Thirty-two women who had spontaneous abortions were studied by interviews and psychological testing and were compared to a group of 46 women who had therapeutic abortions. In contrast to the therapeutic abortion group, the spontaneous aborters demonstrated little in the way of serious psychopathology. However, in the spontaneous group those women who developed clinically significant depressive reactions did so at the time of the abortion, which was not the case in the therapeutic abortion group. Psychological tests indicated conflicts around sexual identity and sadomasochism in spontaneous aborters resembled but were not as severe as in the therapeutic abortion group. The evidence suggests that the pregnancy and abortion itself may be seen as a primary way of acting out unconscious sadomasochistic conflicts in spontaneous aborters.