Anxiety After Miscarriage. A Review of the Empirical Literature and Implications for Clinical Practice

By Norman Brier, PhD

[EDITED] ABSTRACT: Background: Most practitioners now view a miscarriage as a significant psychosocial stressor that results in a high level of dysphoria and grief. Anxiety, although also commonly present, is less frequently considered and less frequently addressed. A review of the empirical literature was conducted to determine if anxiety after a miscarriage is elevated, and if risk is increased for particular types of anxiety syndromes. An attempt was also made to identify the types of interventions that have been found to be helpful in alleviating anxiety.  CONCLUSIONS: Practitioners, as part of routine care after a miscarriage, should screen for signs of anxiety as well as depression. When signs of anxiety are present, opportunities for catharsis, understanding, and legitimation are likely to be helpful, as is reassurance that the stress is likely to appreciably lessen over the next 6 months. (BIRTH 31:2 June 2004)


(I have bolded certain passages.)

  • 77 percent of women described intrusive recollections, distress when exposed to reminders of the miscarriage, and flashbacks, and 68 percent described strong feelings of helplessness. These results are consistent with the analysis by Defrain et al of 172 mothers’ writings about their miscarriage experience, with disturbing flashbacks and nightmares also said to be common (19). Walker and Davidson similarly found a relatively higher level of posttraumatic stress disorder symptoms after an early pregnancy loss, but contrary to expectations, did not find any lessening of distress when women had warn- ing signs that a miscarriage may be impending (20). Thus, no differences in levels of distress were found when 40 women who had perceived early indications that a pregnancy loss might be imminent were com- pared with 40 women who lacked this “early warning.”
  • [There is a risk for] obsessive-compulsive disorder, particularly for individuals with a prior history of this disorder, and a posttraumatic stress disorder. The two disorders share the characteristic of involving repetitive thoughts.
  • The woman’s subjective appraisal of how she is coping strongly affects the degree of stress she experiences (21). An anxiety screening therefore would start with an inquiry about the woman’s self-evaluation of the adequacy of her coping
  • SCREENING keyed up or tense, irritable, fatigued, unable to concentrate or sleep, and/or has muscle tension. To screen for obsessions and compulsions, she is asked if she has had recurrent and persistent thoughts or images that felt intrusive and distressing, particularly in regard to the miscarriage, and/or is engaging in repetitive behaviors, such as hand washing or checking. Finally, to screen for traumatic symptoms, the woman is asked if she is experiencing recurrent and distressing recollections and/or dreams about the miscarriage in which she feels intensely fearful, helpless, or horrified; if she feels generally numb or detached since the miscarriage, and if she feels intensely distressed when exposed to cues that remind her of the event (17). If the screening indicates that the woman is highly symptomatic, is failing to cope adequately with tasks of everyday life, or both, a referral to a mental health practitioner should be considered.
  •  Psychological debriefing, right after the miscarriage, has been shown to have no effect of to make things worse. 
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