Tuesday, March 31, 2020
Abortion and DSM III

By Annie Banno in 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 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.


Update 2006 by Annie Banno:

NOW: "This fact sheet is currently being updated."
THEN: "Well-designed studies of psychological responses following abortion have consistently shown that risk of psychological harm is low."

The above archived webpage of the American Psychological Association was last seen live on (ironically) Christmas Day, 2005. Its title was "APA Briefing Paper on The Impact of Abortion on Women - The Impact of Abortion on Women: What Does the Psychological Research Say?"

Since at least Jan 11, 2006, that report was gone, and instead the page childishly and breathlessly informed us:


Looks like we've moved some pages around and the one you're looking for no longer exists!

Please select an area from the Popular Areas list below, or visit our homepage, site map, or contact page to find what you are looking for.

Starting April 26, 2006, it suddenly switched from "we've just moved some pages around" to "we're currently updating this page."

They've been "currently updating" it all right--for eight months and counting.

Longtime readers of this blog will recall when, 2 1/2 years ago, I exposed the APA's initial inclusion of abortion as one of several causes of Post-Traumatic Stress Disorder, for seven years in its DSM-III-R manual, and then its mysterious, unexplained, unresearched removal of abortion from the DSM's next edition.

I don't like to quote pro-life sources (and I don't--even here--exclusively, note the actual study's journal cite), but this NRLC article is really quite good in reporting the "he said, she said" while I look for non-secular sources to add:

However, the arrival of the large, well-designed New Zealand study by David M. Fergusson in January 2006 [Fergusson, D.M., Horwood, L.J., & Ridden, E.M. (2006. Abortion in young women and subsequent mental health. Journal of Child Psychology and Psychiatry, 47(1), 16-24], definitively linking abortion and depression, has thrown pro-abortion groups and their political allies for a loop. Fergusson, who has publicly stated that he is "pro-choice," found that among the young women he studied, "those having an abortion had elevated rates of subsequent mental health problems including depression, anxiety, suicidal behaviors and substance abuse disorders." Fergusson noted that "this association persisted after adjustment for confounding factors." (For a more detailed analysis of Fergusson's study, see the August 2006 edition of NRL News.)

Notable in the "Discussion" section of Fergusson's study is his singling out the APA for criticism. Quoting directly from the APA's Briefing Paper the claim that "well-designed studies ... have consistently shown that the risk of psychological harm is low," Fergusson said, "This relatively strong conclusion about the absence of harm from abortion was based on a relatively small number of studies which had one or more of the following limitations: a) absence of comprehensive assessment of mental disorders; b) lack of comparison groups; and c) limited statistical controls."

To make matters worse for Russo and her APA colleagues, Fergusson chided the group for a statement that "appears to disregard the findings of a number of studies that claimed to show negative effects for abortion." He specifically cited Jesse Cougle, David Reardon, and Priscilla Coleman, who have previously done research on abortion and depression, as well as work by Finnish researcher Mika Gissler, who found higher suicide rates among aborting women.

Russo defended the APA position by arguing, "To pro-choice advocates, mental health effects are not relevant to the legal context of arguments to restrict access to abortion" (Washington Times, 1/21/06). Russo tried to argue that Fergusson's study failed to distinguish between planned and unplanned pregnancies. "There has yet to be a well-designed study,” Russo told the Washington Times, "that finds that abortion itself contributes to increased risk of mental health problems."

Fergusson fired back. "We took into account social background, education, ethnicity, previous mental health, exposure to sexual abuse, and a series of other factors," he said. "It's true we did not take into account specifically whether a pregnancy was wanted or not. However, this limitation is not sufficient grounds for dismissing the results."

The New Zealand study had a ripple effect. It was enough to prompt 15 of Britain's top obstetricians and psychiatrists to send an open letter to the London Times.

On October 27, 2006, these 15 OBs and PSYs wrote:

This research has prompted the American Psychological Association to withdraw an official statement denying a link between abortion and psychological harm.

Withdraw it, they most certainly did.

Where will the National Abortion Federation go for its "facts," now that they can't leave gems like this on their website? "[M]ainstream medical opinions, like that of the American Psychological Association, agree there is no such thing as "post-abortion syndrome."

By the APA's medical definition of a syndrome, they're right--on paper. But the APA was wrong to remove abortion from the DSM in 1994 as a stressor causing PTSD, so even pro-choice folks would have to acknowledge the possibility exists that they're wrong about PAS as a literal syndrome.

The NAF statements also rely on the same 1989 "panel of experts" which in turn spawned the above now-defunct APA Briefing Paper, both of which researcher Fergusson took to the woodshed this year.


What will pseudo-news sites like this do? The NewStandard actually used the defunct APA Briefing Paper as one of its "proofs" and tries to link to the archived webpage in its right sidebar alongside a story about how CPCs were accused by a congressional report of allegedly lying about abortion's harm to women! On July 18, 2006, seven months after the Briefing Paper had been removed from the Internet and the Fergusson study published, this article flatly stated:

The American Psychological Association says that abortions do not cause an increase the likelihood of PTSD or depression. In fact, the PTSD rate is lower for women who have had abortions than women who have not, according to a position paper published on the group's website.


And people still don't believe me when I say we shouldn't believe everything the so-called "news media" gives us?

We didn't see the withdrawal of the APA's faulty briefing paper and the brouhaha around it in the major newspapers. I didn't see this on the major news networks. Not even the little news networks. Did you?

I can't count how many people have called me a liar and worse for years over all this. Now a pro-choice, published, peer-reviewed, qualified, scientific researcher (not the first one such, Dr. Janet Daling was first) stands up to the pro-abortion/pro-choice medical establishment and says, "Hey, all you who dissed David Reardon? You who dissed Dr. Priscilla Coleman? You were dead wrong to do so, chaps and chapettes."

I honest to God wish we were the ones who were wrong. But we're not.

HT goes to reader Susan who tipped me off, the "on hiatus blogger," to the recent, growing storm around this that I'd missed. She asked me if this was the tack the APA would take. As it has apparently since 1969, when it discussed and issued its resolution to see abortion as a woman's "civil right" to feel free to introduce mental trauma to herself:

As an APA Council member, I [Dr. Henry P. David, Transnational Family Research Institute, Bethesda, MD] had joined with the Association for Women Psychologists to introduce a resolution declaring that termination of an unwanted pregnancy was a mental health and child welfare issue, and thus a legitimate concern of APA . The resolution resolved that termination of pregnancy be considered a civil right of the pregnant woman, to be handled as any other medical and surgical procedure in consultation with the woman's physician...

Doesn't that make you as angry as it makes me? That the nation's psychiatric experts knew--in 1969, pre-Roe--it would cause us mental health trauma, distress, call it what you will, and they said, let them do it anyway??

If a "mental health issue" was caused by any. other. reason, and the APA decided to drop it and not advise against subjecting oneself to this cause, they'd be roasted alive. ANY. OTHER.

The amount of scientific data and research it takes to get anything admitted to the DSM as a cause of PTSD or any mental disorder is always quite daunting, as it should be. That's how abortion got in the DSM in the first place: psychiatrists had to have seen the evidence firsthand. This 1999 document describing the work of the 1969 Task Force, however, explains completely how the APA then removed abortion from the DSM within one edition. Someone--somewhere--must have reminded them in no uncertain terms of their 1969 "resolution" to protect abortion.


Annie Banno is a contributor to After Abortion, a website focused on life after abortion: news, opinion, personal experience and resources.  She also contributes to:  Abortion Pudit;  The "sibling" blog to After Abortion (politics, law, morality, debate).





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