Reactive Attachment Disorder

What is Attachment Psychology

Attachment theory is a part of developmental psychology that has to do with attachment in children. The idea is that emotional and physical attachments must be formed with caregivers as an infant and child in order for a personality to develop. These attachments, which we so need as infants, help children to feel secure and stable and lead healthy lives later.

Attachment disorders occur in children that have been abused or neglected before five years of age. Children that are bounced around in foster care without access to their parents are more likely to develop an attachment disorder.

Attachment theory and ideas about attachment styles started with the work of John Bowlby. In the 1930’s he was a psychiatrist in London where he worked with emotionally troubled children. Because of this, he realized the importance of a child’s relationship with their mother. Without this bond with their mother, children would have stunted emotional, social, and cognitive development.

John Bowlby found that an infant’s separation from its mother would lead to later problems. This was the foundation of his attachment theory.

Stages of attachment

Babies’ attachments develop over time in four stages.

The first occurs in 0-6 weeks and is called Asocial. This is when infants produce a positive reaction, like a smile, to both social and non-social interactions.

The next is 6 weeks- 7 months. This stage is called Indiscriminate Attachments. During this stage, infants enjoy all interactions with people.  This can be a parent or a primary caregiver, the infant is happy either way. Around three months is when an infant will smile more at caregivers.

At 7-9 months an infant is in the Specific Attachment stage. This is when an infant develops an attachment for a specific person, usually a parent or primary caregiver. The infant will have anxiety and be upset when they are away from their parents.

The last stage is Multiple Attachment and is from 10 months and on. In this stage, an infant forms many attachments. The babies with the healthiest attachments had their needs met right away during infancy. An infant who had a less attentive parent or primary caregiver will have weaker attachments.

Forming attachments is very important for a child and needs to happen between 0-5 years old. If it doesn’t there will be lasting effects like lower intelligence, higher aggression, and reactive attachment disorder.

What is Reactive Attachment Disorder or RAD 

Attachment disorders are on a spectrum. Some problems and mild but the most severe attachment disorder is reactive attachment disorder or RAD.

Reactive attachment disorder is a condition where a child was neglected and unable to form a healthy attachment to their primary caregiving, usually their mother. This could be from early abuse, neglect, failure to have their needs met by parents, or being in the foster care system without a primary caregiver or support.

Without experiencing emotional intimacy and having their needs met, a child is left unable to regulate their emotions and form relationships with others. This results in a lack of trust or self worth in children. A person with RAD will have a fear of getting close to others and they constantly feel unsafe and alone.

Reactive attachment disorder is common in children that are abused or had their primary caregiver or parent taken away from them before they could form a bond. Children with RAD are also developmentally delayed and struggle with anger.

Reactive Attachment Disorder in Adults vs. Children 

Reactive attachment disorder effects both children and adults. But, in order to be diagnosed with RAD as an adult the symptoms must have been present since age 5 or before.

RAD manifest similarly in children and adults but the way it is expressed changes. As we age we have access to even more coping methods, this is where children and adults with RAD differ.

Children with RAD don’t trust adults because adults didn’t take care of them when they needed it. The coping mechanisms children with RAD turn to are lying, aggression, manipulation, and controlling behaviors. Children with RAD lack empathy with other people and animals and can act cruelly.

If RAD goes untreated in childhood, it carries into adulthood. Adults will still have trouble with empathy and trust. Because of this, relationships are a challenge for adults. Adults with RAD carry their behaviors from childhood with them and will continue lying and manipulating to maintain control.

Adults with RAD will also deny responsibility for their actions and have a tendency to turn to addictive behaviors. This can be substance abuse, sex addiction, and alcoholism. These behaviors combined with not taking responsibility lead to trouble with the law.

Reactive Attachment Disorder Symptoms 

Reactive attachment disorder symptoms start in infancy. The earlier you notice the symptoms, the better for a child’s development. Some early symptoms are:

  • A child spends a lot of time comforting themselves
  • Inconsolable crying
  • Child doesn’t smile
  • avoiding eye contact
  • No response when comfort is given
  • Not asking for help or assistance
  • Not engaging in social interactions
  • Doesn’t reach up to be picked up
  • An infant that doesn’t make sounds
  • Child or infant that doesn’t notice when left alone
  • Rejects efforts to calm or connect
  • No interest in playing with toys or games

The symptoms become more serious as children age. Symptoms of older children with RAD are:

  • Control issues: children with RAD want to maintain control so they can avoid feeling helpless. This is because of the lack of control they had as infants. Children will want to control things their own way. This manifests as disobedient and argumentative children.
  • Anger problems: Children with RAD express their anger through tantrums and emotional outbursts. But, children with RAD may also hide their anger and express it in secret. This could be something like hugging another child too hard.
  • Not wanting to be touched or physical affection: Children with RAD perceive touch as a threat. They flinch, laugh, or pull away from touch, even if the touch is affection.
  • Underdeveloped conscience: Children with RAD won’t show remorse or guilt after they have done something bad or broken a rule.
  • Difficulty showing affection: A child with reactive detachment disorder will have difficulty showing love and affection. They can be overly affectionate with someone they don’t know and then show no affection to their parent.

Reactive Attachment Disorder in DSM 5 | Diagnosis 

In order for a doctor to diagnose a personality disorder, there are protocols in place. This comes in the form of the Diagnostic and Statistical Manual of Mental Disorders, also known as DSM-5. In order to diagnose a child or an adult with RAD the following criteria have to be met.

  • A consistent pattern of emotionally withdrawn behavior towards caregivers.
  • Minimal social and emotional responses to others
  • The child has had a repeated pattern of insufficient care such as:
    • Basic emotional needs not met by primary caregiver
    • Foster care system or orphanage system with little access to a caregiver
    • Repeated change of primary caregiver
  • The symptoms were present before age 5
  • The child doesn’t have autism
  • The disorder has been present for more than a year

If a child meets these criteria from the DSM-5 then they are diagnosed with reactive attachment disorder.

Reactive Attachment Disorder Treatment 

Treatment for reactive attachment disorder starts with one important goal: to make sure a child is in a safe environment. If they have been bounced around in foster care or come from extreme abuse and neglect, a stable home and primary caregiver are important. This is where treatment starts.

Helping a child develop relationships with parents and caregivers is also important. If a child is living with their primary caregiver and has RAD, then parental education is where treatment starts.

RAD treatment starts with counseling is necessary to find the issues that affect the caregiver’s relationship with the child. A parent must be taught to change their behavior to the child to help form attachments.

Play therapy is one treatment used for RAD. This helps children with RAD to learn to positively interact with others. Also, if a parent is learning how to bond with their child, the two can do play therapy together. This can help build up the attachments that were missing and builds strong relationships.

Family therapy is a RAD treatment that’s important for issues that affect both the child and parents or caregivers. Family therapy involves fun, group activities that help form attachments. It also helps parents and children understand the symptoms of the disorder and find ways to change their behaviors.

Another RAD treatment is trauma-focused cognitive behavioral therapy. This helps a RAD child of extreme abuse and neglect deal with their past traumas and find new patterns of thinking.

Reactive Attachment Disorder: Final Thoughts 

Reactive attachment disorder is a difficult disorder and effects children and adults. Bonds between people are one of the things that make us happy as humans and everyone should be able to feel that.

Sadly, abuse and neglect happen and can have lasting effects on children. But, there is hope. Many treatments are successful and children have learned to form attachments and move on to live healthy and productive lives.


Attachment Theory In Psychology


author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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