The abortion trauma is reexperienced as recurrent and intrusive distressing recollections of the experience; recurrent distressing dreams of the abortion or of the unborn child; sudden acting or feeling as if the abortion were recurring, accompanied by illusions, hallucinations and dissociative episodes especially upon awakening or when intoxicated; intense psychological distress at exposure to events that symbolize or resemble the experience (eg, clinics, pregnant mothers, subsequent pregnancies); anniversary reactions of intense grieving or depression. There is persistent avoidance of stimuli associated with the abortion trauma or numbing of general responsiveness (not present before the abortion), such as: efforts to avoid or deny thoughts or feelings associated with the abortion; efforts to avoid activities, situations or information that might arouse recollections of the abortion; inability to recall the abortion or an important aspect of the abortion (psychogenic amnesia); markedly diminished interest in significant activities; feeling of detachment or estrangement from others; withdrawal in relations and/or reduced communication; restricted range of effect, [eg] unable to have loving or tender feelings; sense of foreshortened future, [eg] does not expect to have a career, marriage, children or a long life. Associated persistent symptoms can include: difficulty falling or staying asleep; irritability or outbursts of anger; difficulty concentrating; hypervigilance; exaggerated startle response to intrusive recollections or reexperiencing of the abortion trauma; physiologic reactivity upon exposure to events or situations that symbolize or resemble an aspect of the abortion; depression or suicidal ideation; guilt about surviving when one's unborn child did not; self devaluation and/or an inability to forgive oneself; secondary substance abuse. The disturbance can exceed a month in duration or the onset may be delayed by six months or more after the abortion.