Adoption-Related Complex Trauma

Also called Cumulative Trauma – The research is definitive. Adopted kids are not only traumatized by the original separation from their parents, they may also have been traumatized by the events that led to them being put up for adoption. In addition to that, foster care itself is considered an adverse childhood experience.

I recently wrote a blog titled “It’s Simply NOT the Same.” Though the traumas may originate similarly, the outcomes are not the same because just like any other person, no two adoptees are exactly alike. That should not prevent any of us from trying to understand that adoptees carry wounds, even if the adoptee is unaware that the wounds are deep within them.

It is not uncommon for an adopted person and/or the adoptive family to seek mental health services due to the effect of the adoptee experiencing traumatic events. Unfortunately, for psychology and psychiatry clinicians, adoption related training is rare. In my all things adoption group, the advice is often to seek out an adoption competent therapist for good reason.

“What does an adopted baby know ? She knows her mother, she knows her loss, sadness and hurt, she knows that those who hold her today may be gone tomorrow and that she will be the only one left to pick up the pieces that no one seems to think are broken.”
~ Karl Stenske, 2012

The reasons a child is put up for adoption or relinquished are many – an unwanted or unplanned pregnancy, often compounded or driven by a lack of financial resources (poverty) or no familial support to care for a child. Becoming a single parent may simply seem too daunting to an unwed expectant mother. Sadly, for some, a chronic/terminal illness or certain diseases may lead the mother to believe she cannot provide proper care for her baby. Certainly, prolonged substance addiction and/or severe mental health issues (which may be related to addiction) can cause parental rights to be forcefully terminated by child welfare authorities. Adoptees who come out of the child welfare system (legal termination of parental rights by a court of law) cannot legally be returned to their birth families due to safety or other reasons that are considered serious.

Adoption is not always a success. Disruptions and dissolutions do sometimes occur.

Disruptions can happen after the adoption has been finalized when the adoptive parents then experience difficulties with their adopted child. The adoptive parents may have difficulty finding support and the resources they require to deal with the issues that come up.

Risk factors leading to a higher rate of disruptions are: older age when adopted, existing emotional and behavioral issues, having a strong attachment to their birth mother, having been a victim of pre-adoption sexual abuse, suffering from a lack of social support from relatives causing the adoption to occur, unrealistic expectations surrounding the adoption and the child on the part of hopeful adoptive parents, and a lack of adequate preparation and ongoing support for the adoptive family prior to and after the placement.

A devastating occurrence is a dissolution or breakdown. This applies to an adoption in which the legal relationship between the adoptive parents and the adoptive child is severed, either voluntary or involuntarily. Usually this will result in the entry or re-entry of the child into the foster care system, or less commonly a second chance adoption, or even the private transfer of the child from the adoptive parents to a non-vetted receiving parent.

Adoption has been subject to both positive and negative assumptions related to the practice and this is of no surprise to anyone who has studied the practice of adoption for a period of time.

There are 6 main assumptions about the practice of adoption –

[1] Adoption is a joyous event for all involved – known as the Unicorns and Rainbows Fantasy in adoption centric communities; [2] adoption parallels genetic birth experience and a biological family life – which close observation and mixed families (who have both biological and adopted children often belie); [3] once adopted, all of the child’s problems disappear and there will be no additional challenges – rarely true – and often attachment or bonding fail to occur; [4] creating a family through adoption is “false,” only biological families are “real” – this goes too far in making a case because many adults create chosen families – the truth is as regards children, family is those persons we grow up with – believing we are related to them – in my case, both of my parents were adopted and all of my “relations” growing up were non-genetic and non-biological but I have a life history with them and continue to have contact with aunts, an uncle and cousins I obtained through my parents’ adoptions; [5] the adoptive life is better than the biological life the child had or would have had – never a known assumption – more accurately, the adoptee’s life is different than that child would have had, if they had not been adopted; and, [6] closed adoptions are in the best interest of the child – this one was promoted with the intention of shielding adoptive parents from original parents who regretted the surrender, from the child who might yearn for their original family and often in some cases to shield a person operating unscrupulously, such as the baby thief Georgia Tann who sold ill-gotten children. Popular media has reinforced both the positive and the negative messages about adoption and many myths and stereotypes regarding adoptive families and birth parents are believed in society as a whole.

The term “adoption-related complex trauma” is rarely used in discussing symptoms and behaviors. It is more common to see terms such as “developmental trauma” or “complex trauma” to describe the psychological effects found within the adopted population.

The terms complex trauma and complex post-traumatic stress disorder have been used to describe the experience of multiple and/or chronic and prolonged, developmentally adverse traumatic events, most often of an personal nature such as sexual, physical, verbal abuse or of a societal nature such as war or community violence. These exposures often have occurred within the child’s caregiving environment and may include physical, emotional and/or other forms of neglect and maltreatment that begin early in childhood. In the case of infant adoptions, the trauma is non-verbal but stored in the body of that baby – not conscious but recorded.

Some of this content has been sourced from a long dissertation titled Treatment Considerations For Adoption-related Complex Trauma. Anyone interested is encouraged to read more at the link.

Healing Trauma

I’ve only just learned about this book and have not read it but didn’t want to wait for whenever, if ever, that might happen to pass it on to readers here.

Many adoptees and foster children have some degree of trauma. It is said that this is one of the best-known books about trauma, and in particular early life trauma (which especially applies to the topics I cover in this blog). 

It is not light weight reading, has almost 500 pages that includes a significant reference section. Someone who did read this (link at bottom of this essay) says – “It’s very in-depth, giving plenty of detail, but it’s not unnecessarily complicated. There’s some technical terminology used, particularly with respect to the functioning of the brain, but I thought this was explained well.”

Van der Kolk is a psychiatrist who initially began working with trauma while treating war veterans. There was a lot that wasn’t known about trauma then. He’s been an active researcher throughout his career and often considered at the forefront of new trauma-related knowledge.

In this book, he repeatedly stresses the importance of recognizing the changes that occur in the brains and nervous systems of people who’ve been through trauma, and targeting treatment accordingly with the goal of getting back the functioning they have lost. He is quoted as saying, “Trauma results in a fundamental reorganization of the way mind and brain manage perceptions. It changes not only how we think and what we think about, but also our very capacity to think.”

Imaging studies have produced some new understandings about flashbacks. There’s activation of the right brain along with a drop in activity in the brain structure called the thalamus, which prevents the events from being remembered as a coherent narrative, as would be the case with other kinds of memories.

Brain scans have also shown an impaired self-awareness. Van der Kolk explains that this is why it’s important to work on breathing, mindfulness, and recognizing the link between physical sensations and emotions. He writes further: “The body keeps the score: If the memory of trauma is encoded in the viscera, in heartbreaking and gut-wrenching emotions, in autoimmune disorders and skeletal/muscular problems, and if mind/brain/visceral communication is the royal road to emotion regulation, this demands a radical shift in our therapeutic assumptions.”

The book pays a lot of attention to early life trauma, including issues like attachment and attunement. The author explains that trauma increases the need for attachment, even when the only attachment figure available to the child is the abuser.

Van der Kolk championed adding complex PTSD as a separate diagnosis from PTSD. He was part of the working group that proposed C-PTSD for inclusion in the DSM-IV, and the group that proposed developmental trauma disorder for inclusion in the DSM-5. American Psychiatric Association did not approve any of these suggestions as new diagnoses.

I am indebted to Ashley of The Mental Health @ Home blog for her review which is the basis of my own blog today. You can read more about this book in her article.