanation for the higher suicide rate after an abortion could be low social class, low social support, and previous life events or that abortion is chosen by women who are at higher risk for suicide because of other reasons."

New Zealand

A longitudinal study by University of Otago Christchurch School of Medicine completed in 2006 used data gathered from children and young women (ages 15-25) living in New Zealand who sought abortions over a 25-year period. The study found an increased occurrence of clinical depression, anxiety, suicidal behavior, and substance abuse among women who had previously had an abortion compared to women who did not have abortions. Information was obtained on: a) the history of pregnancy/abortion for female participants over the interval from 15-25 years; b) measures of DSM-IV mental disorders and suicidal behaviour over the intervals 15-18, 18-21 and 21-25 years; and c) childhood, family and related confounding factors. The study concluded that those who had an abortion were more likely to have "mental health problems including depression, anxiety, suicidal behaviours and substance use disorders. This association persisted after adjustment for confounding factors." The authors write, "The findings suggest that abortion in young women may be associated with increased risks of mental health problems," and "on the basis of the current study, it is our view that the issue of whether or not abortion has harmful effects on mental health remains to be fully resolved."

Norway

A study in Norway compared the mental distress of women who experienced a spontaneous abortion (miscarriage) and those who had a voluntary abortion. Women who had had a miscarriage exhibited significantly quicker improvement on Impact of Event Scale (IES) scores for avoidance, grief, loss, guilt and anger throughout the observation period. Women who experienced induced abortion had significantly greater IES scores for avoidance and for the feelings of guilt, shame and relief than the miscarriage group after two and five years. Compared with the general population, women who had undergone induced abortion had significantly higher Hospital Anxiety and Depression Scale (HADS) anxiety scores at all four interviews, while women who had had a miscarriage had significantly higher anxiety scores only at ten days. The conclusion of the study showed that women who had experienced a miscarriage experienced more mental distress after 10 days and six months than those who had induced abortions. Furthermore, "The responses of women in the miscarriage group were similar to those expected after a traumatic and sad life event. However, the women in the induced abortion group had more atypical responses. This may be because the mental health of the aborting women was somewhat poorer than that of the miscarrying women before the pregnancy termination event. The more complex nature of the induced abortion event, which includes economic and relationship issues, may also account for differences in the course of psychological responses between the two groups." The study recommended that women be informed about common psychological responses to pregnancy termination and that they be offered talks with health personnel..

South Africa

A study of 155 women in South Africa was intended to compare levels of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation. The authors concluded that, "The weight of evidence suggests that women who freely choose to terminate a pregnancy are unlikely to experience significant mental health risks..." The authors found that cortisol levels are elevated in women who chose a local anesthetic and that, "The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status."

Spain

Spanish Social Work researchers claim that some psychopathological characteristics are frequently observed in women who have voluntarily aborted. These include "dreams and nightmares related with the abortion," and "feelings of guilt". Using a cohort of 10 women, Gomez, Lavin C., & Zapata examined ways to categorize PAS under the assumption that it exists and is related to Post Traumatic Stress Disorder. Abortion is illegal in Spain.

United States

Vincent Rue, who shares similar pro-life views as David Reardon, testified before Congress in 1981 that he believed abortion caused post-traumatic stress disorder. When Ronald Reagan asked Surgeon General C. Everett Koop to issue a report on the health effects of abortion in 1987, Koop refused as he viewed psychological impact of abortion to be "miniscule from a public-health perspective." That same year, the American Psychological Association convened a review panel which dismissed Reardon's research and concluded that other "well-designed studies" did not find statistically significant links between abortion and psychological harm.

In a 1990 article in Science, the panel stated "The weight of the evidence does not pose a psychological hazard for most women." In the Journal of the American Medical Association in 1992, Nada Stotland, now the vice-president of the APA, also stated "here is no evidence of an abortion-trauma syndrome." Experts have emphasized that abortion carries the same psychological risk as giving birth.

University of Chicago

In a 1992 commentary published in the Journal of the American Medical Association (JAMA), psychiatrist Nada Stotland of the University of Chicago argued that PAS is a myth perpetuated by anti-abortion advocates

Surgeon General

The former U.S. Surgeon General, C. Everett Koop, an opponent of abortion, conducted a review in 1989 of over 250 studies pertaining to the psychological impact of abortion, but told a congressional committee in 1999 that there was not enough evidence to assess the psychological effects of abortion on women and that a reliable scientific report was not possible. In a letter to Ronald Reagan, Koop wrote, "In the minds of some , it was a foregone conclusion that the negative health effects of abortion on women were so overwhelming that the evidence would force the reversal of Roe vs. Wade." He went on to note that, "...doctors had long ago concluded that the physical results of abortion are not major health factors and required little additional study." He recommended a $100 million dollar prospective study would be required to conclusively examine the mental health effects of abortion.

In subsequent testimony before a congressional committee regarding his review of the literature, Koop stated: "There is no doubt about the fact that some people have severe psychological effects after abortion, but anecdotes do not make good scientific material."

Feelings experienced after miscarriage or abortion

Various studies suggest that some women experience stress after a miscarriage or abortion. The kind of stress and the amount of stress women experience varies from culture to culture. Studies also suggest that an individual woman's stress level is influenced by her economic status, family situation and the status of her mental health before the pregnancy. Although no studies have been able to find a causal relationship between abortion and depression or stress, many studies cite the pre-existence of depression and stress in many women who seek abortions. Some women may experience some or all of the following feelings after an abortion.

• Guilt
• Anxiety
• Depression
• Anniversary syndrome

Some empirical research suggests that some women are more likely than others to develop stress after after a miscarriage or abortion. The risk factors found in some clinical studies include:

• Low self-efficacy for coping with the abortion
• Low self-esteem
• External locus of control
• Difficulty with the decision to have an abortion
• When there is emotional investment in the pregnancy
• Perceptions of one's partner, family members, or friends as non-supportive
• Timing during adolescence, being unmarried, or poor
• 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
• Involvement in violent relationships
• Traditional sex-role orientations
• Conservative views of abortion and/or religious affiliation
• When a pregnancy is initially intended
• Abortion during the second trimester
• When the woman is in an unstable partner relationship
• Being forced into abortion by one's partner, others, or by life circumstances

Recent research and APA's Response

Fergusson, a self-described "pro-choice atheist", argued that the APA's position statement implies a greater degree of certainty than Fergusson feels actually exists. In response, Dr. Nancy Russo, who was referred to a Washington Times reporter by the APA, explained 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". Russo also stated that "There has yet to be a well designed study that finds that abortion itself contributes to increased risk for mental health problems," and noted that feelings of guilt and shame after abortion may result from social disapproval and efforts to cast abortion as a moral failing, rather than from the procedure itself. Fergusson argued that better research was needed, but that "...the abortion debate and its implications drive out the science."

References

1. Bazelon, Emily. The New York Times. Is There a Post-Abortion Syndrome?
2. "Research and Destroy", by Chris Mooney
3. ^ Gomez, Lavin C & Zapata, Garcia R."Diagnostic categorization of post-abortion syndrome", Actas Esp Psiquiatr. 2005 Jul-Aug;33(4):267-72.
4. Grimes DA, Creinin MD (2004). "Induced abortion: an overview for internists". Ann. Intern. Med. 140 (8): 620–6. PMID 15096333. Key summary points of article state that "Abortion does not lead to an increased risk for breast cancer or other late psychiatric or medical sequelae." On p. 624, the authors state: "The alleged 'postabortion trauma syndrome' does not exist."
5. Prior to 1994, the DSM III-R listed abortion as a "psychosocial stressor." 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." Abortion in this context is pregnancy loss before 20 weeks that can be spontaneous or therapeutically induced.
6. Stotland NL. The myth of the abortion trauma syndrome. JAMA. 1992 Oct 21;268(15):2078-9. PMID 1404747.
7. Cooper, Cynthia L. Abortion Under Attack
8. American Psychological Association. "APA research review finds no evidence of 'post-abortion syndrome' but research studies on psychological effects of abortion inconclusive." Press release, January 18, 1989.
9. Zabin, L.S., Hirsch, M.B., Emerson, M.R. (1989). When urban adolescents choose abortion: effects on education, psychological status and subsequent pregnancy. Family Planning Perspectives, 21 (6), 248-55. Retrieved September 8, 2006.
10. Russo, N. F., & Zierk, K.L. (1992). Abortion, childbearing, and women. Professional Psychology: Research and Practice, 23(4), 269-280. Retrieved September 8, 2006.
11. Schmiege, S. & Russo, N.F. (2005). Depression and unwanted first pregnancy: longitudinal cohort study Electronic version. British Medical Journal, 331 (7528), 1303. Retrieved 2006-01-11.
12. Adler NE, et al. "Psychological responses after abortion." Science, April 1990, 248: 41-44.
13. Sexual behavior during the first eight weeks after legal termination of pregnancy
14. Suicides after pregnancy in Finland, 1987-94: register linkage study
15. Abortion in young women and subsequent mental health.
16. ^ The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study - Norway
17. Suliman S, Ericksen T, Labuschgne P, de Wit R, Stein DJ, Seedat S (2007). "Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation". BMC Psychiatry. 7: 24. doi:10.1186/1471-244X-7-24. PMID 17565666.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
18. Gomez, Lavin C., & Zapata, Garcia R. (2005). – "Diagnostic categorization of post-abortion syndrome". Actas Esp Psiquiatr, 33 (4), 267-72. Retrieved Setepmber 8, 2006
19. Emily, Bazelon (2007-01-21). "Is There a Post-Abortion Syndrome?" (HTML). The New York Times. p. 10. Retrieved 2007-11-29. pg 2
20. Emily, Bazelon (2007-01-21). "Is There a Post-Abortion Syndrome?" (HTML). The New York Times. p. 10. Retrieved 2007-11-29. Soon after Koop's refusal in 1987 to report on the health effects of abortion, the American Psychological Association appointed a panel to review the relevant medical literature. It dismissed research like Reardon's, instead concluding that "well-designed studies" showed 76 percent of women reporting feelings of relief after abortion and 17 percent reporting guilt. "The weight of the evidence," the panel wrote in a 1990 article in Science, indicates that a first-trimester abortion of an unwanted pregnancy "does not pose a psychological hazard for most women." Two years later, Nada Stotland, a psychiatry professor at Rush Medical College in Chicago and now vice-president of the American Psychiatric Association, was even more emphatic. "There is no evidence of an abortion-trauma syndrome," she concluded in an article for The Journal of the American Medical Association.
21. Stotland NL.The myth of the abortion trauma syndrome JAMA. 1992 Oct 21;268(15):2078-9.
22. New York Times: Koop Says Abortion Report Couldn't Survive Challenge
23. ^ New York Times: Koop Says Abortion Report Couldn't Survive Challenge
24. Post abortion syndrome: myth or reality?
25. ^ Sexual behavior during the first eight weeks after legal termination of pregnancy
26. ^ Legal abortion: a painful necessity - Sweden
27. Abortion and guilt, France
28. ^ Psychological effects of abortion Portugal
29. Predictors of anxiety and depression following pregnancy termination: a longitudinal five-year follow-up study, Norway
30. Anniversary reactions and due date responses following abortion.
31. 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.
32. 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.
33. Cozzarelli, C. (1993). Personality and self-efficacy as predictors of coping with abortion. Journal of Personality and Social Psychology, 65, 1224-1236.
34. Bracken, M.B. (1978). A causal model of psychosomatic reactions to vacuum aspiration abortion. Social Psychiatry, 13, 135-145.
35. Osofsky, J.D., & Osofsky, H.J. (1972). The psychological reaction of patients to legalized abortion. American Journal of Orthopsychiatry, 42, 48-60.
36. 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.
37. 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.
38. Major et al. (1990).
39. Major, B., & Cozzarelli, C. (1992). Psychological predictors of adjustment to abortion. Journal of Social Issues, 48, 121-142.
40. Adler, N.E. (1975). Emotional responses of women following therapeutic abortion: How great a problem? Journal of Applied Social Psychology, 6, 240-259.
41. Bracken, M.B., Hachamovitch, M., & Grossman, G. (1974). The decision to abort and psychological sequelae. Journal of Nervous and Mental Disease, 158, 155-161.
42. Campbell, N., Franco, K., & Jurs, S. (1988). Abortion in adolescence. Adolescence, 23, 813-823.
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)
61. 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.
62. Warren Throckmorton. "Abortion and mental health." Washington Times. January 21, 2005.

External links

Articles from non-aligned sites

• Post-Abortion Syndrome from Ontario Consultants on Religious Tolerance
• Is There a Post-Abortion Syndrome? from The New York Times by Emily Bazelon
• Post-Abortion Politics: a 2007 NOW on PBS video investigation.

Articles from pro-choice sites

• "The Myth of PAS" by Cynthia L. Cooper

Articles from pro-life sites

• "Women Who Have Abortions: Their Reflections on the Unborn" by David Reardon

• Abortion debate
• Popular psychology