American Psychiatric Association & PAS

When describing the diagnosis and symptoms of PTSD, abortion is one of the life events the APA acknowledged in 1987 that could bring on some or all symptoms of PTSD.
  • Commonly the person has recurrent and intrusive recollections of the event or recurrent distressing dreams during which the event is re-experienced.
  • Avoidance of reminders of the trauma may include psychogenic amnesia for an important aspect of the traumatic event.
  • One of the psychosocial stressor categories is: "Physical illness or injury: e.g., illness, accident, surgery, abortion."
  • It is important to understand why the APA considered abortion to be a psychological stressor in 1987 but not in 1994.
In 1987, the American Psychiatric Association stated in its then newly revised manual of diagnostic criteria, the Diagnostic and Statistical Manual (DSM) of Mental Disorders III-R (DSM-III-R), that abortion is a type of 'psychosocial stressor' (an event outside the range of usual human experience) of the type capable of causing 'post-traumatic stress disorder' (PTSD).

When describing the diagnosis and symptoms of PTSD, abortion is one of the life events the APA acknowledged in 1987 that could bring on some or all symptoms of PTSD.

The DSM includes PTSD as one of the "Anxiety Disorders" and lists it in Chapter 1.

Page 247-251: "309.89 Post-Traumatic Stress Disorder

  • "...The characteristic symptoms [of PTSD] involve re-experiencing the traumatic event, avoidance of stimuli associated with the event or numbing of general responsiveness, and increased arousal. The diagnosis is not made if the disturbance lasts less than one month.
  • "The disorder is apparently more severe and longer lasting when the stressor is of human design. The specific stressor and its severity should be recorded on Axis IV (p. 18).
  • "...The traumatic event can be re-experienced in a variety of ways. Commonly the person has recurrent and intrusive recollections of the event or recurrent distressing dreams during which the event is re-experienced.
  • "There is often intense psychological distress when the person is exposed to events that resemble an aspect of the traumatic event or that symbolize the traumatic event, such as anniversaries of the event.
  • "In addition to the re-experiencing of the trauma, there is persistent avoidance of stimuli associated with it, or a numbing of general responsiveness that was not present before the trauma.
  • The person commonly makes deliberate efforts to avoid thoughts or feelings about the traumatic event and about activities or situations that arouse recollections of it. This avoidance of reminders of the trauma may include psychogenic amnesia for an important aspect of the traumatic event.
  • "Diminished responsiveness to the external world, referred to as 'psychic numbing' or 'emotional anesthesia,' usually begins soon after the traumatic event. A person may complain of feeling detached or estranged from other people, that he or she has lost the ability to become interested in previously enjoyed activities, or that the ability to feel emotions of any type, especially those associated with intimacy, tenderness, and sexuality, is markedly decreased.
  • "Persistent symptoms of increased arousal that were not present before the trauma include difficulty falling or staying asleep (recurrent nightmares during which the traumatic event is relived are sometimes accompanied by middle or terminal sleep disturbance), hypervigilance, and exaggerated startle response.
  • Some complain of difficulty in concentrating or in completing tasks. Many report changes in aggression. In mild cases, this may take the form of irritability with fears of losing control.
  • In more severe forms, particularly in cases in which the survivor has actually committed acts of violence (as in war veterans),the fear is conscious and pervasive, and the reduced capacity for modulation may express itself in unpredictable explosions of aggressive behavior or an inability to express angry feelings."
Stressors
The 'Severity of Psychosocial Stressors Scale' enables coding of the overall severity of a psychosocial stressor or multiple psychosocial stressors that have occurred in the year preceding the evaluation, and that may have contributed to any of the following:
  • development of a new mental disorder
  • recurrence of a prior mental disorder
  • exacerbation of an already existing mental disorder (e.g., divorce occurring during a Major Depressive Episode, or during the course of chronic Schizophrenia)
"Note: Post-traumatic Stress Disorder is an exception to the requirement that the stressor has occurred within a year before the evaluation.)..."

Types of psychosocial stressors to be considered.
To ascertain etiologically significant psychosocial stressors, the following areas may be considered:...

The DSM then lists psychosocial stressor categories and examples, some of which are:
  • conjugal (engagement, marriage, discord, separation, death of spouse)
  • parenting (becoming a parent, illness of child)
  • other interpersonal (illness of best friend)
  • occupational (unemployment)
  • living circumstances (change in residence)
  • financial, legal, developmental (phases of the life cycle)

One of the psychosocial stressor categories is: "Physical illness or injury: e.g., illness, accident, surgery, abortion." 

(Note: A physical disorder is listed whenever it is related to the development or management of a personality disorder [which PTSD is].)


Abortion no longer included
The DSM-IV, published in 1994, no longer included abortion as one of the psychosocial stressors that can contribute to not only PTSD, but apparently, perhaps, to any other mental disorder, according to The American Psychiatric Association.

The obvious question is this: Why did the APA consider abortion to be a psychological stressor in 1987 but not in 1994? This change was certainly not due to the findings of new medical studies on PAS, because no conclusive research was done during this period.

"The only logical explanation is that the APA could not continue to endorse something that is generally admitted to cause significant psychological damage. Therefore, it took the easy way out. The APA simply removed all evidence of psychological trauma caused by abortion from its DSM-IV."

It took the APA about 13 years after abortion was legalized nationally to recognize abortion as one of those psychosocial stressors causing serious distress and to include it in the 1987 manual.

The process by which the APA adds a diagnosis to the body of disorders is considerably intense and time-consuming, and when it is politicized, no one wants to touch it at the APA. So it is not very likely that abortion as a "psychosocial stressor" will be added back to the DSM in the foreseeable future.

The American Medical Association
The American Medical Association has long supported legal abortion. Since 1972, the AMA's amicus briefs to the Supreme Court have provided Justices like Justice Harry Blackmun (who ruled in the Roe v. Wade decision that legalised abortion in the U.S.)  with a "medical" justification for abortion on demand.

The crux of this "medical" justification is the claim that abortion is "safe" - specifically that the maternal mortality rate for legal abortion is lower than that for childbirth.

But in recent years the Supreme Court has finally begun to recognize that abortion involves other non-fatal risks, such as reproductive damage and psychological sequelae (consequences).

Read more about the AMA and what their editorial policy is here.

Post-traumatic Stress Disorder (PTSD)
Symptoms of (PTSD) summarised from the official definition (American Psychiatric Association, 1984) are as follows:
    A. Traumatic event

    B. Re-experiencing the trauma
    1. Recurrent, intrusive recollections
    2. Dreams
    3. Sudden acting or feeling the event is recurring
    4. Intense distress at cues that resemble the trauma
    5. Physical stress reactions to cues of the trauma

    C. Numbing
    1. Avoiding anything associated with the trauma
    2. Avoiding things that remind about the trauma
    3. Inability to recall something important about the trauma
    4. Markedly diminished interest in significant activities
    5. Feeling detached or estranged from others
    6. Constricted affect
    7. Sense of foreshortened future

    D. Increased arousal
    1. Sleep problems
    2. Irritability, outbursts of ange
    3. Trouble concentrating
    4. Hypervigilance
    5. Exaggerated startle response