Many families have an adoption story to tell. As an adoptee myself, and a therapist who works with adoptees, I am impressed by both the diversity of experiences surrounding adoption, and the commonalities. The diversity speaks for itself—many adoptions save lives, provide loving homes for adoptees, and offer extended biological and adoptive family networks. Still others have stories of abuse, loss, and cultural estrangement. No two adoption stories are the same, yet it’s the commonalities that tend to bring clients to my office, as adoptees struggle to make sense of their (largely unknown) life and ancestral histories.

Given the nature of adoption, which severs adoptees from their birth parents and often places them in the homes of parents and families that lack blood ties, many adoptees suffer from Reactive Attachment Disorder or RAD. Even when the adoptive parents love their adopted children as if their biological progeny, siblings, grandparents, aunts, uncles and cousins may not share that same filial attachment. Consequently, it’s no surprise that adopted children often feel displaced, different, and “less than” in their adoptive families, a constellation of emotions that manifest as RAD. RAD presents in childhood as an inability to form normal relationships—fear and distrust of others, particularly adults, leaves them feeling isolated and withdrawn, particularly when one or both adoptive parents fail to bond with their adoptive child.

Sometimes these adopted children become desperate for affection, seeking out affection from any adult who shows them any interest. By the time they seek therapy as adults, they may be perceived as borderlines, chasing after affection in all the wrong places, and pushing it away once they receive it. Or they may have developed highly effective ways to erect walls between themselves and others. The commonality is an inability to establish normal intimacy with their partners, children, and others in their lives. We see RAD especially in adoptees from Russia, China, and Romania, where they received no physical affection for the first couple of years of life. RAD is also common among children who come from abusive environments, where neglect, physical abuse and sexual abuse left them unable to trust and understand healthy physical and emotional affection.

One way RAD manifests is when the adult adoptee tries to establish a new “family.” They will view their spouse’s family as their own family, in a manner that goes beyond normal in-laws. They will expect to be treated as an equal family member, and view any exclusion, however slight, as a rejection. Divorce can be especially traumatic for adoptees with RAD because they view the breakdown of the marriage as not just a loss of the spouse or a shattering of the nuclear family, but they will feel as if they have lost their entire extended family. They often persist in trying to maintain their relationships with their ex-spouse’s family even after the divorce, and can feel traumatized, rejected, and angry if the family establishes any boundaries with them. Because the attachment to the spouse’s family is not always reciprocated, or boundaries limit the attachment, even during the marriage, these boundaries can retraumatize the adoptee leaving both the adoptee, and the in-laws, confused, frustrated, and angry.

As children, adoptees are often stigmatized and bullied for having been rejected by their birth parents. I know I was bullied for being an adoptee, though I was lucky because my mother was aware of the stigma I faced, and she prepared me for it. But others aren’t so lucky and their adopted families don’t understand what’s going on with the child. They may not even notice the bullying, and in many cases, not only do they not notice the child’s sense of self as different, but they become angry at the child for having such feelings. The attitude such families convey to their child is, “You’re lucky we took you in, how can you be so ungrateful?” These children grow into adults who carry with them the Imposter Syndrome, not only in their work, but in their marriages, their friendships, and their most private thoughts.

Finally, there is one other area that is only beginning to receive attention and that’s epigenetic trauma. The stress a bio-mom is going through during her pregnancy is usually severe, and that stress can damage RNA and DNA. This epigenetic trauma, as well as prenatal exposures to drugs or alcohol that may never be known, can cause cognitive impairments, developmental disabilities, and behavioral problems that the adoptee can’t always control.

With the rise in international adoptions, changes in adoption laws that have opened previously sealed records, and now the ability to post our DNA online and find our birth families, the impact of adoption has never been greater. What this means for many families is that an avalanche of emotions are exposed as birth families discover, or rediscover, family members given up for adoption. Adoptees may find loving acceptance with their birth families, leading to confusion, reassessment of their life histories, and potential estrangement from their adoptive families. Or they may find rejection, triggering a traumatic response and intensified signs and symptoms of RAD. And the adoptive families often face fear of losing their child to the birth family, alienation, or other complex emotional responses that they are unprepared for.

When working with adoptees, therapists must be careful we don’t just ignore the role their adoption has played in the social and emotional issues they bring to us, and clients who have been adopted can gain valuable insights by exploring the role their adoptive status may have played in their lives. Many adoptees may or may not be aware of how much their early childhood loss and placement in a new family has played in what’s going on with them, but through skilled therapeutic intervention, they may be surprised to discover that their adoption has influenced their lives. Whether it’s relationship difficulties, substance abuse, sleep disturbance, poor decision-making or goal setting, their adoptive status in the families that raised them, and not knowing their ancestry, medical history, or blood relations, places the adoptee in the fuzzy zone of “other.” As adoptees, we struggle to reconcile the “other” we’ve internalized, with the story of our birth and why we’re here, in this world, and with this family that has raised us, and not the family that gave us life. As therapists, our task is to shine a light on how this early primal loss and unique familial history contribute to the cognitive, emotional, social, and behavioral patterns our clients present. It’s a therapeutic challenge that we’re only beginning to understand, but one I find to be as exciting as it is fascinating, and as complex as it is misunderstood. And it all begins with understanding that adoption impacts anyone whose family and biology are two entirely separate worlds.