Therapeutic Abortion: Who Needs a Psychiatrist?

Clinical experience in evaluating more than 500 women requesting therapeutic abortion has led to the development of 10 diagnostic syndromes. Inclusion of a woman into one of these syndromes implies the need for psychiatric consultation and the probability of adverse emotional sequelae if abortion is performed. Although most women do not require psychiatric consultation, it is essential for psychotic women, those with a history of psychosis and those who have suicidal ideation which persists after the offer of an abortion. Evaluation includes a detailed, private interview with the woman as well as ancillary interviews with involved third parties whenever possible. A cooling off period is recommended for women who are ambivalent or under acute stress. Because of the emotional complexities of pregnancy and abortion, the therapeutic relationship should not be severed with the performance of the abortion.