Abortion and emotional disturbances
Women with a history of spontaneous abortion often experience pain that, both on an emotional and behavioral level, approaches the intensity of a real loss. This pain is usually alleviated spontaneously after about 6 months, or with the arrival of a new pregnancy. What happens when this doesn’t happen?
Daniela Chieppa – OPEN SCHOOL, Cognitive Studies San Benedetto del Tronto
Advertising message The Diagnostic Manual of Mental Disorders (DSM 5) has included the onset of the “peripartum” as a specification of many psychiatric diseases, signifying the growing importance of all nine months of pregnancy from conception and up to four weeks after delivery.
One of the conditions that most frequently occurs during this period is spontaneous abortion. It is defined as the spontaneous termination of pregnancy in the gestational period preceding the viability of the fetus, before the development of the autonomous life capacity, corresponding approximately to the period of 23 weeks.
Women who have a spontaneous abortion, although initially presenting a higher mental stress than women who voluntarily terminated pregnancy (IGV), experience a statistically significant improvement in initial psychological disorders faster than those who have voluntarily aborted. Therefore, the psychological response to spontaneous abortion and voluntary abortion is different and it is possible to attribute this difference to the characteristics of the two types of abortion.
In the Italian legal system, abortion procured must occur before three months from the presumed conception and can be implemented if there is a physical or mental danger to the health of the mother. IVG, after the first 90 days, can be practiced when: pregnancy or childbirth pose a serious danger to the woman’s life and when pathological processes are ascertained, including those relating to significant anomalies or malformations of the unborn child, which determine a serious danger to the physical or mental health of the woman.
Women with a history of spontaneous abortion often experience pain that, both emotionally and behaviorally, approaches the intensity of a real loss; this pain is usually alleviated spontaneously after about 6 months, or with the arrival of a new pregnancy. Initially, symptoms of a generic suffering characterized by shock and disbelief appear, consequently feelings of sadness, guilt, shame and helplessness are experienced, often associated with somatic symptoms.
Mourning reactions seem to represent the most common form of psychic suffering following an abortion, especially if spontaneous; it probably assumes the same forms, duration and phases of other forms of mourning resulting from significant losses (Brier, 2008).
Over the years, an increasingly large literature has highlighted the importance of abortion in the pathogenesis of psychopathological disorders. The literature seems to demonstrate how the termination of pregnancy is certainly related, although with an extremely variable frequency from case to case, to manifestations of subjective suffering, generally constituted by mourning reactions or by anxious and / or minor depressive manifestations (Iles, 1989; Rosenfeld, 1992; Bianchi-DeMicheli, 2007; Romans-Clarkson, 1989; Shadmi et al, 2002).
The risk of psychic suffering generally seems higher in the case of spontaneous abortion (Friedman & Gath, 1989; Lapelle, 1991; Frost & Condon, 1996; Lee & Slade, 1996; Klier et al, 2002; Geller et al, 2004; Brier, 2004; Lok & Neugebauer, 2007; Brier, 2008). Voluntary termination of pregnancy seems to be less problematic in general, which in most cases seems to be associated with an attenuation of the pre-existing conditions of emotional distress to the termination of pregnancy itself (Greer et al, 1976; Payne et al, 1976; Romans-Clarkson, 1990, Teichman et al, 1993; Rosenfeld, 1992, Schleiss et al, 1997; Bradhaw & Slade, 2003; Bianchi-DeMicheli, 2007).
Advertising message In any case, even the voluntary termination of pregnancy is not necessarily free of significant consequences in terms of mental health. In fact, a study, carried out on women who had voluntarily aborted 8 weeks before, found that 44% had mental disorders, 36% sleep disturbances, 31% had regretted and 11% had been prescribed psychotropic drugs since your family doctor. Another study found that 25% of women who have an abortion perform psychiatric visits, compared to 3% in the control group, and that women who have an abortion have a much higher probability than others of being hospitalized later in a psychiatric ward. Bradshaw et al. (2003) examined the level of psychological stress present immediately before the termination of pregnancy and found that a high level of anxiety is present in 45% of women. Immediately after the surgery, however, there is a reduction in stress levels, but a minority of women continue to have important psychological disorders, which frequently consist of very high anxiety.
The stress caused by abortion can evolve into an even more painful experience that can lead to an increase or beginning of the intake of drugs and alcohol, changes in eating behavior, social withdrawal, low self-esteem, up to suicidal ideation and attempts suicide. Additionally, abortion has been shown to correlate with Post Traumatic Stress Disorder. In a research on women who had practiced voluntary termination of pregnancy, 46% of the participants showed symptoms of stress such as sleep disturbances, dissociative states, recurrent and intrusive memories of the event, avoidance of stimuli that recalled abortion.
Abortion increases the risk of suicide, as an impulsive act of despair. A Finnish study found that 5.4% of all suicides committed are associated with pregnancy. Of these, 5.9% are associated with the birth of the child, 18.1% with spontaneous abortion, while 34.7% with voluntary abortion.
In conclusion, abortion represents a stressor for the woman who initially is not processed and integrated into the personality structure, since she is in a state of vulnerability causing the appearance of a series of disorders in the emotional sphere: anxiety, post-traumatic disorder stress, depression, substance and alcohol abuse and extreme behavior such as suicide.