Traumatic Grief and Post-Abortion Trauma – A New Diagnosis for Those Struggling After Abortion
Traumatic Grief and Post-Abortion Trauma
A New Diagnosis for Those Struggling After Abortion
Dr. Pravin Thevathasan
Post-abortion trauma has traditionally been proposed 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 woman 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 to 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 development of a number of excellent treatment models for post-abortive women. However, it could be argued that not all women with post-abortion trauma appear to have the classic symptoms of post-traumatic stress disorder. Many women appear to have 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 treatment of post-abortion trauma. This article is an exploration of certain conclusions found in the book Traumatic Grief, by Selby Jacobs. Those who have worked with women who present with post-abortion trauma will recognize a number of symptoms in the criteria for traumatic grief shown below.
Exploring Traumatic Grief
The basic aim of Jacobs’ book is to integrate recent findings in the two fields of bereavement and trauma. Jacobs makes no mention 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.
Jacobs writes that 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 also include symptoms specific to bereavement, such as being devastated and traumatized by the death. For a diagnosis of traumatic grief, the symptoms need to be “marked and persistent and last at least two months.” These symptoms cause “clinically significant impairment” in the person’s social and occupational lives and in other 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 underlying dimensions of the disorder: (1) separation distress caused by the loss of a loved one, and (2) traumatic distress, reflecting feelings of devastation caused by the death.
Post-Traumatic Stress Disorder vs. 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 reexperiencing of a horrifying event .” (p. 38)
Some aborted women experience dread when confronted by reminders of the abortion event. Others may seek out reminders in order to cope with the loss. They may even have an “atonement baby” in circumstances similar to the abortion but with an obviously positive outcome. Thus, “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 during the circumstances of death, including “major depressive episodes, panic disorder, generalized anxiety disorder, and post-traumatic stress disorder.” (p. 37) Women with post-abortion trauma often appear to have generalized anxiety or major depression and the underlying post-abortion trauma goes unrecognized.
Jacobs writes that traumatic grief puts women at higher risk for “suicidal ideation, heart trouble, high systolic blood pressure, cancer and high-risk behaviors such as excess consumption of food, alcohol, and tobacco.” (p. 37) Women with post-abortion trauma frequently seek counseling for substance abuse, eating disorders, and other high risk behaviors.
Anniversary reactions are commonly identified in post-abortion trauma. “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)
Treatment of Traumatic Grief
Women can overcome traumatic grief when there is a genuine, empathetic, 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 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 treatment of post-abortion trauma. Rather than a specific form of therapy, what really matters is the supportive, understanding therapeutic relationship.
Groups that foster “hope, the development of understanding, social supports, a sense of normalization and a setting to use and practice new skills” are recommended alongside “problem-focused” counseling. (p. 72)
“The substrate of the clinical process of evaluation and treatment is the patient’s story of the death and the 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.
Conclusion
Traumatic grief is an emerging disorder. Many of its features are in keeping with the symptoms of post-abortion trauma, and the term may prove helpful in the further development of treatment models. A significant number of women with post-abortion trauma will continue to experience symptoms of post-traumatic stress disorder. Others will have a cluster of symptoms more in line with traumatic grief, and “post-abortion traumatic grief” is suggested as a term of clinical use in such cases.
Dr. Pravin Thevathason is a consultant psychiatrist in Britain and is actively involved in the pro-life movement, especially in the area of post-abortion trauma.
All references are taken from Traumatic Grief, by Selby Jacobs (New York: Brunner/Mazell, 1999).
Proposed Criteria for Traumatic Grief
Criterion A
1. Person has experienced the death of a significant other.
2. The response involves intrusive, distressing preoccupation with the deceased person (e.g., yearning, longing, or searching).
Criterion B
In response to the death, the following symptoms may be marked or persistent:
1. Frequent effort to avoid reminders of the deceased (e.g., thoughts, feelings, activities, people, places)
2. Purposelessness or feelings of futility about the future
3. Subjective sense of numbness, detachment, or absence of emotional responsiveness
4. Feeling stunned, dazed, shocked
5. Difficulty acknowledging the death (e.g., disbelief)
6. Feeling that life is empty or meaningless
7. Difficulty imaging a fulfilling life without the deceased
8. Feeling that part of oneself has died
9. Shattered world view (e.g., lost sense of security, trust, or control)
10. Assumes symptoms or harmful behaviors of, or related to, the deceased person
11. Excessive irritability, bitterness, or anger related to the death
Criterion C
1. The duration of disturbance (symptoms list) is at least two months.
Criterion D
1. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.
