Complicated Mourning: Dynamics of Impacted Post Abortion Grief
Current estimates are that one in every five women in the United States will have undergone at least one abortion, with 1.4 million abortions occurring annually. Increasingly, long-term stress reactions to abortion have been documented in the research literature. Post Abortion Syndrome (PAS), a variant of Post Traumatic Stress Disorder, occurs in women who experience their abortions as traumatic. When the emotional components of the abortion experience are repressed, as in PAS, impacted grief and complicated mourning result. Diagnosis and treatment strategies are discussed, as well as the societal dynamics that have slowed recognition of this disorder.
Adler, N., David, H., Major, B., Roth, S., Russo, N., & Wyatt, G. (1990). Psychological responses after abortion. Science, 248.
American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: American Psychiatric Association.
American Psychological Association. (1987). Research review: Psychological sequelae of abortion. Unpublished testimony presented to the Office of the U.S. Surgeon General. Washington, DC: American Psychological Association. (Available from the American Psychological Association, 750 First Street, N.B., Washington, D.C., 20002-4242).
Angelo, E. (1992). Psychiatric sequelae of abortion: The many faces of post-abortion grief. Linacre Quarterly, 59 (2) pg. 69-80.
Barnard, C. A. (1990). The long-term psychosocial effects of abortion. Portsmouth, NH: Institute for Pregnancy Loss.
DeVeber, L., Ajzenstat, J. & Chisholm, D. (1991). Post abortion grief: Psychological sequelae of induced abortion. Human Medicine, 7 (203-209).
Doka, K. (1989). Disenfranchised grief. In K. Doka (Ed.) Disenfranchised grief: Recognizing hidden sorrow. Lexington, Mass.: D.C. Heath and Company, p.3.
Donavan, D. & Mclntyre, D. (1990). Healing the hurt child: A developmental contextual approach. New York: Norton.
El-Mallakh, R. & Tasman, A. (1991). Recurrent abortions in a bulimic: Implications regarding pathogenesis. International Journal of Eating Disorders 10, No. 2,215-219.
Forrest, J. (1987). Unintended pregnancy among American women. Family Planning Perspectives, 10, 76-77.
Fox, R. (1990). Proceedings of the American Psychological Association, Incorporated for the year 1989: Minutes of the Annual meeting of the Council of Representatives. American Psychologist 45, 817-847.
Hanley, D., Piersma, H., King, D., Larson, D., & Foy, D. (1992). Women outpatients reporting continuing post-abortion distress: Preliminary inquiry. Paper presented at the annual meeting for the International Society for Traumatic Stress Studies, Los Angeles.
Harris, B. (1986). Induced abortion. In T. Rando (Ed.), Parental loss of a child (pp. 241256). Champaign, IL: Research Press.
Horowitz, M. J. (1974). Stress response syndromes: Character style and dynamic psychotherapy. Archives of General Psychiatry 31, p. 769.
Koop, C. (1989, March 16). Testimony before the Human Resources and Intergovernmental Relations Subcommittee on Government Operations, U.S. House of Representatives. In Medical and psychological impact of abortion, (pp. 193-203, 218, 223-250). Washington, D.C.: U.S. Government Printing Office.
Krier, B. (1990, April 22.). RU-486: The abortion battle's new frontier. Los Angeles Times, pg. 1.
Liebman, M. & Zimmer, J. (1979). Abortion and the cognitive foundation of dehumanization. In D. Mall & W. Watts (Eds.) The psychological sequelae of abortion. University Publications of America: Washington D.C.
Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry 101, 141-149.
Magyari, P., Wedhase, B., Ifft, R. & Callanan, N. (1987). A supportive intervention protocol for couples terminating a pregnancy for genetic reasons. Birth Defects 23, 7583.
Mall, D. and Watts, W. (1979). The psychological aspects of abortion. University Publications of America: Washington D.C.
Mesaros, J., Larson, D., & Lyons, J. (1992). Depressive symptoms in late adolescent and young adult females: Effects of pregnancy resolution. (Manuscript)
McCall, K. & Wilson, W. (1987). Ritual mourning for unresolved grief after abortion. Southern Medical Journal 80(7): 817-821.
McCann, I.L., & Perlman, L.A. (1990). Psychological trauma and the adult survivor: Theory, therapy and transformation. New York: Brunner Mazel. p. 11.
Ney, P. (1982). A consideration of abortion survivors. Child Psychiatry in Human Development 13, (1982), pp. 168-179.
Peppers, L. (1987). Grief and elective abortion: Breaking the emotional bond? Omega 18, 1-12.
_____(1989). "Grief and elective abortion: Implications for the counselor." In Doka, K. (ed.) Disenfranchised grief: Recognizing hidden sorrow, Lexington, Mass.: D.C. Heath and Company, 135-145.
Peterson, K., Prout, M. & Schwarz, R. (1991). Post-traumatic stress disorder. New York: Plenum Press.
Rando, T. (1984). Grief, dying and death: Clinical interventions for caregivers. Champaign, Ill.: Research Press.
Rando, T. (Ed.). (1986). Parental loss of a child. Champagne, IL: Research Press.
Rando, T. (1991, June). Complicated Bereavement. Paper presented at the Eastern Regional Conference on Abuse and Multiple Personality Disorder. Dominion Hospital.
Raphael, B. (1972). Psychosocial aspects of induced abortion. Medical Journal of Australia 2, 35-40A.
Reardon, D. (1987). Aborted women: Silent no more. Chicago, IL: Loyola University Press.
Rue, V. (November 5, 1981). Abortion and family relations. Testimony presented before the U.S. Senate Judiciary Committee, Subcommittee on the Constitution, Washington, D.C.
Rue, V. (1985) Abortion in relationship context. International Review of Natural Family Planning 9 (2) pg. 95-121.
_____ (1986, August). Post abortion syndrome. Paper presented at the Conference on Post Abortion Healing, University of Notre Dame.
_____ (1987, August). Current trends and status of post-abortion syndrome. Paper presented at the Conference on Post Abortion Healing, University of Notre Dame.
Rue, V. & Speckhard, A. (1992a). Informed consent & abortion: Issues in medicine and counseling. Medicine and Mind 6 (1-2) (pg. 75-94).
Rue, V. & Speckhard, A. (1992b). Post abortion trauma: Incidence and diagnostic considerations. Medicine and Mind 6 (1-2) (pg. 57-74).
Saltzman, L., & Policar, M. (Eds). (1985). The complete guide to pregnancy testing and counseling. San Francisco: Planned Parenthood of Alameda/San Francisco.
Selby, T. (1986, August). Post abortion stress syndrome. Paper presented at the Conference on Post Abortion Healing, University of Notre Dame.
_____ (1990). The mourning after: Help for post abortion syndrome. Grand Rapids, MI: Baker Book House.
Shostak, A., & Mclouth, G. (1984). Men and abortion: Lessons, losses and love. New York: Praeger.
Speckhard, A.C. (1986, August). A discussion of post abortion syndrome. Paper presented at the Conference on Post Abortion Healing, University of Notre Dame.
_____ (1987a). Post abortion counseling. Portsmouth, N.H.: Institute for Pregnancy Loss.
_____ (1987b). Psycho-social stress following abortion, Kansas City: Sheed and Ward.
Speckhard, A. & Rue, V. (1992). Post Abortion Syndrome: An emerging public health concern. Journal of Social Issues 48 (3) (pg. 95-120).
Stotland, N. (1989). Psychiatric issues in abortion, and the implications of recent legal changes for psychiatric practice. In N. Stotland (ed.), Psychiatric aspects of abortion (pp. 1-16). Washington, D.C.: American Psychiatric Press.
_____ (1992). The myth of the abortion trauma syndrome. Journal of the American Medical Association 268 (pg. 2078-2079).
Weiner, A., & Weiner, E. (1984). The aborted sibling factor: A case study. Clinical Social Work Journal 3, 209-215.
Wilmoth, G., Bussell, D., & Wilcox, B. (1991). Abortion and family policy: A mental health perspective. In E.A. Anderson and R.C. Hula (Eds.), The reconstruction of family policy, (pp. 111-127). New York: Greenwood Press.
Worden, W. (1982). Grief counseling and grief therapy. New York: Springer.
Zimmerman, M. (1977). Passage through abortion: The personal and social reality of women's experiences. New York: Praeger Special Studies.
Anne Speckhard, Ph.D. and Vincent Rue, Ph.D.
Anne C. Speckhard is in private clinical, research, and consulting practice in Alexandria, Virginia. She has consulted on various postpartum-stress research projects and has conducted many training workshops for mental health and medical professionals on the topic of diagnosing and treating post abortion stress. Dr. Speckhard is the author of two books on the subject and coauthor of "Post Abortion Syndrome: An Emerging Public Health Concern" published in 1992 in the Journal of Social Issues. She served as a Public Health Service Fellow in the Office of Population Affairs at DHHS and has testified on the subject of Post Abortion Syndrome (PAS) before a committee of the U.S. House of Representatives.
Vincent M. Rue is currently Co-Director with Susan Stanford-Rue of the Institute for Pregnancy Loss, Portsmouth, New Hampshire, which is a nonprofit intensive-treatment center, a clearinghouse for information, and a clinical training and research center for Traumatic Pregnancy Loss Experiences including Post Abortion Syndrome. He has been a practicing psychotherapist for seventeen years and has served as a consultant to DHHS and the Office of the Surgeon General. Dr. Rue is coauthor of the paper "Post Abortion Syndrome: An Emerging Public Health Concern" recently published in the Journal of Social Issues.
Address correspondence to Anne Speckhard, Ph.D., Family Systems Center, 4009 David Lane, Alexandria, VA 22311.