Appendix A: Diagnostic Criteria for Post-Abortion Syndrome
- Stressor: The abortion experience, that is, the intentional destruction of a woman’s unborn baby/POC, is sufficiently traumatic to cause significant symptoms of re-experience and avoidance in some women who have experienced this procedure.
- Re-experience of the abortion stressor may occur in at least one of the following modes:
- recurrent and intrusive recollections of the abortion or the potential infant
- recurrent dreams of the abortion or potential child
- sudden acting or feeling as if the abortion were reoccurring
C. Avoidance phenomena by which there is reduced responsiveness or involvement with the external world may occur in at least one of the following modes:
- markedly diminished interest in significant activities
- a feeling of detachment or estrangement from others
- reduced capacity for feeling or expressing emotions
- reduced communication and/or increased hostile interactions
- depressed mood
D. Associated Symptoms include at least two of the following:
- hyper-alertness, exaggerated startle reaction, or explosive hostile outbursts
- sleep disturbance
- intensification of symptoms by exposure to reminders of the stressor, for example, contact with pregnant mothers, nurseries, or clinics
- guilt about surviving when the unborn child did not or about the abortion decision, and the inability to forgive self for involvement
- memory impairment or trouble concentrating
- avoidance of activities which are reminders of the abortion stressor
E. Subtypes include:
- Acute: onset within six months of the abortion stressor and of less than six months duration
- Chronic: duration longer than six months
(3) Delayed: onset more than six months after the abortion stressor (Selby and Brockmon, 1990).
Appendix B: Diagnostic Criteria for Post-Traumatic Stress Disorder (PTSD)
- The person has experienced an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone. e.g., serious threat to one’s life or physical integrity; serious threat or harm to one’s children, spouse, or other close relatives and friends; sudden destruction of one’s home or community; or seeing another person who has recently been, or is being, seriously injured or killed as the result of an accident or physical violence.
B. The traumatic event is persistently reexperienced in at least one of the following
- recurrent and intrusive distressing recollections of the event
- recurrent distressing dreams of the event
- sudden acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative (flashback) episodes, then those that occur upon awakening or when intoxicated)
- intense psychological distress at exposure to events that symbolize or resemble an aspect of the traumatic event, including anniversaries of the trauma
C. Persistent avoidance of stimuli associated with the trauma or numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:
- efforts to avoid thoughts or feelings associated with the trauma
- efforts to avoid activities or situations that arouse recollections of the trauma
- inability to recall an important aspect of the trauma (psychogenic amnesia)
- markedly diminished interest in significant activities
- feeling of attachment or estrangement from others
- restricted range of affect, e.g., unable to have loving feelings
- sense of a foreshortened future, e.g., does not expect to have a career, marriage, or children, or a long life.
D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:
- difficulty falling asleep or staying asleep
- irritability or outbursts of anger
- difficulty concentrating
- exaggerated startle response (physiologic reactivity upon exposure to events that symbolize or resemble an aspect of the traumatic event e.g., a woman who was raped in an elevator breaks out in a sweat when entering any elevator)
- Duration of the disturbance (symptoms B, C, D) of at least one month.
- Specify delayed onset if the onset of symptoms was at least six months after the trauma (DSM-III-R)
Appendix C: Interview Questions
- When did the abortion take place? Give the date, your age at the time, and any other information that stands out about that day.
- How many months pregnant were you when you had the abortion?
- How did you feel during the abortion procedure?
- How did you feel right after the abortion? How about a week later? Several months later?
- Did you feel like you were informed about all the options when you became pregnant?
- What sources (e.g. people, articles, TV) did you draw from while making the decision to abort?
- How do you feel or what do you think when you look back on your abortion experience?
- If you could make the decision again about whether or not to have an abortion, what would you do?
- Has the abortion changed any of the significant relationships you had at that time or that you presently have?
- Did your religious beliefs affect your decision about having an abortion? How?
- Have you experienced any changes in health since the abortion took place? If yes, please explain.
- What is your economic condition at the present time? Do you feel that this was a factor in your abortion decision?
- Would you consider yourself to have grown up with conservative or liberal views?
(Freed & Salazar, 1993; Mannion, 1994; Selby & Brockmon, 1990; Boyland, 1992)
The first question is designed to attain general information about the abortion experience, the woman’s age, the date of the abortion, and anything else that stands out to them about the incident. Building rapport with the interviewee will be a primary focus as well as creating an environment where the woman is respected and listened to, with the purpose of facilitating further sharing.
Asking how many months pregnant the woman was at the time of the abortion connects well with the previous question, and provides a preliminary look at the contributing forces to her abortion decision. If the woman post-poned the abortion to a later time, that could have been caused by hesitation or significant conflict in making the decision (Lewis, 1997; Selby & Brockmon, 1990). Likewise, an abortion early in the pregnancy may indicate little hesitation and therefore reveal a less conflicted woman.
Expressing feelings related to the abortion experience has been shown to aid the woman in explaining how the abortion has affected her. Creating an opportunity for the woman to place herself in that situation again and share the feelings she dealt with during and after the abortion experience has the potential to facilitate recognition and expression of what the woman felt about this decision and to even prompt the woman to face that decision for the first time in years.
A major characteristic of PAS is a denial period, which can last for years, that prevents the woman from recognizing the significant impact the abortion experience has had on her life (Boyland, 1992; Doherty, 1995). Therefore, this question in combination with the MCMI-III could reveal whether denial is preventing her from recognizing unhealthy behaviors that have become prevalent in her life. On the other hand, this question could also reveal that some women are aware of the consequences of aborting and are satisfied with their choice (Reardon, 2000; Doherty, 1995).
Being informed about other options when considering an abortion has been shown to be a significant factor in the decision about whether to abort as well as contentment with the decision afterwards. When the woman is able to make a decision based on all the facts, she tends to deal with the abortion aftermath in a healthier manner and may, in fact, decide not to terminate the pregnancy.
The question encouraging the woman to reflect on the abortion serves a dual purpose of attaining a summary of how their feelings have changed about the abortion and what their attitude is toward the procedure at the present time. By asking how they feel or what they think about the abortion now, they will have the opportunity to defend their decision or possibly deal with areas they did not examine as thoroughly as they could have or should have. This also brings them to the present and may facilitate reflection on how the abortion may be affecting her now.
The lack of knowledge about all the available options is considered again through a slightly different lens when the woman is asked to consider her choice to abort again. Not only does this question have the potential to stir up a wide variety of emotions concerning their decision, but it also addresses whether the woman feels like she was informed at the time of the abortion and if she not does she have information now that would have changed her mind. This question also provides an opportunity to go deeper into how age at the time of abortion can potentially affect the decision (Mannion, 1994; Franz & Reardon, 1992).
Abortion has been shown to significantly affect the close relationships in a woman’s life (Franz & Reardon, 1992; Reardon, 2000; Zolese & Blacker, 1992).
Distancing themselves from people who coerced them into the abortion is common as well as an inability to form intimate relationships due to the abortion (Mannion, 1994; Reardon, 1990). There is also evidence that couples who go through an abortion are not likely to stay together (Reardon, 2000).
Religious beliefs play an integral role in the abortion decision and may lead to higher levels of guilt or regret because of conflict with the church and beliefs the woman adheres to that contradict her choice to abort (Freed & Salazar, 1993; Lewis, 1997). Having moral conflict over the abortion decision is also common (Freed & Salazar, 1993), and can lead to prolonged periods of denial or alienation from those who oppose the woman’s decision. By asking about religious orientation, we will be able to discover which of these factors, if any, were prevalent in her particular situation.
Pursuing information about any health problems related to the abortion is critical because of the significant amount of women affected by “botched abortions”. The interviewer will need to probe in an effort to determine whether these health problems were also an issue before the abortion took place. Therefore, assessing the health problems prevalent in their life now that were not significant before the abortion took place can begin the process of collecting data reporting how frequently physical complications occur.
Another aspect of post-abortion sequelae that needs to be evaluated concerns emotional problems that occur for the first time after the abortion has taken place. There has been evidence that women can become emotionally detached, very emotional, or even develop mood swings, depression, and/or anxiety. Exploring these emotional changes provides clues to adjustment as well as problem areas the woman may be dealing with.
The sources that the woman draws from when making her abortion decision not only reveal her values, but also indicate the influence the media has on the decision to abort. This question may reveal the people who were most influential in her decision to have an abortion, much like questions four and nine.
Economic conditions are rarely examined in relationship to post-abortion women. Therefore, any information about how economic conditions may have played a role in the woman’s decision process or number of options will be beneficial. Checking the results for a significant number of women from a particular economic situation may facilitate further research to identify the economic level at highest risk for problems post-abortion1.
Appendix D: MCMI-III Scales
11 Clinical Personality Pattern Scales
3 Scales of Severe Personality Pathology
7 Basic Clinical Syndrome Scales
N Bipolar: Manic
B Alcohol Dependence
T Drug Dependence
R Post-Traumatic Stress Disorder
3 Severe Syndromes
SS Thought Disorder
CC Major Depression
PP Delusional Disorder
Appendix E: Post-Interview Evaluation Form
1. How honest and open were you during the course of this interview?
Very honest 1 2 3 4 5 6 7 8 9 10 Not honest
2. How would you rate the interviewer in their understanding of your situation?
Very understanding 1 2 3 4 5 6 7 8 9 10 Not understanding
3. Did you feel comfortable sharing with the interviewer?
Very comfortable 1 2 3 4 5 6 7 8 9 10 Not comfortable
4. How did you feel about the interview?
Very good 1 2 3 4 5 6 7 8 9 10 Not good
5. Did you feel that the questions assisted you in sharing about your abortion experience?
Yes, very much 1 2 3 4 5 6 7 8 9 10 Not at all
Any other comments
Appendix F: Personal Information Form
Age: _____ Home State: ______________
Marital Status: Single Married Divorced
Number of Children: ________
Race: Caucasian African-American Hispanic Asian Indian
Religious Affiliation: _______________________ (if not, please write none)
Economic Status: Under 10,000 10,000 to 25,000 25,000 to 35,000
35,000 to 45,000 45,000 to 70,000 Above 70,000
Number of Siblings _______
Are you the: Middle Child ____
Oldest Child ____
Youngest Child ____
Occupation of your parents _____________________________________________
Economic Status of Your Parents:
Under 10,000 10,000 to 25,000 25,000 to 35,000
35,000 to 45,000 45,000 to 70,000 Above 70,000
Number of extended family members you are in contact with on a daily basis ______