TRAUMATIC STRESS DISORDERS

Traumatic stress disorders following first-trimester spontaneous abortion

By Stephen V. Bowles, PhD, Rebecca S. Bernard, PhD, Ted Epperly, MD, Stephanie Woodward, MA, Karni Ginzburg, PhD, Raymond Folen, PhD, Theresita Perez, Cheryl Koopman, PhD

QUOTES:

(I have bolded certain passages.)

  • Would you know the key symptoms or historical factors to look for in determining whether a patient will develop acute stress disorder (ASD) or posttraumatic stress disorder (PTSD)? Most women discharged from the hospital after spontaneous abortion consult their primary care doctor for emotional distress related to the lost pregnancy.

  • Some authors have projected that 10% of women who experience a spontaneous abortion meet criteria for acute stress disorder and 1% for posttraumatic stress disorder. Subsequent research has indicated even higher levels of acute stress disorder and posttraumatic stress disorder. Approximately 15% met criteria for acute stress disorder at 3 weeks/ 25% met criteria for posttraumatic stress disorder at 1 month, and 7% met criteria for posttraumatic stress disorder- at 4 months.
  • Our pilot study sought to validate research that found high rates of acute stress disorder and posttraumatic stress disorder in this population, examine potential risk-factors for acute stress disorder, examine women’s perception of support after their spontaneous abortion, and determine whether acute stress disorder is predictive of posttraumatic stress disorder.
  • We begin by sharing the take-home points of our study, and follow with the details of methods used and study results.
  • Approximately 15% met criteria for acute stress disorder at 3 weeks/ 25% met criteria for posttraumatic stress disorder at 1 month, and 7% met criteria for posttraumatic stress disorder- at 4 months.

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Symptom of acute stress disorder and posttraumatic stress disorder

Exposure to a traumatic event

Response involves intense fear, helplessness, or horror

Repeatedly re-experience trauma (dreams, flashbacks, thoughts)

Avoidance of trauma-related stimuli

Increased arousal (hypervigilance, exaggerated startle response, irritability)

Significant impairment in important areas of functioning Three or more dissociative symptoms (derealization, depersonalization, numbing) (for ASD only)

Duration: 2 days-4 weeks (for ASD), >1 month (for PTSD)

__________________________________________________________________________________________________

  • 39% met criteria for posttraumatic stress disorder at 1 month. These findings were consistent with other research. Moreover, women who developed acute stress disorder were significantly more likely to exhibit subsequent posttraumatic stress disorder.
  • Women whose acute stress disorder symptoms remain untreated following a miscarriage may maintain their symptom level or experience further exacerbation of acute stress disorder symptoms.
  • Echoing previous research, women reporting an abuse history were more likely to experience acute stress disorder. Thus, physicians should assess for past traumatic experiences that could influence the patient’s emotional response to the spontaneous abortion.
  • Several psychological beliefs and perceptions also were related to acute stress disorder. Women were significantly more likely to develop acute stress disorder if they felt personally responsible for the miscarriage, lacked a sense of control in their lives, or reported feeling bonded to the unborn child.
  • Women lacking spousal support may need increased support from you and other health care team members
 
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