Discovery of unexpected paternity after direct‐to‐consumer DNA testing and its impact on identity

• Published date: 01 October 2023
• Author: Michele Grethel,Jennifer Lewis,Rob Freeman,Courtney Stone
• Date: 01 October 2023
• DOI: http://doi.org/10.1111/fare.12752

RESEARCH

Discovery of unexpected paternity after

direct-to-consumer DNA testing and its

impact on identity

Michele Grethel

1

|Jennifer Lewis

1

|Rob Freeman

2

|

Courtney Stone

1

1

Department of Social Work, University of

Southern California, Los Angeles, CA

2

John Jay College of Criminal Justice, City

University of New York (CUNY), New

York, NY

Correspondence

Michele Grethel, Department of Social Work,

University of Southern California, 669 W. 34th

Street, Los Angeles, CA 90007, USA.

Email: mgrethel@usc.edu

Abstract

Objective: In this study, we describe the experiences of

individuals who received direct-to-consumer DNA test

results indicating unexpected parentage.

Background: The availability of recreational DNA testing

has left individuals navigating unexpected results with lim-

ited resources. Little is known about the emotional impact

of learning about unexpected paternity.

Methods: This qualitative study used inductive thematic

analysis of in-depth interviews with adults (n=27; age 40–

70 years)whoreceiveddirect-to-consumerDNAtest

results revealing unexpected biological paternity.

Results: Identity transformation occurred while integrating

DNA results. Themes included (a) initial discovery marked

by shock, fear, crisis, and loss of genetic relatedness;

(b) identity exploration encompassing anxiety, emotional

challenges, determination to conduct genealogical

research, and confronting family; (c) identity reconstruc-

tion due to new familial connections and reconciliation of

personal and familial history; and (d) synthesis of and shift

in worldview, impacting trust in kinship.

Conclusion: Identity transformation after unexpected

DNA results is often accompanied by intense change in

personal and community identity and a shift in identity

related to race, ethnicity, religion, family status, belonging,

or other facets of one’s self. Temporal trauma, grief, and

loss are common outcomes. Isolation, shame, and a lack

of emotional support are prevalent.

Implications: This research elucidates emotional processes

related to learning unexpected DNA results.

Received: 6 August 2021Revised: 24 December 2021Accepted: 28 May 2022

DOI: 10.1111/fare.12752

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and

reproduction in any medium, provided the original work is properly cited.

© 2022 The Authors. Family Relations published by Wiley Periodicals LLC on behalf of National Council on Family Relations.

2022 Family Relations. 2023;72:2022–2038.

wileyonlinelibrary.com/journal/fare

KEYWORDS

adult development, family relationships, family secrets, identity

formation, stress and coping

The number of people who have had their DNA analyzed with direct-to-consumer (DTC)

genetic tests more than doubled during 2017 and now exceeds 30 million globally (Bobkowski

et al., 2020). In the context of genetics, it is now possible to delineate biological family relation-

ships, discover one’s“authentic”race and ethnicity, and unintentionally reveal family secrets,

such as marital affairs and donor-conceived births. Using information from genetic and behav-

ioral studies, Bellis et al. (2005) estimated that 0.8% to 30% of test recipients discover being bio-

logically fathered by someone unexpected. A literature review found little data on nonpaternity

rates; when they were reported, they were not the primary focus of the paper and lacked suffi-

cient detail (Greeff & Erasmus, 2015). Further, extant research reports inconsistent rates and

estimates of nonpaternity events or misattributed paternity findings. The most commonly cited

figure in the media is 10% (Gilding, 2005).

Research on DTC genetic testing largely addresses logistics, including the history of DNA

testing and the call for greater U.S. Food and Drug Administration regulations, privacy impli-

cations for participants and nonconsenting family members (e.g., anonymous sperm donors),

describing motivations of consumers who use testing (e.g., health, hobby, insight into identity),

and implications for medical providers interacting with patients who have received DTC genetic

testing results (Allyse et al., 2018; Gill et al., 2018; Larmuseau, 2018; Strong et al., 2019). Most

research conducted on the effects of DTC genetic testing results have focused primarily on

health markers, such as cancer genes and chronic illness (Mahon, 2018; Middleton et al., 2017;

Thrush & McCaffrey, 2010). Despite calls for genetic and mental health counselors to provide

education and support for test recipients, there remains an absence of research to guide clinical

practice (Kirkpatrick & Rashkin, 2017; Larmauseau, 2018; Mahon, 2018; Roberts &

Ostergren, 2013).

The growth in consumers accessing genetic DTC testing inevitably will result in greater

numbers of individuals accidentally learning about unexpected biological paternity. Therefore,

it is necessary to understand the emotions that one endures when receiving DTC DNA results

of unexpected biological paternity. The notion that the father who raised an individual or was

identified as their biological parent is suddenly biologically unrelated may, understandably,

cause a cacophony of emotions. Clinicians need this information to support individuals effec-

tively as they experience the emotions associated with this stressful experience.

NOT PARENT EXPECTED

Until now, there has not been unifying language to capture the meaning of not-parent-expected

(NPE) findings. In medicine, NPE paternity findings are often referred to as misattributed

paternity. In genealogy and genetics, the phenomenon is commonly known as nonpaternal,or

nonpaternity event. More recently, individuals refer to this experience as NPE, which is intended

to humanize individuals’experiences, although we acknowledge that this language will likely

evolve as the field advances. Historically, terminology has been stigmatized (e.g., cuckoldry,

illegitimacy), and today the experience oftentimes connotes shame and secrecy for many who

are managing the disclosure.

The President’s Commission for the Study of Ethical Problems in Biomedical and Behav-

ioral Research (1982) recommended that “misattributed paternity”be disclosed to both part-

ners. Eleven years later, an Institute of Medicine (1994) committee suggested that “information

on misattributed paternity be communicated to the mother, but not be volunteered to the

ADULT IDENTITY TRANSFORMATION2023