In this article, you will find information on relinquishment trauma (aka adoption trauma, adoptee birth trauma, separation trauma, primal wound) and how it impacts the way an adoptee views and interacts with their world. The relinquishment trauma information presented in this article synthesizes stories of relinquishment trauma with developmental trauma research, prenatal experiences, and how the human brain works. This article includes how adoption trauma can impact relationships. It concludes with information on adoption counseling and resources.

What is Adoptee Relinquishment Trauma?

While post-traumatic stress disorder is a recognized mental health condition with treatment protocols, tragically, relinquishment trauma – the trauma that occurs to a child when the bond with their mother has been severed due to relinquishment -is frequently ignored by the mental health clinicians and the adoption research community[1]. The adoption community believes relinquishment trauma is a form of developmental trauma [2] that occurs when a psychological wound happens to a newborn or child that has been separated from their mother due to adoption, foster care, or orphanage. Just because some adoptees do not develop relinquishment trauma with symptoms, it does not mean that relinquishment trauma is not a mental health condition with debilitating effects for some adoptees.

Often relinquishment trauma and adoption trauma are used synonymously. This author believes relinquishment trauma is one type of adoption trauma. In addition to relinquishment trauma, there are additional adoption traumas that could be traumatizing to an adoptee. Other adoption traumas include: finding out you were adopted as an adult (late discovery adoptee), being raised as a white person when an adoptee is a person of color, and adoptees being raised “as if” they were born into their family. Beyond the scope of this article would be an article that presented cumulative adoption traumas for adopted persons.[3] With some adopted persons having multiple adoption traumas, it is extremely important for mental health clinicians working with adopted persons to do a comprehensive adverse relinquishment and adoption experiences assessment that includes a range of traumas from the birth mother’s pregnancy, relinquishment, time with the adoptive family, and community experiences.

Nancy Verrier, author of The Primal Wound: Understanding the Adopted Child, describes the primal wound as a “physical, emotional, psychological, and spiritual wound, a wound which causes pain so profound as the have been described as cellular by those adoptees who allowed themselves to go that deeply into their pain.” Interestingly, Nancy Verrier[4] realized this as an adoptive parent whose daughter reenacted her rejection and abandonment issues with testing-out behaviors.

With each adopted person having their own unique story, personality, family, and community, it is important to recognize that some adoptees will feel an event is traumatizing while another adopted person experiencing a similar event will not. While research has shown having a strong nurturing attachment to a primary caretaker (usually a parent) can be a protective factor in lessening the impact of trauma, having a good relationship with an adoptive parent does not automatically heal relinquishment trauma. Adoptees can love their adoptive parent(s) and feel traumatized by their relinquishment and adoption.

How Does Adoptee Relinquishment Trauma Happen?

Research has shown that babies in utero learn their mother’s characteristics. Characteristics include the sound of their mother’s voice and her olfactory signatures from the pregnancy[5][6]. The newborn child may become easily frightened and overwhelmed when the caretaker is not their first mother. The greater discrepancies between the adoptee’s prenatal and early life (sound of the mother’s heartbeat, language, sounds, facial features, smells, the personal gait of walking, level of activity) the greater stress on the child. When a child is not with their first mother day after day, the newborn frequently becomes anxious and confused causing the infant’s body to release stress hormones. Even newborns that are placed with the adoptive parent within days of their birth can feel traumatized. Newborns know their mother is missing and they are being cared for by strangers. The newborn’s trauma experience is multiplied when there are numerous caregivers and placements before the child joins their adoptive family. The number of caretakers babies and children have been exposed to in foster care, orphanages, lengthy hospital stays, homes run by adoption agencies, and college-run domecon classes have set the stage for some adoptees to grow up with issues of anxiety, depression, attachment issues, and post-traumatic stress disorder. Birth psychology researcher, Paula Thomson[7] states “early pre-and post-natal experiences, including trauma, are encoded in the implicit memory of the fetus”. This may include that a child could inherit a predisposition for sadness or anxiety if their first mother was anxious or depressed while pregnant. This writer is unaware of any research that studies the impact of a mother not connecting with her child in the womb and the potential impact of the child’s ability to attach later in life. It is not the adoption that causes the trauma, it is the relinquishment and the loss of the familiar that is traumatizing[8]. Adoption is the legal process that occurs after the relinquishment.

Relinquishment Trauma as a Developmental Trauma Disorder

When trauma researchers saw the majority of children who experienced trauma did not meet the diagnostic criteria for post-traumatic stress disorder and were labeled with an unhelpful diagnosis that described behaviors, trauma researchers began to think of a new way to diagnostically describe how a child’s mind and body changes because of trauma. This led to the proposal of developmental trauma disorder[9]. The diagnostic criteria for developmental trauma states a child or adolescent needs to have been exposed to:

“interpersonal violence or a significant disruption of protective caregiving as the result of repeated changes in primary caregivers, repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse”.

Tragically, most mental health clinicians and developmental trauma researchers do not include the relinquishment of a newborn child as part of the changes in caregivers as part of developmental trauma diagnostic criteria. This leaves adoptee relinquishment trauma to be overlooked by mental health professionals creating a significant lack of adoption competent mental health professionals. While the American Psychiatric Association declined to include developmental trauma disorder in the DSM-V, developmental trauma disorder has been accepted by many trauma researchers and mental health clinicians.

What are the Characteristics of Relinquishment Trauma?

Trauma changes an individual’s brain chemistry and functioning. Relinquishment trauma can elevate adrenaline and cortisol and lower serotonin resulting in adoptees feeling hypervigilant, anxious, and depressed. Difficulty with transitions and separation anxiety are common experiences. Paul Sunderland has a fascinating lecture “Adoption and Addiction: Remembered Not Recalled” which describes relinquishment’s impact on a child’s brain and their view of their world[11]. The lecture can be watched by clicking the video to the left.

The title of his lecture includes addiction because he believes addiction (drugs, alcohol, sex, the adrenaline rush of risky behaviors) is often the result of adoptees trying to soothe the imbalance of their brain chemistry caused by relinquishment trauma.

Trauma causes individuals to become emotionally stuck at the age that the trauma happens. Thus, we frequently hear adoptees described as “emotionally immature for their age”. This is a result of their brain chemistry interfering with a brain’s developmental trajectory. MRIs of children’s brains who have experienced trauma look different than their non-traumatized counterparts.

Trauma research tells us the traumatic event causes current events to be viewed through the lens of the trauma – i.e. the world is unsafe, loved ones leave. The trauma experience is worsened when the adoptive parent minimizes the adoptee’s grief and fears of abandonment. These experiences cause an adopted person to mistrust their inner self. It is common for adult adoptees to emotionally believe they must have caused their relinquishment even though they intellectually know it was the decision of the adults involved, not them. With children being prone to fantasies, the young adoptee can develop the fantasy that meeting the birth parent will heal their trauma. The pain of the relinquishment is so great that it becomes easy for an adopted individual to spend decades believing their healing fantasy. Even if the reunion with the birth parent goes exceptionally well, a wonderful relationship does not completely heal the traumatized brain.

With the relinquishment trauma happening soon after birth, an adoptee’s personality may be defined by the trauma. When an adult experiences a significant trauma, they can remember what they were like before the trauma. When relinquishment trauma happens, the adult adopted person does not have words to describe their trauma experience because the experience occurred preverbally. The maturing adoptee has no frame of reference for what they were like before their relinquishment trauma. The adoptee’s survival skills – hypervigilance, need for control, lack of close relationships- are seen as personality traits rather than a response to a traumatic experience. These adoptee issues are referred to as the core issues of adoption.

Isolation, Secrecy, and Shame Negatively Impact Trauma

The life of an adopted person is impacted by the lack of information on their story and lack of validation of what they have been through. Adoptees can easily be made to feel something is wrong with them when individuals dismiss their belief their lost connection to their first family matters. This can lead to the adopted person not verbalizing their truth. When the painful truth is not spoken, it can compound the trauma. The secrecy, lack of acknowledgment, and isolation often create a feeling of shame.

Shame negatively impacts healing from trauma. Research by Regina Hiraoka[11] found less post-traumatic stress disorder symptoms in combat veterans that practiced self-compassion than veterans with have higher shame and self-judgment. I believe this trauma research can be extrapolated to birth parents and adoptees in that the shame placed on birth parents and adoptees (society, others, and themselves) can potentially increase the symptoms of relinquishment trauma.

Adoption Trauma and Relationships

The beginning of the adoptee’s connection to the adoptive parent often starts with anxiety and confusion. The infant knows their caretakers are not the same. Key to the adoptee child’s ability to attach to the adoptive parent is the adoptive parent’s ability to attach to their child without taking their child’s grief and anxiety of missing their first parent personally. When the adoptive parent, usually the adoptive mother, does not feel entitled to parent, the infant can sense the parent’s ambivalence creating further anxiety for the child. A strong bond to an adoptive parent is a protective factor against developing relinquishment trauma. That being said, an excellent relationship with an adoptive parent does not replace the birth mother. When the adoptive parent has their own attachment issues -from their childhood or feeling their bond will never be as good because they are not the real parents- the greater risk of relinquishment trauma. The relationship between the adoptive parent and child becomes further damaged when the adoptive parent minimizes the adoptee’s true story that they have a first family and history. It is traumatizing to an adoptee to be told they should feel “grateful” for being adopted and they are “disloyal” for wanting to talk about their birth family and how it feels to be adopted. There is extensive research on that when adopted persons can talk to their adoptive parents about their adoption experience with genuine openness and no shame the stronger the parent-child relationships and adopted person’s risk for mental health issues decreases.[12][13]

“The legacy of this trauma for the relinquished child is a conflict between wanting to connect and fearing connection. This is often experienced as hypervigilance that has an enormous impact on relationships and functioning which can disrupt the ability to be present, with feelings that one is both “too much” and “not enough.”–Paul Sunderland

When the relinquishment trauma happens before the age of three, the memories of the trauma are stored in the unconscious part of the brain as implicit memories. Implicit memories are not coded in the brain as coherent but as fragmented sensory and emotional fragments- images, sounds, and physical sensations. This leaves an adopted person to feel like something is missing, they have a hole inside of them, or their connections feel fragile and insecure. These feelings will impact how an adopted person interacts with family and friends. The traumatized brain often responses with flight, flight, freeze, or fawning (people-pleasing) when the implicit traumatic memories are triggered. Common scenarios of adopted persons reacting to their trauma trigger include: provoking an argument with a loved one and walking out knowing their loved one will go after them, running away as a teenager while leaving clues for their adoptive parents to find them, or emotionally freezing when boundaries are crossed. An example of a fawning response is going along with something that a person does not want to do for fear there will be negative consequences to the relationship. Fight, flight, freeze, and fawning are common reactions during early reunion contact.

Adoption reunions are filled with complexities due to ghost images[14] of the lost relative, expectations for what the relationship should be, the triggering of implicit memories, and trauma. Contact with lost relatives often brings answers and a relationship (even if it is not the original type of relationship desired). Genetic mirroring can often fill the hole inside the adoptee. Reunions cannot rewire the traumatized brain. With the fear of losing their relative again, reunion relationships can be filled with an obsessive need for contact. Some reunion relationships have a genetic sexual attraction that is caused by a combination of brain chemistry and a need for the adoptee and their birth relative to heal their relinquishment trauma. Intimate contact between an adoptee and a birth relative will not heal the primal wound. Thus, adoptees need to have realistic expectations for the reunion relationship to not heal their trauma.

Adoption Counseling for Healing Relinquishment Trauma

While there is research on helping adoptees with identity issues and grieving losses, and other “adoptee issues”, there is a lack of research specific to relinquishment trauma. We know from trauma therapy research that recovery can be achieved when an individual feels free to know what they know while desensitizing themselves to their emotional triggers. In other words, finding a way to stay calm in response to images, thoughts, sounds, or other physical sensations that remind a person of their trauma[15]. Thus, therapy techniques that focus on helping individuals stay grounded in the present while stressful events are recalled may be helpful. Evidenced-based trauma therapies include eye movement desensitization and reprocessing (EMDR), brain spotting, neurofeedback, and the Emotional Freedom Technique (tapping). Other modalities that may be helpful are yoga and mindfulness. Julie Lopez’s book Live Empowered! – Rewire Your Brain’s Implicit Memory to Thrive in Business, Love, and Life includes case information on adopted individuals and detailed information on trauma therapies. Adoptees also greatly benefit from adoption support groups. When an emotional injury occurs from an interpersonal relationship often healing can come from the interpersonal nature of support groups.

Counseling for individuals with trauma symptoms should include an adverse childhood experiences assessment. It could be harmful to assume that all trauma symptoms were caused by the relinquishment. The assessment should include prenatal trauma (i.e. alcohol, drugs, lack of nutrition), number of caretakers before placement and after placement, psychological, physical, or sexual abuse, and additional traumatic events (homelessness, a parent with significant mental health issue). Additionally, the assessment should evaluate for other adoption traumas. Other adoption traumas include being a person of color raised to having a white identity, late discovery adoptee, adoption microaggressions, shaming for wanting to talk about how it feels to be adopted and birth parents. The Adverse Relinquishment and Adoption Experiences Assessment discusses the extent of adoption traumas for adopted persons, birth parents, and adoptive parents.

Discussion

So, where do we go from here? First, we need to change the narrative around adoption and allow the losses, trauma, and other negatives to be acknowledged. The mental health professional community needs to recognize relinquishment and adoption traumas have an impact on an adopted person’s mental health. Having a loving family does not heal the brain. If it did, most mental health conditions would disappear if individuals were in a loving relationship. Developmental trauma researchers need to acknowledge relinquishment as a cause of developmental trauma. The research needs to look at why some adoptees are more resilient than other adoptees and what can be done to reduce the impact of the traumas.

Relinquishment trauma needs to be taught in all levels of clinical training – college level, continuing education, and adoption competency trainings.[16] Research has repeatedly shown adoptee teens are over-represented in the clinical population- outpatient counseling, residential treatment, and psychiatric hospitalization. Additionally, the suicide rate of transracial teen adoptees is higher than the general population [17]. Mental health professionals frequently are not understanding what is behind the depression, anxiety, or acting out behaviors of many adopted individuals. Too often, adoptive parents are blamed for their child’s emotional struggles.

The length of time a child spends in foster care and orphanages needs to be minimized as much as possible. The more caretakers the greater chance of trauma. Adoptive parents need to be educated on relinquishment and adoption issues before a child is placed with them. Adoptees with “issues” should not be labeled as having bad genes or ungrateful.

It is important to conclude that this blog post should not be construed as proof that adoption is so harmful to an adoptee that adoption should be discontinued. As you can tell by reading this blog post, I believe in reading the research. What I have found by reading the long-term metanalysis research on adopted individuals is that adopted persons do as well as nonadopted persons in studies of individuals outside of clinical settings when adoptees are evaluated in middle age. Notice I did not say teenage adoptees. Too often poorly designed research studies on adoptee mental health issues are being used as proof that adoption is predominately harmful. Examples of poor research designs include research that only studies adoptees in therapy – not the general public, research without a control group of non-adopted persons, research that did not control for adverse childhood experiences (i.e. trauma, prenatal alcohol exposure) prior to the adoption, or the researchers that coded the results were not blind to the adoption status of the individuals they were evaluating. Using statistics out of context like adopted teens are over-represented in residential treatment programs only furthers the malignment that all adoptees are messed up. Adopted teens are over-represented in residential treatment, but if the research does not control for preadoption traumas (abuse prior to adoption, prenatal alcohol exposure, multiple caregivers due to foster care) then there is no delineation of what caused the need for residential treatment – preadoption risk factors, adoption as the risk factor or both. Well-designed research on adoptees that show mental health issues can be insightful to the risk factors. An example is Keyes[18] research Risk of Suicide Attempted in Adopted and Non-Adopted Offspring which found teenage adoptees in their study had a four times risk of a suicide attempt. The demographics of the adopted teens in this research – non-newborn placement age, transracial adoption, transcultural (i.e. international), and poor relationships with adoptive parents – are risk factors for mental health issues for teen adoptees. Ideally, a follow-up study would be same race newborn placement of adopted teens who had good relationships with their parents with a control group of non-adopted teens with similar demographics.

We should not only believe in family preservation but provide financial resources for those that want to parent their child. When adoption does occur, it should be done as humanely as possible with having the least number of adverse conditions for the adoptee to decrease the risk of relinquishment trauma and other adoption traumas. The goal of this article on relinquishment trauma is to help adoptees, birth parents, their family members, and the mental health professionals that work with them to have a framework for understanding relinquishment trauma. The more individuals know about adoption traumas, traumatized adoptees can receive support for their healing journey.

Please do not conclude or cite this blog post as anti-adoption.

[1] While adoption trauma can be found in an Internet search, this author was unable to find one research article on adoptee relinquishment trauma. Nancy Verrier’s book The Primal Wound is a testament to the impact of relinquishment on adoptees but it is not a research paper. A few research papers have been written on post-traumatic stress disorder in birth mothers because of relinquishment. These articles are cited on the Adoption Search and Reunion blog page.

[2] To learn more about developmental trauma disorder read The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk. While researchers of developmental trauma do not describe or use the term “relinquishment trauma”, case examples of adoptees with developmental trauma can be found in the writings of developmental trauma researchers.

[3] Hoksbergen, R., van Dijkum, (2001), Adoption and Fostering, Trauma Experienced by Children Adopted from Abroad, 25(2), 18-25

[4] To learn more about Nancy Verrier and her contributions to the psychology of the adoptee person visit her website http://nancyverrier.com/about-the-author-nancy-verrier/

[5] Paul, A. (2011, November 29). What We Learned Before We’re Born, Ted Talks

[6] Porter, R., Balogh, R., Cernoch, J., Franchi, C., (1986). Recognition of Kin Through Characteristic Body Odors, Chemical Senses, 11(3), 389-395

[7] Thomson, P., (2004), “The Impact of Trauma on the Embryo and Fetus: An Application of the Diathesis-Stress Model and the Neurovulnerablity-Neurotoxicity Model, Birth Psychology, 19, (1)

[8] Gonzales-Gonzalez, N. L., Suarez, M.N., Perez-Pinero, et al., (2006), Persistence of Fetal Memory into Neonatal Live, Aca Obstetricia et Gynecologica, 85: 1160-1164 discusses the ability of newborns to remember in utero experiences.

[9] Diagnostic criteria for developmental trauma disorder can be found at the Attachment and Trauma Network’s website at https://www.attachmenttraumanetwork.org/developmental-trauma-disorder

[10] Paul Sunderland lecture can be found on YouTube at https://www.youtube.com/watch?v=3e0-SsmOUJI

[11] Hiraoka, R., Meyer, E. C., Kimbrel, N. A., DeBeer, B. A., Gulliver, S. B., Morissette, S. B., (2015). Self-Compassion as a Prospective Predictor of PTSD Symptom Among Trauma-Exposed U.S. Iraq and Afghanistan War Veterans, 28(2), 127-133.

[12] One research article on this is David Brodzinsky’s research Family Structural Openness and Communication Openness as Predictors in the Adjustment of Adopted Children, Adoption Quarterly, 9 (4), 1-18

[13] Triseliotis, J., Feast, J., Kyle, F., (2005), The Adoption Triangle Revisited: A Study of Adoption, Search, and Reunion Experiences, British Association for Adoption and Fostering, pp. 146

[14] Lifton, B. J. (2009). Ghosts in the Adopted Family, Psychoanalytic Inquiry, 30(1), 71-79

[15] van der Kolk, B, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma (2014)

[16] Research has shown the majority of college degree programs for mental health training do not teach adoption issues. Even the best-known adoption competency training program does not present information on relinquishment and adoption trauma.

[17] Keyes, M., et al. (2013), Risk of Suicide Attempt in Adopted and Nonadopted Offspring, Pediatrics, 132(4), pp 639-646

[18] Keyes, M., Malone, S., Sharma, A., Iacono, W., McGue, M., (2013). Risk of Suicide Attempted in Adopted and Nonadopted Offspring, Pediatrics, 132(4), 639-646.

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