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Post Abortion Survivor Syndrome (PASS): signs and symptoms.

To the Editor: Observations of psychiatric patients led me to believe that some were deeply affected by pregnancy losses, particularly abortion; both theirs and their parents'. It appeared that there were deep existential conflicts, experienced by survivors that result in many psychiatric symptoms and psychophysiologic illnesses when they were spared, but those who were near and dear to them were killed or died for reasons over which they had no control. One might think that people who survive should be glad to be alive and greet every dawn with gladness; instead, studies have shown many survivors of torture, concentration camps, disaster accidents and illness have a pervasive sense of guilt, morbid thoughts, suicidal ideation, and difficulty grappling with the exigencies of life. What was first known as a "concentration camp syndrome" (1) later became the "survivor syndrome." (2) These and other symptoms not only affected the survivor but also their children. (3)

Clinical impressions seemed to indicate that survivor symptoms of persistent high anxiety and deep depression did not easily fit any DSM category. The question was, were there signs and symptoms that were sufficiently specific to constitute a syndrome for those who survived when their siblings were aborted? A sample of 293 adults (98 patients and 195 counseling trainees, of which 85% were women and 13% were men) were given an 86-item self-report questionnaire. Demographic data indicated they were a reasonably representative sample of the population. Most questions were visual analoy. Internal reliability of the questions was determined by parallel form questions. A stepwise regression of symptoms associated with various pregnancy losses of the subjects' mothers indicated that the most prominent symptom was, "I don't feel I deserve to be alive." The Table indicates the other symptoms associated with it. These symptoms were not significant when the pregnancy loss was due to a miscarriage, stillbirth or early infant death.* Those who survive a mother's miscarriage feel that life is worth living. Those who had an abortion had a significantly different constellation of symptoms. Comparing the data from the patients' reports of their own pregnancy outcome and that of their mothers indicate significant correlations and a surprisingly accurate knowledge of their parent's pregnancy outcomes. Subjects who had past problems with repeated depression indicate the most likely causes were mistreatment as a child and an abortion of a sibling. Their mother's history of having an abortion was also a prominent contributor to the subject or the subject's partner having an abortion.

It appears that the symptoms and problems of abortion survivors have a number of distinctions from those of other types of survivors. (4) This is not surprising when it is understood that, during childhood, their lives were threatened by those who were supposed to care for them in any situation. When children realize their parents are willing to sacrifice one of their own children, it is understandable that they may have deep fears of those who care for them.

If the data and clinical impressions are correct, there appears to be a definable and diagnosable syndrome of symptoms and problems that arise in people whose parents have aborted their unborn siblings: the Post Abortion Survivor Syndrome (PASS). This constellation of existential guilt, risk-taking behaviors, sense of impending doom and prepsychotic terror appears to be distinct from symptoms that may arise in other types of pregnancy-loss survival situations, from childhood mistreatment, or from an abortion experienced by the individual or the individual's partner. (5) These symptoms are specific enough to point to a likely cause being the loss of a sibling by abortion. Unless the conflicts behind this existential dilemma are addressed, it is unlikely that the expression of these, ie, the need for psychiatric admission, or repeat depressions, are likely to be successfully treated by any other modality.

Philip Ney MD, FRCP, MA, RPsych

Claudia Sheils

Marek Gajowy, MA

Department of Family Practice

University of British Columbia

Victoria, British Columbia, Canada


1. Chodoff P. Late effects of the concentration camp syndrome. Arch Gen Psych 1963;8:323-333.

2. Niederland WG. Clinical observations on the "survivor syndrome". Int J Psychoanal 1968;49:313-315.

3. Krell R. Holocaust families: the survivors and their children. Compr Psychiatry 1979;20:560-568.

4. Ney PG. A consideration of abortion survivors. Child Psychiatry Hum Dev 1983;13:168-179.

5. Ney PG, Fung T, Wickett AR, et al. The effects of pregnancy loss on women's health. Soc Sci Med 1994;38:1193-1200.

*The full set of data can be obtained by request from the author at: PO Box 27103, Langford RPO, Victoria, BC V9B 5S4.
Table. Symptoms associated with "I feel I don't deserve to be alive"

Symptoms coefficient t-score Significance

a) I am not glad to be alive 0.360 7.117 0.000
b) I feel something terrible 0.229 4.772 0.000
 is going to happen to me
c) I have tried to kill myself 0.118 2.468 0.014
d) I fear I am losing my mind 0.181 3.375 0.001
e) I have injured myself 0.132 2.685 0.008

Step wise regression with cut off P < 0.05.
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sharon valerie dutton (Member): 369 student 4/14/2008 3:30 PM
The article could have been written about me. My mother tried to abort me and succeeded in aborting my twin. I survived. A lifetime, so far of depression, low self esteem, feelings of grief and so much more have pervaded my life. Therapy has done nothing to help and I am on anti-depressants. The work of Dr Ney is remarkable. I wish he was available in England for consultation. Bless him for his work and caring

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Author:Gajowy, Marek
Publication:Southern Medical Journal
Article Type:Letter to the editor
Date:Dec 1, 2006
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