Is Post-Abortion Syndrome Real?

The term “Post-Abortion Syndrome” (PAS for short) was coined by a pro-life activist called Vincent Rue in 1981, and the idea that undergoing an abortion is an immensely traumatic experience for some women has been promoted by pro-life campaign groups ever since.

The view that PAS does not exist has been around just as long as the term itself, and it's fair to say that both sides of the abortion debate feel equally strongly about Post-Abortion Syndrome. Abortion is a topic that provokes strong feelings in almost anyone. Abortion has very much become a political topic, and there is no reason to believe it won't remain so.

Meanwhile, real women with real-life situations are facing an unwanted pregnancy, or a wanted pregnancy that they think they may not be able to continue for whatever reason. Women from all political, religious, and socio-economic backgrounds get pregnant in difficult situations and find themselves considering abortion. Women of all ages, married, single, partnered consider terminating their pregnancy for all kinds of reasons ranging from medical to financial or personal reasons.

Politics are the last thing on the mind of these women.

When a woman weighs the pros and cons of terminating her pregnancy, many things will be on her mind. Whether or not she'll end up with Post-Traumatic Stress Syndrome afterwards is but one of them, but an important one nonetheless. Is Post-Abortion Syndrome Real? In other words, can women who had an abortion end up with PTSD symptoms? Or perhaps we should be asking why she couldn't?

An Apolitical Look At Post-Abortion Syndrome

Anyone reading an article vaguely related to abortion wants to know the bias of its author so it is, I think, reasonable to start there. I am a mother of two. I consider myself to be a feminist. I am pro-woman. Abortion makes me sick, as a concept and because I believe that the vast majority of women who choose abortion would not have done so if they felt they had a viable alternative.

I'd like to call myself anti-abortion, but I can't. As I said, any sexually active fertile woman could end up in a situation in which she considers one. That includes me, though my husband and I needed fertility treatment to conceive so it's unlikely. I wish no woman who isn't absolutely comfortable with the decision to abort would feel she had no other choice, but reality doesn't reflect that wish. That, then, leaves me being pro-choice and with a lot of respect for any woman who faces adverse pregnancy circumstances — no matter what she ends up deciding.

A few other things that might be relevant. I'm not an American. Here in Europe, abortion doesn't seem to be quite as political as it appears to be on the other side of the Atlantic Ocean. I was also diagnosed with Post-Traumatic Stress Syndrome from childhood sexual abuse. I aim to take an apolitical look at “Post-Abortion Syndrome”, or, perhaps better said, PTSD as the result of abortion.

PTSD Symptoms Following Abortion

A 1990 review of methodologically-sound studies into the psychological effects of legal abortions in US women concluded that “legal abortion of an unwanted pregnancy in the first trimester does not pose a psychological hazard for most women”.

The analysis reported that women may experience regret, sadness, or guilt, but that the incidence of severe negative reactions after abortion is low. One of the studies reviewed found that 76 percent of interviewed women experienced relief after their abortion, while only 17 percent felt guilt.

A conclusion was that “severe negative reactions [after abortion] are rare and are in line with those following other normal life stresses”. Interestingly enough, a 2008 systematic review of mental health after abortion found that high-quality studies demonstrated no or few psychological consequences after abortion, while low-quality (AKA biased) studies were more likely to report such consequences.

It appears to be completely logical that women who were facing a truly unwanted pregnancy, or women who were totally comfortable with their decision to have an abortion, tend to experience little but relief in the aftermath.

Statistics and studies are useful, but they never tell all. They are altogether irrelevant if you are personally affected by something the majority of people don't suffer with. The chances are that you, personally, know a woman who had an abortion and who later had nightmares, flashbacks, constant negative feelings, or who blamed herself or others. She may have told you about it, or she may have kept it to herself.

On the internet, women who had abortions speak more freely about the feelings that had afterwards — anonymously, without the risk of social stigma in their own circles (either for the abortion, or the feelings that came after). Conduct a web search yourself, and you'll find their stories for yourself. Of course, the skeptic in everyone says, some of these women are actually pro-life activists incognito.

Even the most cynical person will have to admit that actual women share their actual stories online, however, and many of them are certainly heartbreaking. They are something else too: familiar to the PTSD symptoms I experienced before I went into therapy.

So, let's forget about “Post-Abortion Syndrome” if you like — the term is politically loaded, and it doesn't appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Instead, let's take a look at the diagnostic criteria for a disorder that is recognized by all. Just Post-Traumatic Stress Disorder, without any mention of abortion in the name.

Before we do so, I'd like to return to the study from above briefly and argue that abortion is not a "normal life stress" at all. There is no way of knowing how many women really experience mental health difficulties after abortion, but even the staunchest pro-choice activist will recognize that deciding on an abortion is hard and life-changing. It's nothing like worrying about the next electricity bill, that horrible co-worker, or even chronic medical conditions. 

PTSD In The DSM-5

These are the criteria for PTSD diagnosis as they appear in the latest DSM, the DSM-5 released this year:

• Criterion A: The person was exposed to death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence in person or indirectly by being a witness.

  Read More: Post-Traumatic Stress Disorder (PTSD): Therapies & Meds

• Criterion B: The traumatic event is re-experienced in at least one of the following ways — through recurrent, involuntary intrusive memories, traumatic nightmares, flashbacks, dissociative reactions, prolonged distress after being exposed to triggers, or physical symptoms when confronted with triggers.

• Criterion C: The person avoids trauma-related thoughts and feelings and physical reminders of the trauma.

• Criterion D: “Negative alterations in cognition and mood”. This can include not being able to recall part of the traumatic event, persistent negative beliefs about self or others, blame, and negative trauma-related emotions like guilt, shame, horror and fear. Also, not being able to experience positive emotions, feeling alienated from others, and a diminished interest in things that were previously significant. Two required.

• Criterion E: Self-destructive and irritable or aggressive behaviors, concentration problems and sleep difficulties — as well as hypervigilance and an excessive startle repsonse. Two required.

• Criterion F: Symptoms persist for at least one month.

• Criterion G: Symptoms disrupt daily life.

• Criterion H: Symptoms are not attributed to other factors like use of medication or illegal substances.

Women will have abortions, and voices that champion their right to do so continue to come from many corners, every time someone seeks to limit that right. Women will have abortions when faced with a truly unwanted pregnancy, and women will continue to have abortions when they feel they have no other choice too.

Some women will feel their abortion was the right decision, while others will regret theirs with all their being. Sometimes, abortion leads to PTSD. Looking at the diagnostic criteria, it appears to be crystal clear that it is indeed possible to experience the full-range of symptoms after abortion. If you don't believe me, look for stories of women who experienced exactly that.

Not every woman who has an abortion will end up with Post-Traumatic Stress Disorder, just like not every combat veteran or sexual abuse survivor will. Nobody claims it isn't possible to develop PTSD after the latter two.

Are You Facing Post-Abortion PTSD?

PTSD is an interesting beast. Its symptoms initially serve as a survival mechanism that gets us through the tough spots and gets our body ready for another round of trauma. When they linger even once it's clear that the trauma won't repeat itself, they stop us from living instead of saving our lives. Many folks with PTSD need quite a while to realize they have it, in part because the PTSD itself prevent us from seeing our situations clearly. 

If you have had an abortion and think you have PTSD as a result, you are in a difficult spot. You may run into therapists that don't recognize abortion as a traumatic event and believe you can't have PTSD. Instead, you could also run into organizations that acknowledge the existence of PAS but have a political agenda or wish to convert you to their particular religious views. 

The chances are that you will find the right therapist for you in the end, but don't hesitate to try with a new one if therapy isn't helping you as much as you think it could. 

Also, don't underestimate the power of peer support on the internet. The PTSD forum I am part of has quite a few women who had abortions and developed symptoms weeks, months, or even years later. Talking to others in your situation can be truly comforting.