The emotional impact of diethylstilbestrol (DES) exposure is described in a series of 50 mothers and daughters interviewed by psychiatrists. Patterns of response to this trauma and methods of resolution are discussed, and opportunities for preventive intervention by gynecologists are suggested. Specific, open dialogue about DES with the patient as a colleage can minimize the emotional sequelae of the experience.
PIP: This study analyzes the emotional impact of diethylstilbestrol (DES) exposure in an index population consisting of 50 women at risk plus 30 mothers who were all interviewed about their DES experience in an open-ended, in-depth, clinical style. The findings show that significant emotional upset is the normal response to the knowledge that the ingestion of a drug during pregnancy can cause or has caused some abnormality in the offspring. Nevertheless, the capacity of a woman to come to terms with the anxiety DES has generated, once she had been given the chance to express her feelings and fears, was impressive. DES daughters reacted to the DES experience in one of 3 ways, in descending order of frequency: 1) trust (80%). Most DES daughters rationalized that their mothers and doctors did the best they could, and were generally cooperative in their follow-up care; 2) hostility (10%); and 3) fear (10%). 90% of DES mothers came to terms with the knowledge and implications of DES exposure in ways characteristic of their life-long personality styles; in contrast, the remaining 10% who did not come to terms with the reality of DES exposure felt overwhelmed by quilt, paranoid rage, fear, and despair. Physicians can help patients deal with such problems by: 1) acknowledging problematical feelings and expecting them to be difficult to deal with; 2) noting the patient's pattern of response, and supporting her strengths; 3) giving factural information matter-of-factly; 4) listening to reactions to this information; 5) giving a structured plan in which the woman participates and be available for follow-through on it (eg, periodic colposcopic examinations); and 6) referring the women to support groups for an extended network of information and continued support.