Thursday, April 21, 2011

Adoption Related Post Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD) may occur soon after a major trauma, or it can be delayed for more than 6 months after the event. When it occurs soon after the trauma, it usually gets better after 3 months. However, some people have a longer-term form of PTSD, which can last for many years...PTSD can occur at any age and can follow a natural disaster ... assault, domestic abuse, or rape....The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD.  PubMed Health
PTSD is recognized by the National Institute of Mental Health (NIMH) who defines it as:
Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat. 
PTSD is an anxiety disorder that some people get after seeing or living through a dangerous event.
When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in PTSD, this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger.
Symptoms of PTSD fall into three main categories:

1. Repeated "reliving" or "re-experiencing" of the event, which disturbs day-to-day activity.
  • Flashback episodes, where the event seems to be happening again and again
  • Recurrent distressing memories of the event
  • Repeated dreams or nightmares of the event
  • Physical reactions to situations that remind you of the traumatic event
2. Avoidance
  • Emotional "numbing," or feeling as though you don’t care about anything
  • Feelings of detachment
  • Inability to remember important aspects of the trauma
  • Lack of interest in normal activities
  • Less expression of moods
  • Staying away from places, people, or objects that remind you of the event
  • Feeling strong guilt, depression, or worry
  • Losing interest in activities that were enjoyable in the past
  • Having trouble remembering the dangerous event. 
  • Sense of having no future
3. Arousal or hyperarousal
  • Feeling tense or "on edge"
  • Difficulty concentrating
  • Exaggerated or easily startled
  • Excess awareness (hypervigilance)
  • Irritability or outbursts of anger
  • Sleeping difficulties
You also might feel a sense of guilt about the event (including "survivor guilt"), and the following symptoms, which are typical of anxiety, stress, and tension:
  • Agitation, or excitability
  • Dizziness
  • Fainting
  • Feeling your heart beat in your chest (palpitations)
  • Fever
  • Headache
  • Paleness
I KNOW that I suffer PTSD.  I have experienced MULTIPLE trauma in my life both before and after the loss of my daughter to adoption.

The work I have done for the past 40 years in adoption is my coping mechanism.

Let's share...


BL said...

The problem with PTSD is the way it is currently defined. The DSM-IV-TR states that one must first have “experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others." These are called "gateway events," and exclude the loss of a child to adoption. The debate about what constitutes a "gateway event," or even if gateway events should be defined, is known as the "Criteria A Debate."

So the current definition of a gateway event would exclude the loss of a child to adoption. The ironic thing is that counsellors, psychologists, etc. use this as "Proof" that natural mothers do not and can not have PTSD, when in fact the question of whether PTSD might result from the loss of a child to adoption was NEVER TESTED FOR in the field trials of the current diagnostic criteria! No-one bothered looking for it, so it was excluded by error of omission, NOT by deliberate decision!

There is a large body of evidence in the literature that points to the fact that it IS a highly traumatic event for many natural mothers.

But Weathers and Keane (2007), who are big proponents of keeping the existing criteria A, do encourage research on broader categories of potentially traumatic events: "Clearly more studies are needed in which a wide variety of stressors is examined with respect to their ability to elicit PTSD symptoms. Regardless of how Criterion A is officially defined, investigators can and should empirically evaluate the impact of alternative definitions on the prevalence of trauma exposure and PTSD, if they include explicit operational definitions such that others can critique or attempt to replicate their findings." (pp. 114-115).

So, some refuse to provide trauma-focused therapy for natural mothers, using this as the rationale. Other counsellors and psychologists go by what the DSM-IV-TR says on page xxxii, "The specific diagnostic criteria included ... are mean to serve as guidelines to be informed by clinical judgment and are not meant to be used in a cookbook fashion."

There are several of us who are trying our best to convince organizations such as the APA to consider that gateway events for PTSD be expanded to include something like: "For a child, permanent separation from (or loss of) a parent. For a parent, separation from (or loss of) a child."

But we also have to go ahead and encourage researchers do study this question. My own M.A. thesis involved creating a research proposal for such a study. I would love to see someone take it on as I am not currently in a PhD program and am not certain when I will be able to enroll in one, given my family commitments right now.

Does one blame a rape victim for her "decision" and try to make her "take responsibility for her rape"? No, but since DeSimone did his dissertation in 1994 linking coercion and grief, this is the standard counselling practice to treat natural mothers. I feel it is both harmful and unethical.

Unknown said...


It does fit under the NIMH definition however.

Anyone who wants/needs counseling or therapy specific to this event needs to find one of the RARE therapists who are sensitive to adoption issues. Nonexistent in the majority of states!

BL said...

For anyone who wants to make a difference -- who wants to inform trauma researchers and encourage them to research adoption-related PTSD, and inform clinicians that there is a huge group of traumatized mothers who are looking for competent trauma treatment -- please write to the International Society of Traumatic Stress Studies ( They need to hear from us. Unless we speak out to the people who do the research, give input on what goes into the DSM, and conduct the clinical practice, our experiences will remain invisible to them.

Mirah Riben said...


Three mothers - in a discussion of this issue on facebook - state that they were officially diagnosed with PTSD as a result of their adoption loss. You can go to MY facebook page and see the discussion, or email me and I will send you more info.

I admit to being a bit confused how that can be if it is not recognized as a diagnosis in these cases.

BL said...

I was also diagnosed by a registered PhD-level psychologist as having PTSD from the loss of my son to adoption. BUT, these diagnoses are not recognized by the DSM, because we have not experienced the necessary "gateway event." I can email you a long list of articles that debate what should be considered a "gateway event" and whether the current Criteria A (what constitutes such an event) should be expanded. It's an ongoing argument.

These psychologists etc who have diagnosed us as having PTSD (here where i live, only psychiatrists and psychologists are qualified to diagnose) have "broken the rules" -- and the problem is that there is just as many such clinicians (including counsellors and social workers out there who adhere strictly to the DSM and refuse to treat natural mothers of adoptees for PTSD. Because, strictly speaking, PTSD cannot result from the loss of a child to adoption because there was nothing dangerous, physically injurious life-threatening to it.

309.81 DSM-IV Criteria for Posttraumatic Stress Disorder

"A. The person has been exposed to a traumatic event in which both of the following have been present:

"(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others (2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior."

I am glad that many clinicians are ignoring this criteria, but the DSM has to change if we are going to get help for more mothers.

Anonymous said...

I doubt that the DSM committees will take advice of this kind unless there is clear evidence to support it. They've been making that point for the past several years. They don't want to encourage criterion creep-- the broadening of a diagnosis to cover more symptoms and causes than makes real sense.

I am wondering where the master's thesis mentioned above was done, and exactly how it was proposed that anyone go about looking for evidence either for or against the hypothesis. The usual approach is to try to reject the hypothesis by looking for information that will disconfirm it.

As for the treatment issue, there's no reason why the use or non-use of a specific diagnosis should prevent treatment. The diagnosis is more for third-party payment than for any other reason. Unless you have in mind some particular treatment that you consider the only one that can treat the symptoms a person experiences, there shouldn't be any issue, whether PTSD includes a certain history or not. Any of the symptoms mentioned in the post are adequate to justify treatment and can be effectively treated in the same ways whether they're called PTSD or something else.

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