This article appears in the November 2002 edition of the Catholic Medical Quarterly
Post Abortion Traumatic Grief
Post Abortion Trauma has traditionally been regarded as a specific form of Post Traumatic Stress Disorder by its proponents. The woman experiences the abortion event. There is then a latency period during which she appears to cope well. This is then followed by the person experiencing a cluster of symptoms including intrusive memories and flashbacks of the event, vivid nightmares, repeated reliving of the trauma, a persistent sense of numbness, sleep disturbance, anxiety, depression and suicidal feelings. The psychologically self-protective symptoms include denial and aversion from painful reminders of the trauma. The proposal that Post Abortion Trauma is a form of Post Traumatic Stress Disorder has led over the years to the developmentofa number of excellent treatment models.
However, it could be argues that women with Post Abortion Trauma present with the classic symptoms of Post Traumatic Stress Disorder. Many women appear to present with symptoms more in keeping with a grief reaction. Recent research developments in the field of trauma and loss may be relevant to the diagnosis and management of Post Abortion Trauma. This paper is an exploration of certain conclusions found in the book Traumatic Grief by Selby Jacobs. The basic aim of the book is to integrate recent finding in the two fields of bereavement and trauma. Jacobs makes no mention of the subject of abortion in his book. However, a number of concepts described under the terms �Traumatic Grief� bear a striking resemblance to symptoms of �Post Abortion Trauma�.
Traumatic Grief is a "Disorder that occurs after the death of a significant other. Symptoms of separation distress are the core of the disorder and amalgamate with bereavement specific symptoms of being devastated and traumatised by death. For diagnosis, symptoms must be marked and persistent and last at least two months. The symptomatic disturbance causes clinically significant impairment in social, occupational or other important areas of functioning." (p 24)
The term "Traumatic" describes a subjective experience of the death. The woman need not encounter a violent event in order to experience trauma. It is essentially an internal experience. The term "Traumatic Grief captures the two underlying dimensions of the disorder: the separation distress and the traumatic distress of feelings of devastation.
Proposed Criteria for Traumatic Grief
The person has experienced the death of a significant other.
The response involves intrusive, distressing preoccupation with the deceased person (e.g., yearning, longing, or searching).
In response to the death, the following symptoms are marked and persistent:
Frequent effort to avoid reminders of the deceased (e.g., thought, feelings, activities, people, places).
Purposelessness or feelings of futility about the future.
Subjective sense of numbness, detachment, or absence of emotional responsiveness.
Feeling stunned, dazed or shocked.
Difficulty acknowledging the death (e.g., disbelief)
Feeling that life is empty or meaningless.
Difficulty imagining a fulfilling life without the deceased.
Feeling that part of oneself has died.
Shattered world view (e.g., lost sense of security, trust, or control)
Excessive irritability, bitterness, or anger related to the death.
The duration of disturbance (symptoms list) is at least two months.
The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
Those of us who have worked with women who present with Post Abortion Trauma will recognise a number of symptoms in the above list.
Post Traumatic Stress Disorder and Traumatic Grief
Traumatic Grief is different from Post Traumatic Stress Disorder. In Traumatic Grief, the symptoms of separation anxiety are a "function of a wish to be reunited with the deceased person rather than an intrusive, fearful re-experiencing of a horrifying event." (p. 38) Some aborted women experience dread when confronted by reminders of the abortion event. Others may seek out for reminders in order to cope with the loss. They may even have an "atonement baby" in similar circumstances to the abortion but with an obvious positive outcome. "Hypervigilance as part of traumatic grief relates to scanning the environment for cues of the deceased person rather than monitoring potential threats of a recurrent horrifying event." (p. 38)
Other disorders can occur in the circumstances of death including "major depressive episodes, panic disorder, generalised anxiety disorder and Post Traumatic Stress Disorder." (p. 37) Women with Post Abortion Trauma often present with such generalised anxiety or major depression, that the underlying Post Abortion Trauma goes unrecognised.
"Traumatic Grief predicts a higher risk of suicidal ideation, heart trouble, high systolic blood pressure, cancer and high risk health behaviours such as excess consumption of food, alcohol and tobacco." (p. 37) Women with Post Abortion Trauma frequently present with substance misuse, eating disorders and other high risk behaviours.
"If the diagnosis of Traumatic Grief is missed during the first year of bereavement, the first anniversary and subsequent anniversaries of the death are landmarks which often help in making the diagnosis." (p. 34) Anniversary reactions are commonly identified in Post Abortion Trauma.
Positive outcomes are associated with a genuine, empathic and compassionate therapeutic relationship and a "knowledge of loss and grief that the therapist imparts to the patient . . . reviewing the relationship to the deceased person and the circumstances of the death emerge as the common foci of therapy." (p.71) The aborted woman will need to undergo the additional task of developing a relationship with the "deceased person."
Different therapies for different people are recommended Again, this is a common finding in the management of Post Abortion Trauma. Rather than a specific form of therapy, what really matters is the supportive, understanding therapeutic relationship.
"Groups that offer the inculcation of hope, the development of understanding, social supports, a source of normalisation and a setting to learn and practise new skills" are recommended alongside problem-focused counselling. (p. 72)
"The substrate of the clinical process of evaluation and treatment is the patient s story of the death and its consequences for his or her life." (p. 85) Use of poems, stories and other narrative forms are to be recommended The aborted woman will frequently find that these means are important as part of the healing process.
Traumatic Grief is an emerging disorder. Many of its features are in keeping with the symptoms of Post Abortion Trauma: the term may prove helpful in the further development of treatment models. A significant number of women with Post Abortion Trauma will continue to present with symptoms of Post Traumatic Stress Disorder. Others will have a cluster of symptoms more in keeping with Traumatic Grief, Post Abortion Traumatic Grief is suggested as a term of clinical use in such cases.
Traumatic Grief by Selby Jacobs (Brunner/Mazel, 1999)
Doctor Pravin Thevathasan is a Consultant Psychiatrist in Shrewsbury.