Psychosocial Consequences of Disclosing Misattributed Paternity: A Narrative Review

Abstract

Unlike adoption and donor-assisted reproduction, misattributed paternity occurring within the context of spontaneous conception and outside of formally recognised practices of having a child remains largely an understudied phenomenon. Despite being an age-old phenomenon affecting a substantial population, the psychosocial consequences of disclosing and discovering misattributed paternity continue to lack empirical understanding. The current paper delineates misattributed paternity from other paternal discrepancies and reviews the limited body of scholarly arguments regarding the potential psychosocial consequences of disclosure/non-disclosure for individuals with paternal discrepancy. Four major categories of pro- and anti-disclosure arguments have been identified and reviewed: arguments concerned with potential disclosure/non-disclosure consequences for the child; for the parents; for the child-parent relationship and for the family unit. The review highlights the dearth of empirical knowledge on the psychosocial consequences of misattributed paternity and advocates a more nuanced exploration of this phenomenon and the need for specialist support.

The old Roman law maxim ‘mater semper certa, pater (semper) incertus’ [mother is always certain, father is (always) uncertain] viewed the biogenetic bond between a birth mother and a child as legally uncontested (Larmuseau et al., 2017; Zweigert et al., 1973). While this Latin principle can be considered outdated in the age of assisted reproduction, where maternity is less definitive due to the oocyte donation and use of surrogate mothers, it still holds its validity regarding the uncertainty of paternity.

Misattributed paternity, a circumstance when a man is incorrectly assumed to be the genetic father of a child (Dahlen et al., 2022; Larmuseau, 2022), is, therefore, not a new or uncommon phenomenon. Contemporary research, including reliable medical studies, demonstrates that misattributed paternity occurs in around 1%–4% of all births (Bellis et al., 2005; Larmuseau et al., 2017). A recent large-scale survey of 23,196 people who participated in direct-to-consumer DNA testing found that 7% of respondents discovered a different biogenetic father from the one expected (Guerrini et al., 2022). In comparison, the adoption rate is about 2.5% in the United States (Palacios & Brodzinsky, 2010; Wydra et al., 2012), and less than 0.5% of all children born each year are conceived through assisted reproduction globally (Adamson et al., 2018; United Nations, 2022). These numbers indicate that misattributed paternity affects a significant proportion of the population and deserves as much attention as the adjacent fields of adoption and donor-assisted conception.

Despite the prominent significance of misattributed paternity for society (e.g., Dahlen et al., 2022), very little research exists on this subject. The vast majority of the existing literature tends to focus on the phenomenon itself, for example, its prevalence (Lowe et al., 2017), public health implications (Bellis et al., 2005) or legal issues (Anderlik & Rothstein, 2002; Draper, 2007), rather than how it impacts the lives of people affected by it. In 2005, Bellis et al., reviewing scientific literature on public health implications of misattributed paternity, found no papers directly addressing how the discovery of paternal discrepancy affects human lives. Nearly two decades later, the gap in understanding the impact of misattributed paternity and professional guidance on how to support individuals affected by them remains largely unfilled (Dahlen et al., 2022). Only recently, empirical studies focused on the consequences of discovering misattributed paternity for individuals and their families have started to emerge (Avni et al., 2023; Grethel et al., 2022; Lawton et al., 2023). This nascent research has likely been stimulated by the increasing prevalence and accessibility of in-home DNA testing (Rubanovich et al., 2021) with its innate potential to reveal the presence or absence of genetic relationships (Haimes, 2006) and, subsequently, the increasing number of incidental misattributed paternity discoveries (Guerrini et al., 2022). In many cases, such incidental discoveries appear to have a detrimental effect on family relationships, including complete communicational breakdown, due to strong feelings of betrayal by the parents (Becker et al., 2021; Lawton et al., 2023). Significant worsening of mental health post-discovery has been reported as well (Avni et al., 2023). The identified negative consequences of incidental discoveries of misattributed paternity draw attention to the subject of intended disclosure or non-disclosure of such paternal discrepancies. This review represents the first known attempt at a comprehensive summary of the existing body of knowledge on the consequences of disclosure/non-disclosure of paternal discrepancies.

Misattributed Paternity in the Current Review

Several definitions of misattributed paternity exist within the body of literature. Some authors assume a more expansive definition that includes such events as an unknown baby exchange, an adoption not recorded in the official records (also known as hidden adoption; Larmuseau et al., 2017) or medical errors, including mix-ups of semen during artificial insemination and in-vitro fertilisation (Bellis et al., 2005). Additionally, paternal discrepancy occurring as a result of adoption and donor-assisted reproduction is sometimes discussed under the definition of misattributed paternity (e.g., Wright et al., 2019). In the current review, a more focused perspective is employed, defining misattributed paternity as a discrepancy between genetic and social fatherhoods within the context of spontaneous conception and outside of formally recognised child welfare practices, such as adoption.

Scope of the Current Review: Misattributed Paternity, Adoption and Donor-Assisted Conception

The current paper reviews literature discussing existing perspectives on the disclosure of paternal discrepancy with the aim to identify potential psychosocial consequences of disclosure/non-disclosure for individuals with misattributed paternity.

Given the very limited evidence base for psychosocial implications of misattributed paternity, the review also draws from empirical and theoretical arguments on disclosing misattributed paternity and paternal discrepancy in the adjacent fields of adoption and donor-assisted conception. The two later categories of paternal discrepancy – adoption and donor-assisted conception – have important similarities and differences when compared to misattributed paternity, which are discussed next. It is important to acknowledge that the identified literature has focused exclusively on binary constructs of gender and therefore cisgender parents.

Misattributed Paternity and Adoption

Adoption in the Western world is a formally recognised and promoted professional welfare practice where a child is separated from their biogenetic family and placed in the care of a new family typically not related to the child by blood – an adoptive family (Brodzinsky et al., 2021). The practice is explicitly governed by the best interests of the child and is viewed as a mutually beneficial arrangement in which children whose genetic parents are unable to care for them are raised by well-suited families eager and able to care for the child (Baden et al., 2020; Barroso & Barbosa-Ducharne, 2019; Wydra et al., 2012).

In contrast, misattributed paternity is, with very rare exceptions, a result of a sexual relationship (Allan, 2016; Avni et al., 2023; Turney, 2005a). This profoundly private matter is typically concealed even from the immediate family members and can have legal consequences (Draper, 2007), such as contesting paternal responsibilities in court, accusations of paternal fraud or, in case of a non-consensual sexual relationship, criminal investigation. Further, being an extramarital child constitutes a cultural taboo in many societies (Turney, 2005a). While many adoptees may also experience stigmatisation, targeted legislative and professional supports are available in many countries to assist in coping with adoption-related challenges (Brodzinsky et al., 2021). In comparison, a recent study by Lawton et al. (2023) showed that those attending therapy for discovering misattributed paternity rated their therapists’ level of training in this presentation as below average. This indicates that individuals with misattributed paternity and their families lack dedicated and accessible supports.

Another aspect of adoption that contrasts with misattributed paternity is access to genetic information. In many Western countries, such as the United Kingdom or the United States, adoption records with identifying information of the genetic parents can be accessed by adult adoptees who are aware of their adopted status regardless of their social parents’ wishes (American Adoption Congress, 2022; GOV.UK, n.d). However, individuals with misattributed paternity commonly face several hurdles in accessing their biogenetic information, as this information can only be accessed either through a person aware of the actual genetic parenthood – most likely, the person’s mother – or via matching with a close blood relative on genetic databases (Grethel et al., 2022; Rubanovich et al., 2021).

However, adoptees and individuals with misattributed paternity may share similar experiences. Adoption, like misattributed paternity, means both gains and losses. While both groups gain non-biogenetic connections, they experience a loss of a genetic tie to the biogenetic family (for individuals with misattributed paternity, to the paternal lineage) and often a loss of status (Brodzinsky, 2011; Grethel et al., 2022). Additionally, both groups face the challenge of emotionally reconciling these two opposing processes into a coherent sense of self (Barroso and Barbosa-Ducharne, 2019; Grethel et al., 2022).

With misattributed paternity being seldom a planned event, a pregnancy leading to a child with misattributed paternity being born is typically unintended (Malek, 2013). Studies show that children from unintended pregnancies may be maltreated or neglected, have poorer physical and mental health, experience lower-quality relationships with their mothers and display more problematic behaviour (e.g., aggression, emotional dysregulation or underage alcohol consumption) than their peers (Abajobir et al., 2017; Adams et al., 2022).

These presentations in children from unintended pregnancies are consistent with the empirical knowledge on adoption, which shows that adoptees are at higher risk for adverse life circumstances and psychological difficulties (Barroso & Barbosa-Ducharne, 2019; Ranieri et al., 2021). However, like not all unintended pregnancies are unwanted, not all adoptees are impaired in their psychosocial adjustment (Brodzinsky et al., 2021). Similarly, not all children with misattributed paternity may be affected by the circumstances of their conception. On the contrary, the social father of a child with misattributed paternity may provide them with the care and love their biogenetic father would have been unable to deliver, like an adoptive family to an adopted child.

Misattributed Paternity and Donor-Assisted Conception

Both donor-conceived (DC) individuals and individuals born with misattributed paternity are raised by their social, legal parents and, in the case of a sperm donation, by at least one biogenetic mother. In both instances, a child may not know who else was involved in their conception, as disclosing such information is typically up to the social parents (Ravitsky, 2017).

Even when the family decides to disclose the genetic paternity of a DC individual, access to such information can be impossible in jurisdictions with anonymous donations, such as France and Greece (European Society of Human Reproduction & Embryology, 2020; Ravitsky, 2017). When the sperm donor is unidentifiable, a DC child is faced with similar challenges in accessing genetic information as a misattributed paternity child. However, Allan (2016) challenged this perspective, suggesting that in many cases of misattributed paternity, the mother knows the genetic father’s identity and may disclose this information to the child. At the same time, families with an anonymous donation are unable to provide such information and may therefore feel unable to disclose even paternal discrepancy itself. Further, Allan (2016) noted that when misattributed paternity is discovered, affected individuals may seek court orders to establish genetic parentage. For a person conceived via an anonymous donation, such legal pathways may be limited or not accessible. The recent study by Lawton et al. (2023) demonstrated that both DC individuals and those with misattributed paternity engage in DNA-based searches for their biogenetic fathers, indicating that both groups have barriers to accessing this information outside of genetic databases. However, to fully appreciate these challenges more specific research is required.

Additionally, it is essential to state that the challenges faced by DC individuals are subject to public discussion, stimulating legislative changes to reduce the emotional and logistical toll of being a DC individual. So, many governmental institutions worldwide have assumed responsibility for the appropriate treatment of donors, DC children and their social families, leading to legislative changes and the provision of support resources and funding (Allan, 2016; Ravitsky, 2017). However, individuals with misattributed paternity appear to continue their lives in the shadows of the public discourse. As Malek (2013) wrote, misattributed paternity is ‘unwelcome’ in most cases (p. 45). This ‘unwelcomeness’ of misattributed paternity seems to be reflected in how the subject is treated not only academically and institutionally but also in the public discourse. While gamete donation is commonly associated with noble values, such as altruism and family (Skoog Svanberg et al., 2020), unintended pregnancies and misattributed paternity are publicly discouraged and societally undesirable (Turney, 2005a). Larmuseau (2022) noted that societies and professionals tend to avoid misattributed paternity, resulting in limited awareness and understanding of the phenomenon. The growth of the misattributed paternity community is likely to bring more attention to this field; however, broader societal attitudes and beliefs may take longer to change.

The ‘unwelcomeness’ of misattributed paternity highlights the difference between how the children of misattributed paternity are raised and perceived compared to DC children. Research suggests that DC children enjoy the same or even superior quality of care compared to spontaneously conceived children raised by their genetic parents, as DC families often treasure the child they were unable to conceive otherwise (Blake et al., 2014). While no such comparative research exists on the psychological well-being of misattributed paternity children, it is counterintuitive to think of circumstances under which children with misattributed paternity would enjoy better familial care than children without paternal discrepancy or DC children.

Another relevant aspect to consider is the consent of all parties involved in donor-assisted reproduction, wherein the legal parents and donors engage in an arrangement that has led to a child’s birth. This can explain why most donors would like to be informed of the genetic offspring’s fate when the donation is no longer anonymous and report feeling responsible for the child if the social parents are unable to look after the child for some reason (Skoog Svanberg et al., 2020). It can be seen how the consensual agreement is beneficial to a DC child, who has the opportunity to access information about their gamete provider(s). However, misattributed paternity individuals may be deprived of the chance to establish a relationship with their genetic father, as such a relationship may lack consent and therefore be undesired. Further, the biogenetic father of a child with misattributed paternity may not be aware of their fatherhood and reluctant to accept it.

Finally, individuals with misattributed paternity and DC individuals can differ in their health. While potential donors undergo prescribed genetic and health screenings (Raes et al., 2016), no such screenings occur for genetic fathers of misattributed paternity children. Admittedly, despite thorough screening for hereditary conditions, a rare genetic disorder may be overlooked in donor-assisted reproduction (Raes et al., 2016). Overall, the misattributed paternity children are likely to have a higher risk of unknowingly inheriting a health condition than DC children and be disadvantaged in their health prospects due to incomplete medical history information.

Method

Articles were identified using the databases PsycINFO, PubMed and Google Scholar. Search terms misattributed paternity, misattributed parentage, discovery, disclosure, adoption, adoptee*, donor-conceived, non-paternity and paternal discrepanc* were used. Additionally, reference lists of found articles were examined to identify further relevant publications. Only papers in the English language and published in peer-reviewed journals or edited books since 2000 were included.

Given the paucity of empirical studies in the field of paternal discrepancy, it was deemed appropriate to include theoretical and review papers that discussed possible psychosocial consequences of disclosure in addition to research outputs. The inclusion criteria were kept broad for the same reason and only papers that did not explore the consequences of disclosure of paternal discrepancy either empirically or theoretically were excluded.

After returned abstracts were assessed for eligibility against inclusion/exclusion criteria, 166 papers were selected for reading in full. Duplicate papers, papers that did not discuss consequences of disclosure, studies deemed to be of poor quality due to low methodological rigour, as well as theoretical papers lacking strength and transparency of arguments, were excluded. Once the relevance and quality assessment was completed, 45 papers addressing the disclosure and psychological well-being in adoptees, donor-conceived individuals and individuals with misattributed paternity were short-listed and reviewed.

Results and Discussion

The current paper reviewed and synthesised literature on the theoretical and empirical disclosure-related arguments with the aim to identify the key considerations and potential psychosocial consequences of disclosure/non-disclosure for individuals with misattributed paternity. Four major categories of scholarly arguments regarding psychosocial consequences of paternal discrepancy disclosures were identified: arguments discussing 1) consequences for the child; 2) consequences for the parents; 3) consequences for the child-parent relationship and 4) consequences for the family unit.

Consequences for the Child

Many scholars warned that disclosure of misattributed paternity would have important consequences for the child’s welfare, including abandonment or rejection by the family (Wright et al., 2019), family dissolution, anxiety, low self-esteem and antisocial behaviour for the child (Bellis et al., 2005). In cases where disclosure leads to ethnicity change, disclosure may lead to disconnection from the ethnic community and its resources, for example, when a person identifying as Afro-American discovers their lack of African heritage and considers withdrawing from social groups based on that ethnicity (Davis, 2007). Qualitative studies of public opinion on disclosure supported the need to protect the child from these negative consequences (Turney, 2005b). Parents wanted to avoid confusing their children (Greenfeld & Klock, 2004), and mothers caught in a situation of misattributed paternity due to rape or abuse feared that this information might impact their child’s well-being (Turney, 2005a).

Empirical studies provided partial support to concerns for psychological well-being post-disclosure. People told about their discrepant genetic origins in adulthood may experience shock (Jadva et al., 2009; Riley, 2013), distress (Riley, 2013), anger due to feeling betrayed and confusion (Jadva et al., 2009). A study with late discovery adoptees showed that disclosure-related psychological distress could persist and even intensify with time (Baden et al., 2019). Further, late disclosures can negatively affect physical well-being, for example, causing blood pressure issues or weight gain (Baden et al., 2019). However, disclosure in childhood or early adolescence did not appear to produce such adverse impacts. A study with DC children aged 10–14 did not find any differences in children’s socio-emotional functioning post-disclosure (Freeman & Golombok, 2012; Golombok et al., 2002), suggesting that earlier disclosure does not produce a substantial adverse effect. This result is consistent with the findings of Baden et al. (2019) who identified that those who had known about their paternal discrepancy from a very young age fare better than those who learnt about it later in life.

There are distinct parallels between late disclosure and incidental discoveries of paternal discrepancy in adulthood. Adults discovering their discrepant genetic origins by accident may also experience shock (Grethel et al., 2022; Lawton et al., 2023), feelings of betrayal (Lawton et al., 2023), as well as guilt and shame (Lawton et al., 2023). A recent study by Avni et al. (2023) specifically examined the psychiatric effects of misattributed paternity discoveries in adulthood and found significantly higher levels of anxiety, depression and suicidal ideation in the affected population compared to historical controls. These results are echoed by the study of Lawton et al. (2023) who reported that nearly half of individuals with paternal discrepancies experienced anxiety and a significant proportion (39%) were depressed. Interestingly, in this study, adoptees appeared to be least affected by these mental health conditions, while DC individuals were most affected. These findings provide important evidence for the heterogeneity of paternal discrepancy groups discussed earlier. Additionally, studies demonstrated that grief and loss (Becker et al., 2021; Grethel et al., 2022; Lawton et al., 2023), as well as trauma (Grethel et al., 2022), are among the subjective experiences of those discovering their paternal discrepancy.

However, both disclosures and incidental discoveries are not purely negative experiences. Feelings of love, relief, acceptance by others and oneself (Lawton et al., 2023), gratitude for the disclosure (Wright et al., 2008), indifference (Jadva et al., 2009) or curiosity (Lycett et al., 2005) were also reported.

Further, concerns were raised about how the disclosure would affect the child’s identity. Anderlik and Rothstein (2002) cited two opposing opinions: first, that disclosure leads to the ‘cornerstone of identity’ being disproved (p. 230), and second, that if identity is based on a lie, it is best to uncover it. As Haimes (2006) noted, knowing one’s genetic origin is an innate need for a stable sense of identity. Without such knowledge, an individual may suffer from genealogical bewilderment and identity confusion (Kernreiter et al., 2020), which can lead to psychological distress and mental health difficulties (Barn & Mansuri, 2019). Indeed, a study by Tieman et al. (2008) showed that adult adoptees who searched for their genetic roots presented more psychiatric problems. In contrast, a small number of studies with DC children found normative psychological development in non-disclosing families (Haimes, 2006; Kovacs et al., 2015), suggesting that not knowing does not impair a child’s development. However, as discussed previously, DC children may enjoy a more beneficial family climate than misattributed paternity children, and these findings may not represent their population. Additionally, disclosure does not necessarily result in the establishment of true genetic identity, as in many cases, there may be no means to verify the new genetic information (Zadeh, 2016), for example, when the biogenetic parent cannot be identified. In the current age of modern DNA technologies, many individuals with paternal discrepancies looking for their biogenetic fathers are likely to succeed – in the study by Lawton et al. (2023) nearly 70% of those searching found their biological family. However, a substantial proportion of these people did not receive the answers they sought, despite engaging genetic counsellors and search angels (volunteers who assist in the identification of genetic relatives) (Lawton et al., 2023). As a coherent narrative about oneself prevents individuals from experiencing dangerous psychological distress levels (Barroso & Barbosa-Ducharne, 2019; Koskinen & Böök, 2019), the ability to provide a child with misattributed paternity with complete biogenetic information appears to be an important consideration in disclosing paternal discrepancies.

The literature on the psychological well-being of a child with misattributed paternity also discussed the risk of future accidental disclosure and unintended discoveries. Such disclosure can have detrimental consequences for the people involved and was deemed to be avoided (Baden et al., 2019). The fear of accidental disclosure, for example, during an argument or simply through an application of genetic knowledge (Haimes, 2006), could lead to suboptimal circumstances of disclosure and, subsequently, negative feelings associated with disclosure (Zadeh, 2016). Indeed, as studies on misattributed paternity discoveries show, there are substantial negative psychological consequences of such circumstances (Avni et al., 2023; Guerrini et al., 2022; Lawton et al., 2023). The impact of such discoveries on identity appears to be profound as well. In the qualitative study by Grethel et al. (2022), where the discovery of misattributed paternity is described as ‘a radical transformation in both self and familial identity’ (p. 12), the theme of identity transformation permeates all facets of the post-discovery experiences. In adulthood, when a stable identity is formed, discovering a different narrative about oneself can cause a significant internal restructuring that requires substantial emotional resources and coping (Ranieri et al., 2021). Interestingly, discovering your social father is not your biogenetic father is not always completely unexpected. The studies by Becker et al. (2021) and Riley (2013) identified that many individuals with parental discrepancy discoveries were unsurprised by the discovery, suggesting that some individuals with paternal discrepancy may feel their different genetic identity even without being conscious of it.

Another important consideration for individuals with misattributed paternity and their children was medical history. Many scholars highlighted the relevance of having a complete medical history (Raes et al., 2016; Ravitsky, 2017; Wright et al., 2019); however, opposite views were present as well (Haimes, 2006). Without disclosure, incorrect medical decisions can be made (Ravitsky, 2017), including unnecessary medical interventions and dangerous unawareness of possible health risks (Raes et al., 2016).

Consequences for the Parents

Studies with parents of children with paternal discrepancy showed that both disclosure and non-disclosure can have a significant emotional toll on the parents. Feelings of shame, guilt and responsibility for the circumstances surrounding the child’s birth and dealing with the uncertainty related to it were reported by mothers of children with misattributed paternity (Turney, 2005a). When misattributed paternity was disclosed inappropriately, humiliation and shame could compound mothers’ experiences. Still, many reported feeling relief as they no longer had to conceal a difficult secret (Haimes, 2006; Turney, 2005b; Wright et al., 2019). Further, some mothers did not wish to disrupt the life of the child’s genetic father and his family (Turney, 2005b). Indeed, research on genetic fathers suggests that many who did not intend to care for their offspring socially, such as anonymous sperm donors, do not wish to be contacted by their children (Czarnowski, 2020). However, diverging evidence exists as well. In the study by Lawton et al. (2023), complete rejection by the new family occurred only in 15% of all cases. It remains unclear in how many cases this rejection was directly by the biogenetic father and what was behind the rejection.

While research on donor-conceived families indicated that many parents did not regret keeping the child’s genetic parentage a secret (Nuffield Council on Bioethics, 2013) and even attempted to conceal it after its revelation (Lawton et al., 2023), other parents wished they had told the truth to their children (Ilioi et al., 2017). However, they often did not know how to have the conversation (Golombok et al., 2011) or found the secret too complex to disclose (Turney, 2005b). In contrast, literature on disclosure in families created through assisted reproductive technologies showed that there are strategies, such as ‘seed planting’ or waiting for the time when a child can comprehend the disclosed information, that can be utilised to uncover the genetic truth (Ilioi et al., 2017). These strategies, however, may not be suitable for misattributed paternity families, as the situation may be experienced by the families differently than having a child conceived through a donor gamete.

The impact on the social father was another anti-disclosure argument. He may feel ashamed, betrayed or challenged in his sense of fatherhood (Wright et al., 2008) or may also be affected if the child stops contact or experiences anxiety in anticipation of this loss (Daniels et al., 2011). Furthermore, the discovery can also affect the close family network (Moray et al., 2017).

Consequences for the Child–Parent Relationship

The literature cited the protection of the existing relationship between the child and the social parent as a common reason to avoid disclosure. Disclosure of paternal discrepancy, regardless of its circumstances, can potentially jeopardise the established relationship with the caring father and lead to the child rejecting the social father as a parent (Ilioi et al., 2017; Jadva et al., 2009). This belief was also demonstrated in a study with mothers of misattributed paternity children who wished to protect the father-child relationship by maintaining their secret (Turney, 2005a). Indeed, one study with donor-conceived children showed that disclosure leads to less warm relationships between the child and the social father (Freeman & Golombok, 2012). Similarly, a study with adults discovering their misattributed paternity revealed that 14% of participants no longer speak with their social fathers (Lawton et al., 2023). At the same time, other studies showed that families, where children are unaware of the genetic paternity, do not experience any negative consequences for the child-parent relationship (Klock, 2013). However, the reasons for the worsening of the father-child relationships post-disclosure can be quite diverse. For example, in the instance of adult discoveries, such changes can be due to the father’s role in maintaining the paternal discrepancy secret and possibly could have been prevented by carefully planned disclosure.

Family relationships can be strained when the child starts actively seeking biogenetic information (Choy, 2018) or the social father may cease contact with the child post-disclosure (Draper, 2007). Further, some parents worried that the lack of a genetic link to the social father would create an unequal relationship with the child (Skoog Svanberg et al., 2020). Yet it is also possible that children and adults with misattributed paternity feel more positively towards their social father after disclosure or discovery. An account reported by Wright et al. (2008) demonstrated that a relationship between the adult daughter and her social father was reaffirmed after a carefully planned disclosure to both of them by medical professionals. The study by Lawton et al. (2023) also found better father-child relationship quality post-discovery. In both instances, the revelation of paternal discrepancy could have answered existing questions about the father-child relationship. Further, the discoveries may have brought social fathers and their children closer, especially if neither of them were aware of the existing paternal discrepancy.

Very little research explored how disclosure or non-disclosure affects the mother-child relationship. Becker et al. (2021) found that in many cases, the relationship with the biological parent who raised them, that is, the biological mother, was strained prior to the discovery of paternal discrepancy, indicating that non-disclosure can have a negative effect on the mother-child relationship. In contrast, families that voluntarily disclose paternal discrepancies and show empathy for the child’s position seem to enjoy better relationships. The study by Freeman & Golombok (2012) reported that disclosure in donor-assisted families was associated with lower mother-son conflict. Another study demonstrated a more positive mother-child interaction and lower mothers’ emotional distress levels (Golombok et al., 2011). As these studies were conducted with donor-conceived children, they may not reflect the interpersonal changes post-disclosure for those with misattributed paternity.

In comparison, many of those discovering their misattributed paternity on their own reported worsening of their relationship with the mother due to feelings of betrayal and anger, with some choosing to stop the contact altogether (Lawton et al., 2023). Another detrimental factor in these relationships could be the way mothers respond to the discovery. Grethel et al. (2022) reported that many mothers reacted defensively and with anger to being confronted with the discovery by their children. In contrast, a study from New Zealand indicated that when paternal discrepancy disclosure and its consequences are treated openly and without shame families can withstand the impact of such events (Hargreaves, 2006). The cited research suggests that the way paternal discrepancies are revealed and managed plays a critical role in the mother-child relationship. As the quality of these relationships has also been found to mediate the quality of mental health post-discovery (Avni et al., 2023), the exploration of the mother-child dynamic in families with misattributed paternity appears to warrant particular attention in future research.

Very limited knowledge exists regarding disclosure and the child’s relationship with the genetic father. Anti-disclosure arguments suggested a need to protect the child from the potential psychological distress of not being able to access information about the genetic father (Jadva et al., 2009; Zadeh, 2016). By contrast, pro-disclosure literature argued that without disclosure, such a relationship could not be attempted (Ravitsky, 2017). Many individuals discovering misattributed paternity and contacting the newly found biological family are welcome by at least one family member (Lawton et al., 2023), suggesting that non-disclosure prevents biogenetic relatives from forming valued relationships with each other.

Consequences for the Family Unit

Anti-disclosure arguments regarding the consequences for the family unit mainly focused on the disruption of family harmony, potential family break up and, in some instances, domestic violence (Bellis et al., 2005; Draper, 2007; Lowe et al., 2017). Further, as the discovery of misattributed paternity is often associated with the mother’s infidelity, it is likely to challenge the family honour and have negative social consequences (Turney, 2005b). Communication with the extended family, friends and communities (Rubanovich et al., 2021), and the psychological well-being of everyone in the larger family (Skoog Svanberg et al., 2020) were affected. This could explain why even when the paternal discrepancy was revealed, many individuals with misattributed paternity were asked to keep their status secret (Lawton et al., 2023).

On the other hand, those who argued in favour of disclosure stated that it may benefit the family, as it would provide clarity for everyone involved (Schroder, 2009). Ilioi et al. (2017) compared disclosing and non-disclosing DC families and found no significant differences between these families and spontaneous conception families. Yet those who disclosed by the age of seven enjoyed better familial relationships. This is an important finding supporting early disclosure of paternal discrepancy. However, in the case of misattributed paternity occurring during spontaneous conception commonly during multiple sexual relationships (Avni et al., 2023), the existence of such discrepancy may not be known even to the parents themselves.

Conclusion

The reviewed literature demonstrates that paternal discrepancy disclosures and discoveries are multi-faceted constructs affecting many life aspects – from mental health and medical history to identity and family relationships. While the review draws from the extant literature on misattributed paternity, adoption and donor-assisted reproduction, there are important intergroup differences that should be considered in regard to disclosing paternal discrepancy. To our knowledge, this is the first paper outlining the differences and similarities between the three groups in relation to psychosocial consequences of paternal discrepancy. Individuals with misattributed paternity deserve a separate consideration of their unique circumstances, and future research dedicated to this demographic is needed.

From the reviewed 45 papers, only seven publications (Avni et al., 2023; Becker et al., 2021; Grethel et al., 2022; Guerrini et al., 2022; Lawton et al., 2023; Turney, 2005b; Wright et al., 2008) provided empirical data on experiences of individuals directly affected by misattributed paternity. The current review does not claim to include all existing research on the subject; however, it highlights the vast gap in the current understanding of the experiences of those affected by this phenomenon. Knowledge of how misattributed paternity affects the parents, the child-parent relationships and the family unit appears to be particularly scarce. Further, we lack understanding of what supports these individuals and families require. Without this knowledge, it may be difficult to provide appropriate guidance to the families affected by paternal discrepancies or to the professionals supporting these families. Further, this situation may lead to inadequate care, substantial public cost, limited advocacy and insufficient allocation of public resources for the needs of this large population. As can be seen, the field of misattributed paternity provides curious academics from many disciplines with an opportunity to conduct pioneering and highly engaging research.

Just a few years ago scholars were inconclusive on whether to disclose misattributed paternity or not (Pennings, 2017; Prero et al., 2019). Today, in the era of in-home DNA testing, a revelation of such paternal discrepancy has become a matter of when, not if (Avni et al., 2023; Rubanovich et al., 2021). With the high prevalence of unplanned conceptions even in Western countries (Bellis et al., 2005), the projected increased use of genetic testing in the future (Wright et al., 2019) and higher familiarity with medical testing as a result of the COVID-19 pandemic across the world, it is likely that the number of incidental misattributed paternity discoveries will continue to rise. This suggests an urgent need to improve the understanding of the potential impact of such discoveries, how to mitigate any possible negative consequences and inform the professional community of the specific requirements of this population. Further, such research will inform policymaking and ethical guidelines in public and private institutions concerned with misattributed paternity affairs and stimulate future research on misattributed paternity and adjacent fields.