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Friday, May 14, 2004

You might recall my recent comment elsewhere here: I remember reading that in The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM III-R), abortion was listed as a life event which can produce Post-Traumatic Stress Disorder (PTSD). I've ordered a copy of that old version, to see if I can find it.

The book arrived today and it is in there. It’s right there in black and white. “Abortion.”

Keep in mind, I’m not saying, nor does the APA’s 1987 version of its strictly-regulated “rules” in this book say that PTSD = PAS (Post Abortion Syndrome), or that PAS is a clinical diagnosis. What I am reporting as seen with my own eyes is that, 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.

So I’ll quote the symptoms references here. Some background to remember: the book includes PTSD as one of the “Anxiety Disorders” and lists it in Chapter 1’s list of “Axes I and II Categories and Codes.”

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

“…The characteristic symptoms [of PTSD] involve reexperiencing 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).


[NOTE: We’ll come back to this last point at the end.]

“…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 reexperiencing 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.”


Getting back to the reference to “stressors” and “Axis IV (p. 18):”

“Axis IV provides a scale, the Severity of Psychosocial Stressors Scale (see p. 11) for coding the overall severity of a psychosocial stressor or multiple psychosocial stressors that have occurred in the year preceding the current evaluation and that may have contributed to any of the following:
  1. development of a new mental disorder
  2. recurrence of a prior mental disorder
  3. 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:…”


It 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 on Axis III whenever it is related to the development or management of an Axis I or II disorder [Annie’s note: which PTSD is]. A physical disorder can also be a psychosocial stressor if its impact is due to its meaning to the individual, in which case it would be listed on both Axis III and Axis IV.)"


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.

Why? A good explanation is found here (need to scroll down almost the whole way):

"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.”


I’ve been told and have read that 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 don't count on "abortion as psychosocial stressor" being added back anytime soon.

DSM-II was published in 1968. DSM-III in 1980, and DSM-III-R in 1987. I don’t know if abortion was included in the DSM-II or III versions. Assuming it was not, I find it fascinating that it took the APA only 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.

Next up? How the medical profession’s centuries-old Hippocratic oath has been rewritten to be “P.C.” too.

DEC. 19, 2006 UPDATE: It gets worse.

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