In 1371 consecutive admissions to the Department of Psychiatry of the Jewish Hospital of St. Louis over a three-year period, 35 EFA (extrafamilial adoptees) and six IFA (intrafamilial adoptees) were identified. The 35 EFA accounted for an incidence rate of 2.6 percent, which was about 2.5 times greater than the rate in the population served by this facility. This difference is statistically significant.When incidence is calculated by age groups, high rates are found in the child group (5.4 percent) and in the adolescent group (5.6 percent) and a low rate in the adult group (0.7 percent). The incidence rates of EFA in the child and adolescent age groups of patients seen in this facility were four to five and one-half times greater than the base rates in the communities from which the sample is drawn.The average age at adoption for our 35 EFA was 10.6 months, which is significantly higher than the average of 1.8 months for the state of Missouri.The EFA presented with a wide spectrum of psychiatric disorders, but personality disorders and transient situational personality disorders made up 60 percent of the diagnoses.The findings as related to the psychodynamics of adoptees are discussed. Theoretical implications are considered and our data compared to other studies of psychiatric illness in EFA.