Adoption Stress

Adoption Stress

Unfortunately, far too many adoptive children have faced traumatic events including, but not limited to, neglect, physical and sexual abuse and various degrees of abandonment. In recent months, I have accompanied Dr. George Rogu on a speaking tour with As the “Adoption Psychologist,” I regularly explain to adoptive parents that by having an understanding of the symptoms suggestive of traumatic exposure, we can identify children who may be experiencing traumatic stress reactions. Ultimately, by identifying symptoms early, we can address emotional, social, behavioral and educational needs. As I often say to parents, we certainly don’t wait to address physical trauma. And, in the same way, we must not wait to address traumatic stress.

How is traumatic stress manifested in adoptive children?

In the young adopted child, we see immature and regressive behaviors—behaviors that have been abandoned in the past are often observed again (e.g., thumb sucking, bed wetting, fear of the dark, loss of bladder control, speech difficulties, decreases in appetite, clinging and whining, and separation difficulties). Older children may manifest periods of sadness and crying, poor concentration, fears of personal harm, aggressive behaviors, withdrawal/social isolation, attention-seeking behavior, anxiety and fears, etc.

So, what is “Adoption Stress”? Does it refer solely to the experience of so many adoptive children?

The reality is, when we look closely at adoption, we realize that traumatic stress is pervasive - often impacting several, if not all, of the parties involved. Unfortunately, this traumatic stress, “adoption stress,” is generally not recognized and its impact is misunderstood. Consider the following….
Birth parents, who surrender a child for adoption, typically experience a great deal of stress. Oftentimes, due to their circumstance, they have little choice or control and must surrender their child for adoption.

Adoptive parents often bring to the table a history of stress. For example, pre-adoption stressors, which may include fertility problems, losses and significant relationship conflicts. There is also stress associated with the acquisition of an adoptive child. For example, there may be serious medical concerns, “misunderstandings,” and heartbreaking disappointments. Finally, post-adoption stress may center around the realization of a dream, tremendous life changes with new responsibilities, and a future marked by uncertainty and fear.

Adoption stress is manifested in the feelings, thoughts, actions and physical reactions of all parties associated with the adoption process—by birth parents, adoptive parents and certainly, adoptive children. By understanding adoption stress and recognizing the symptoms, we can intervene early, educate and empower victims, and prevent acute difficulties from becoming chronic problems.

Dr. Mark Lerner is a Clinical Psychologist and Traumatic Stress Consultant who focuses on helping people during and in the aftermath of traumatic events. He is the President of the American Academy of Experts in Traumatic Stress ( and the originator of the Acute Traumatic Stress Management intervention model ( Dr. Lerner wrote and produced the newly released audio book, Surviving and Thriving: Living Through a Traumatic Experience ( He is the Editor and Publisher of Trauma Response, the Academy’s official publication, and the author of five books. Dr. Lerner consults regularly with individuals, schools and organizations—where he specializes in the education, training and implementation of Acute Traumatic Stress Management and the development of organizational and school-based crisis management teams. Dr. Lerner has conducted numerous interviews, including CNN Headline News, the Los Angeles Times, Newsweek, Self Magazine, Stars & Stripes, Reuters, the Associated Press and U.S. News & World Report. Most recently, he appeared on Dateline NBC. Dr. Lerner lives in New York with his wife and three children.

Post Adoption Depression

The term "Post-Adoption Depression" has been used to explain the feelings of sadness that are experienced by many adoptive parents subsequent to the adoptive process. Unlike postpartum depression, which may be caused by significant physiological and hormonal changes (e.g., a sudden decrease in estrogen and progesterone in the bloodstream), Post-Adoption Depression cannot. Post-Adoption Depression focuses on the feelings of sadness that are experienced after the attainment of a long-term goal that has required time, money, effort, emotional strain and patience.

New York Post-Adoption Depression is a symptom that falls under a much larger umbrella - what I have called "Adoption Stress." The latter refers to the feelings, thoughts, actions and the physical and spiritual reactions of all parties who are involved in the adoption process (e.g., a mother who surrenders her child for adoption, an adoptive child, an adoptive parent, a compassionate case worker, etc.).

We can better understand and appreciate the depressive symptomatology experienced by many adoptive parents if we first consider 1) pre-adoption stressors, 2) stress associated with the acquisition of an adoptive child and 3) post-adoption stress. By focusing solely on Post-Adoption Depression, we miss the causative or related stressors that contribute to the adoptive parent’s feelings of sadness. For example, the attainment of a long-term goal of having an adoptive child often opens the door to seemingly insensitive questions from others about infertility and prior losses. These questions will likely stimulate unresolved feelings, and may cause adoptive parents to revisit pre-adoption stress. The acquisition of an adoptive child is often colored by serious medical concerns, "misunderstandings" and heartbreaking disappointments. And, the post-adoption experience is often marked by tremendous life changes, new responsibilities and a future marked by uncertainty and fear.

During a recent therapeutic session with a group of adoptive parents, we explored a number of participants’ feelings of sadness. Suddenly, one mother exclaimed, "I didn't sign-up for this!" Her comment was met by applause from several of the participants. Her statement underscores the complex continuum of "before, during and after stressors" that are faced by adoptive parents.

How can we prevent Post-Adoption Depression? First, we must educate all people involved in the adoptive process about Adoption Stress. If more people understood that the feelings, thoughts, actions and the physical and spiritual reactions were a normal response to a very stressful, multifaceted experience, fewer people would struggle with conflicted feelings. We must also focus our attention on parents who have been prone to feelings of depression and do not fare well when faced with considerable stress. We must encourage them to become involved in support groups or counseling. If we do this prior to parents entering into the adoptive process we can ultimately decrease the post-adoption stress that is experienced by many adoptive parents.

Written By Mark Lerner, Ph.D.

Considering suicide?

Considering Suicide How to stay safe and find treatment

Despair and hopelessness may lead you to think about suicide. Learn how to stay safe, get through a crisis and find treatment.By Mayo Clinic staff

When life doesn't seem worth living anymore or your problems seem insurmountable, you may think that the only way to find relief is through suicide. You might not believe it, but you do have other options — options to stay alive and feel better about your life.

Maybe you think you've already tried them all and now you've had enough. Or maybe you think your family and friends would be better off without you. It's OK to feel bad, but try to separate your emotions from your actions for the moment. Realize that depression, other mental disorders, despair and hopelessness can distort your perceptions and impair your ability to make sound decisions. Suicidal feelings are the result of treatable problems. So try to act as if there are other options instead of suicide, even if you may not see them right now.
No, it may not be easy. You might not feel better overnight. Eventually, though, the sense of hopelessness and thoughts of suicide can lift. You can find support, appropriate treatment and reasons for living.

Immediate help for thoughts of suicide

If you're considering suicide right now and have the means available, talk to someone first. The best choice is to call 911 or your local emergency services number.
If you simply don't want to do that, for whatever reason, you have other choices for reaching out to someone when you feel suicidal:
Contact a family member or friend.
Contact a doctor, mental health provider or other health care provider.
Contact a minister, spiritual leader or someone in your faith community.
Go to your local hospital emergency room.
Call a crisis center or hot line.

Crisis centers and suicide hot lines are often listed in the front of your phone book or on the Internet. They generally offer trained volunteer counselors who can help you through an immediate crisis. While some crisis centers with an Internet presence offer e-mail contact, remember that responses may not be as prompt as they are with telephone support.
Talking to someone about your suicidal feelings can help relieve the burden of despair and isolation, even if just temporarily. It may help you shift perspective and more clearly see that you have options instead of suicide.

Daily coping strategies

You may struggle with suicidal feelings frequently, perhaps many times a day if you're in the depths of depression. Develop a strategy to cope with those feelings in a healthy way. Consider asking a doctor, family member or friend to help create a strategy tailored to your specific situation that will help you cope with thoughts of suicide.

That strategy may mean doing things you don't feel like doing, such as making the effort to talk to friends when you'd rather stay in your bedroom all day. Or it may mean going to the hospital for a mental health evaluation. But stick to your strategy, especially when you're in the grips of despair and hopelessness. And if you're already in treatment, be certain to go to all of your psychotherapy appointments and take medications as directed.

As part of your strategy, consider these measures:

Keep a list of contact names and numbers readily available, including doctors, therapists and crisis centers that can help you cope with suicidal thoughts.

If your suicide plans include taking an overdose, give your medications to someone who can safeguard them for you and help you take them appropriately.
Rid your home of knives, guns, razors or other weapons you may consider using for self-destructive purposes.

Schedule daily activities for yourself that have brought you even small pleasure in the past, such as taking a walk, listening to music, watching a funny movie, knitting or visiting a museum. If they no longer bring you at least a modicum of joy, however, try something different.
Get together with others, even if you don't feel like it, to prevent isolation.

Avoid drug and alcohol use. Rather than numb painful feelings, alcohol and drugs can increase suicidal thoughts and the likelihood of harming yourself by making you more impulsive and more likely to act on your self-destructive feelings.

Write about your thoughts and feelings. Remember to also write about the things in your life that you value and appreciate, no matter how small they may seem at the time.

Keeping yourself safe

Some mental health providers and support organizations recommend creating a "plan for life," "safety contract" or similar plan of action that you can refer to when you're considering suicide or are in a crisis. Such plans offer a checklist of activities or actions you promise yourself to take in order to keep yourself safe when you have thoughts of suicide.

For instance, your plan may require that you contact certain people when you begin considering suicide. It may also include commitments to take medication as prescribed, to attend treatment sessions or appointments, and to remind yourself that your life is valuable even if you don't feel it is.

Also, consider creating a list of specific activities to try when negative thoughts start to intrude. The key is to engage in activities you find soothing for your negative feelings. Don't wait to do these activities until you've reached the point of suicidal thoughts. Engage in healthy activities when the first negative thoughts start to creep in. Also, make certain they're activities that would normally offer enjoyment and that can help comfort you, not cause additional stress.
Then, do each item on your list until you feel like you can go on living.

Your list can include such things as:

Practicing deep-breathing exercises
Playing a musical instrument
Taking a hot bath
Eating your favorite food
Writing in a journal
Going for a walk
Seeing a funny movie
Contacting family, friends or other trusted confidantes

Even if the immediate crisis passes with your self-care strategies, consult a doctor or mental health provider, or seek help through a hospital emergency room if your community doesn't offer good access to mental health providers. They can help make certain you're getting appropriate treatment for suicidal thoughts and feelings so that you don't have to continually operate in a crisis mode.

Beyond thoughts of suicide

The despair and hopelessness you feel as you consider suicide may be the side effects of illnesses that can be treated. These emotions can be so overpowering that they cloud your judgment and lead you to believe that taking your own life is the best, or only, option.
But even people who've had suicidal thoughts for months or years can learn to manage them and to develop a more satisfying life through effective coping strategies. Take an active role in saving your own life, just as you would help someone else. Enlisting others for support can help you see that you have other options and give you hope about the future. Remember that suicide isn't a solution — it's an ending.

Stress: Can We Cope?

As modern pressures take their toll doctors preach relaxation
"Rule No. 1 is, don't sweat the small stuff. Rule No. 2 is, it's all small stuff. And if you can't fight and you can't flee, flow."

—University of Nebraska Cardiologist Robert Eliot, on how to cope with stress
It is the dawn of human history, and Homo sapiens steps out from his cave to watch the rising sun paint the horizon. Suddenly he hears a rustling in the forest. His muscles tense, his heart pounds, his breath comes rapidly as he locks eyes with a saber-toothed tiger. Should he fight or run for his life? He reaches down, picks up a sharp rock and hurls it. The animal snarls but disappears into the trees. The man feels his body go limp, his breathing ease. He returns to his darkened den to rest.

It is the start of another working day, and Homo sapiens steps out of his apartment building into the roar of rush hour. He picks his way through the traffic and arrives at the corner just in time to watch his bus pull away. Late for work, he opens his office door and finds the boss pacing inside. His report was due an hour ago, he is told; the client is furious. If he values his job, he had better have a good explanation. And, by the way, he can forget about taking a vacation this summer. The man eyes a paperweight on his desk and longs to throw it at his oppressor. Instead, he sits down, his stomach churning, his back muscles knotting, his blood pressure climbing. He reaches for a Maalox and an aspirin and has a sudden yearning for a dry martini, straight up.

The saber-toothed tiger is long gone, but the modern jungle is no less perilous. The sense of panic over a deadline, a tight plane connection, a reckless driver on one's tail are the new beasts that can set the heart racing, the teeth on edge, the sweat streaming. These responses may have served our ancestors well; that extra burst of adrenaline got their muscles primed, their attention focused and their nerves ready for a sudden "fight or flight." But try doing either one in today's traffic jams or boardrooms. "The fight-or-flight emergency response is inappropriate to today's social stresses," says Harvard Cardiologist Herbert Benson, an expert on the subject. It is also dangerous. Says Psychiatrist Peter Knapp of Boston University: "When you get a Wall Street broker using the responses a cave man used to fight the elements, you've got a problem."
Indeed we have.

In the past 30 years, doctors and health officials have come to realize how heavy a toll stress is taking on the nation's well being. According to the American Academy of Family Physicians, two-thirds of office visits to family doctors are prompted by stress-related symptoms. At the same time, leaders of industry have become alarmed by the huge cost of such symptoms in absenteeism, company medical expenses and lost productivity. Based on national samples, these costs have been estimated at $50 billion to $75 billion a year, more than $750 for every U.S. worker. Stress is now known to be a major contributor, either directly or indirectly, to coronary heart disease, cancer, lung ailments, accidental injuries, cirrhosis of the liver and suicide—six of the leading causes of death in the U.S. Stress also plays a role in aggravating such diverse conditions as multiple