Children who have had breaks from their primary caregiver, unmitigated pain, abuse, neglect or in other ways have not had their needs met can often be impaired in their ability to develop healthy emotional attachments. This is currently called by many names, such as insecure attachment. These less-than-healthy ways of attaching are often not diagnosed as disorders, but are common in children who have backgrounds of abuse or neglect or who are no longer with their biological parents, who have had the loss of one or more parents, who are in foster care, who have had several medical procedures or who have been adopted. Attachment is on a spectrum – from healthy to insecure to disorganized (often diagnosed as an attachment disorder). Some of the basic signs/characteristics that a person struggles with attachment are:
- History of abandonment, neglect, abuse, and/or multiple placements
- Indiscriminately seeks affection and/or comfort from strangers (i.e., pseudo-attachments)
- Anti-social behaviors (e.g., lying, stealing, manipulating, destructiveness, cruelty, fire-setting, aggression)
- Lack of authenticity, spontaneity, flexibility, and empathy
- Lack of physical affection and closeness and/or inappropriate clinginess
- Poor eye contact
- Problems with learning, attending, self-regulating, self-monitoring
- Abnormal eating and elimination patterns (e.g., wetting, soiling, hoarding food)
The children exhibiting the most severe symptoms are sometimes diagnosed with Reactive Attachment Disorder (RAD), or the newer diagnosis — Disinhibited Social Engagement Disorder (DSED). All disorders/impairments of attachment are serious, because they impede the child’s emotional health and ability to have meaningful relationships.
Attachment Disorders: Causes, Types, Symptoms, and Treatment
How do emotional bonds in early life shape our ability to form and maintain relationships? Attachment disorders arise when these crucial bonds are disrupted, affecting emotional development and the capacity to connect with others. In this blog post, we will delve into the world of attachment disorders, exploring their causes, types, symptoms, and treatment options. By understanding the complexities of attachment disorders, we can better support those affected by them and foster healthier relationships.
- Attachment disorders are conditions that can have detrimental effects on emotional and social well-being.
- Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are two distinct attachment disorders which can be caused by childhood neglect/abuse, inconsistent caregiving or experiences in institutional settings.
- Treatment approaches such as therapy, counseling, parenting skills classes and medication/mental health support help individuals with attachment disorders develop secure attachments & improve their relationships.
Understanding Attachment Disorders
Attachment disorders can be a significant obstacle in forming and maintaining healthy relationships. These disorders arise from negative experiences, such as neglect or inconsistent caregiving, during early childhood. Attachment issues can impact a person’s emotional development, making it challenging to form secure emotional bonds with others. Recognizing and addressing attachment disorders in infants and young children is crucial, as early intervention can lead to more positive outcomes.
A comprehensive understanding of attachment disorders requires familiarity with their definition, significance, and the foundational principles of attachment theory. We will examine these aspects in the following sections, shedding light on the complexities of attachment disorders and their impact on individuals and families.
Definition and Importance
Attachment disorders are conditions that hinder the formation of secure emotional bonds, affecting a person’s ability to form and maintain relationships. These disorders can have long-lasting effects on emotional and social well-being.
Healthy development is deeply rooted in secure emotional bonds that foster a sense of trust, safety, and emotional security. Grasping the definition and significance of attachment disorders paves the way for identifying and addressing these challenges in individuals and families.
Attachment Theory Background
Attachment theory, developed by British psychologist John Bowlby, emphasizes the importance of secure emotional bonds between infants and caregivers for healthy development. This theory explains how humans form and sustain attachments, and how these attachments influence emotional and social development.
Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) are two distinct attachment disorders. Both can lead to difficulties in forming healthy relationships and social interactions. The causes of attachment disorders can be attributed to childhood neglect and abuse, inconsistent caregiving, and institutional settings and foster care.
A grasp of the principles underlying attachment theory underscores the importance of secure attachments and the potential ramifications of attachment disorders.
Types of Attachment Disorders
Reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) are two primary attachment disorders. These conditions can have significant impacts on children’s lives. These disorders can significantly impact an individual’s emotional development and ability to form healthy relationships.
Subsequent sections delve into the specific traits of each attachment disorder and how they affect individuals and their families.
Reactive Attachment Disorder
The DSM-5 gives the following criteria for Reactive Attachment Disorder:
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
- The child rarely or minimally seeks comfort when distressed.
- The child rarely or minimally responds to comfort when distressed.
B. A persistent social or emotional disturbance characterized by at least two of the following:
- Minimal social and emotional responsiveness to others
- Limited positive affect
- Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.
C. The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
- Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by caring adults
- Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care)
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios)
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C).
E. The criteria are not met for autism spectrum disorder.
F. The disturbance is evident before age 5 years.
G. The child has a developmental age of at least nine months.
Specify if Persistent: The disorder has been present for more than 12 months.
Specify current severity: Reactive Attachment Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
Disinhibited Social Engagement Disorder
Disinhibited social engagement disorder (DSED) involves over-friendliness with strangers, lack of distress when separated from caregivers, and little preference for trusted adults over unfamiliar individuals. Children with DSED display a lack of preference for their parents over other people, even strangers, and may seek comfort and attention from virtually anyone. They may not exhibit any distress when a parent is not present and may be overly familiar with strangers, yet have difficulty forming meaningful connections with others.
Factors such as childhood neglect and abuse, inconsistent caregiving, and experiences in institutional settings or foster care could potentially cause DSED.
The DSM-5 gives the following criteria for Disinhibited Social Engagement Disorder:
A. A pattern of behavior in which a child actively approaches and interacts with unfamiliar adults and exhibits at least two of the following:
- Reduced or absent reticence in approaching and interacting with unfamiliar adults.
- Overly familiar verbal or physical behavior (that is not consistent with culturally sanctioned and with age-appropriate social boundaries).
- Diminished or absent checking back with adult caregiver after venturing away, even in unfamiliar settings.
- Willingness to go off with an unfamiliar adult with little or no hesitation.
B. The behaviors in Criterion A are not limited to impulsivity (as in Attention-Deficit/Hyperactivity Disorder) but include socially disinhibited behavior.
C. The child has exhibited a pattern of extremes of insufficient care as evidenced by at least one of the following:
- Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults.
- Repeated changes of primary caregivers that limit ability to form stable attachments (e.g., frequent changes in foster care).
- Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child to caregiver ratios).
D. The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the pathogenic care in Criterion C).
E. The child has a developmental age of at least nine months.
Specify if Persistent: The disorder has been present for more than 12 months.
Specify current severity: Disinhibited Social Engagement Disorder is specified as severe when a child exhibits all symptoms of the disorder, with each symptom manifesting at relatively high levels.
Causes of Attachment Disorders
Attachment disorders can be caused by various factors, including childhood neglect and abuse, inconsistent caregiving, and institutional settings or foster care. These factors can disrupt the development of secure emotional bonds, leading to attachment difficulties and challenges in forming and maintaining healthy relationships.
We will delve deeper into each of these factors in the sections that follow.
Childhood Neglect and Abuse
Neglect and abuse during childhood can lead to the development of childhood attachment disorder, as a young child struggles to form secure emotional bonds with caregivers. Children who have experienced neglect or abuse may have difficulty trusting others, controlling their emotions, and forming healthy relationships.
Furthermore, these early experiences can also have a detrimental effect on their self-esteem and lead to difficulties in social and emotional functioning. Providing the necessary support and therapy to individuals who have endured childhood neglect and abuse is important to mitigate the consequences and enhance their overall well-being.
Inconsistent caregiving can result in attachment disorders, as children are unable to develop a sense of security and trust in their caregivers. Children who experience inconsistent caregiving may display aberrant attachment behaviors, deficits in social-emotional development, and insecure attachment.
Insecure attachments may result in confusion, insecurity, and difficulties in forming healthy emotional relationships. Identifying and addressing issues of inconsistent caregiving can aid in preventing the onset of attachment disorders and foster the establishment of secure emotional bonds.
Institutional Settings and Foster Care
Children in institutional settings or foster care may be at a higher risk of developing attachment disorders due to frequent changes in caregivers and lack of consistent emotional support, especially for an infant or young child. These children may struggle to establish secure attachments, and the quality of attachment can be influenced by various risk factors.
Acknowledging the influence of institutional settings and foster care on attachment disorders can guide suitable interventions and support for impacted children.
Insecure Attachment Styles
Insecure attachment styles, which include anxious-preoccupied, dismissive-avoidant, or fearful-avoidant, can manifest in adults as different forms of attachment styles. These styles can significantly impact an individual’s emotional development and ability to form and maintain healthy relationships.
Subsequent sections will delve into each of these insecure attachment styles and their impact on individuals and relationships.
An anxious-preoccupied attachment involves:
- Fear of abandonment
- Tendency to overanalyze the behavior of loved ones
- Struggle with trust issues
- Difficulty with emotional regulation
- Challenges in maintaining healthy relationships
Identifying and addressing issues related to anxious-preoccupied attachment can assist individuals in surmounting these challenges and fostering more secure emotional bonds.
Dismissive-avoidant attachment is characterized by:
- A desire for self-sufficiency
- Difficulty allowing others to provide support or feel close
- Struggles with emotional intimacy, trust, and maintaining healthy relationships.
Identifying and addressing issues related to dismissive-avoidant attachment can empower individuals to overcome these challenges and form more secure emotional bonds.
Fearful-avoidant attachment may lead to:
- Emotional suppression
- Challenges in forming and maintaining relationships
- Difficulty trusting others
- Difficulty in forming close relationships
Identifying and addressing issues related to fearful-avoidant attachment can enable individuals to surmount these challenges and cultivate more secure emotional bonds.
Diagnosing Attachment Disorders
Diagnosing attachment disorders involves assessing symptoms, using diagnostic criteria, and considering potential misdiagnoses and comorbid conditions. Accurate diagnosis is crucial for providing appropriate treatment and support for individuals with attachment disorders.
Subsequent sections will discuss the diagnostic criteria for attachment disorders, along with the potential risks and complications arising from misdiagnosis and co-existing conditions.
Diagnostic criteria for attachment disorders, as outlined in the DSM-5-TR, include:
- Minimal social and emotional responsiveness to others
- Limited positive affect
- Episodes of unexplained irritability, sadness, or distress
- Failure to seek comfort when distressed
- Persistent social and emotional problems
- In some cases, poor hygiene and underdevelopment of motor coordination
These criteria focus on symptoms and behaviors related to emotional bonding and relationships.
Utilizing these criteria can help ensure accurate diagnosis and appropriate treatment for individuals with attachment disorders.
Misdiagnosis and Comorbid Conditions
Misdiagnosis is possible, as attachment disorders can share symptoms with other conditions, such as autism spectrum disorder. Comorbid conditions may also be present, complicating the diagnostic process.
A comprehensive medical history, evaluation of any co-existing conditions, and appropriate diagnostic techniques are necessary to minimize the risk of misdiagnosis. Accurate diagnosis is vital for providing proper treatment and support for individuals with attachment disorders.
Treatment Approaches for Attachment Disorders
Treatment approaches for attachment disorders include:
- Parenting skills classes
- Medication or mental health support when necessary
These approaches aim to help individuals with attachment disorders develop secure attachments, improve their emotional regulation, and enhance their relationship skills.
We will delve deeper into each of these treatment approaches in the sections that follow.
Therapy and Counseling
Therapy and counseling can help individuals with attachment disorders develop secure attachments and improve their emotional regulation and relationship skills. Various therapy approaches that can be utilized include:
- Attachment-based therapy
- Play therapy
- Cognitive-behavioral therapy (CBT)
These approaches can help individuals develop healthy attachment patterns and improve their relationships.
Professional guidance from a therapist, specializing in adolescents’ psychiatry, can offer invaluable support and direction for individuals with attachment disorders and their families.
Parenting Skills Classes
Parenting skills classes can provide caregivers with the tools and strategies needed to support children with attachment disorders and foster healthy emotional bonds. These classes cover various topics, such as:
- Therapeutic parenting
- Trust-based relational intervention (TBRI)
- Circle of security
- Parent-child interaction therapy (PCIT)
Participation in parenting skills classes can enhance caregivers’ understanding and ability to address the specific challenges faced by children with attachment disorders.
Medication and Mental Health Support
Medication and mental health support may be necessary for individuals with attachment disorders who also struggle with comorbid mental disorders, such as anxiety or depression. Antidepressants, anti-anxiety medications, and mood stabilizers may be prescribed to help manage symptoms of these conditions.
In addition, therapeutic approaches can be utilized to help individuals with attachment disorders develop healthy attachment patterns and improve their relationships. It’s paramount for individuals with attachment disorders and their families to consult a mental health professional to determine the most effective treatment plan.
Coping Strategies for Individuals and Families
Coping strategies for individuals and families affected by attachment disorders involve building secure attachments, supporting emotional development, and navigating relationships. These strategies can help individuals with attachment disorders overcome challenges, develop trust and emotional security, and foster healthier connections with others.
Subsequent sections will delve into each of these coping strategies in greater detail.
Building Secure Attachments
Building secure attachments requires patience, consistency, and emotional support from caregivers, helping individuals with attachment disorders develop trust and emotional security. Responsive caregiving, emotional availability, positive reinforcement, consistency and predictability, physical affection, play and exploration, and open communication are all essential components of building secure attachments.
The development of secure attachments can enhance the emotional well-being of individuals with attachment disorders and facilitate the formation of healthier relationships.
Supporting Emotional Development
Supporting emotional development involves:
- Helping individuals with attachment disorders identify and express their emotions
- Providing guidance in managing emotional challenges
- Creating a secure and supportive environment
- Promoting open dialogue
- Assisting individuals in identifying and articulating their emotions
These are essential components of supporting emotional development.
In addition, teaching coping skills, such as deep breathing and mindfulness, can help individuals with attachment disorders manage emotional difficulties and enhance their emotional well-being.
Navigating relationships for individuals with attachment disorders may require:
- Open communication
- Understanding from both parties
- Setting boundaries
- Navigating differences
- Seeking support
These strategies are essential for fostering healthy and fulfilling relationships.
Effective relationship management enables individuals with attachment disorders to overcome challenges and cultivate more secure emotional bonds with others.
In this blog post, we delved into the complexities of attachment disorders, exploring their causes, types, symptoms, and treatment options. We also discussed coping strategies for individuals and families affected by attachment disorders, emphasizing the importance of building secure attachments, supporting emotional development, and navigating relationships. By understanding and addressing attachment disorders, we can help individuals overcome the challenges they face and foster healthier, more fulfilling connections with others. Together, we can make a positive difference in the lives of those affected by attachment disorders.
The behaviors (symptoms) of attachment disorders can be very challenging to parent. Providing safety for these children and the rest of the family is a major concern. Families need continuous support and education to help these children heal.
Most professionals agree that attachment disorders are the result of early childhood trauma, so it’s important to understand how trauma affects a developing brain.
The APA further is recognizing that disorders of attachment are trauma-related and has designed a new category of Trauma and Stressor-Related Disorders, under which both attachment diagnoses will be found.
- Facts for Families – Attachment Disorders – American Academy of Child & Adolescent Psychiatry
- DSM5 313.89 – DSED
Frequently Asked Questions
What are the different attachment disorders?
Reactive attachment disorder (RAD) and disinhibited social engagement disorder are the two attachment disorders recognized by the DSM-5, classified as trauma and stressor-related disorders.
What are the signs of attachment disorder?
Signs of attachment disorder include withdrawal, difficulty forming emotional connections, a lack of eye contact, limited communication skills, and difficulty expressing emotions.
How are attachment disorders typically diagnosed?
Attachment disorders are typically diagnosed through a comprehensive examination including physical exams, lab tests, and psychiatric assessments conducted by a pediatrician or psychologist.
These assessments are used to determine the presence of an attachment disorder and to identify any underlying medical or psychological conditions that may be contributing to the disorder.
The treatment of attachment disorders is typically a combination of psychotherapy and medication.
What are the common causes of attachment disorders?
Neglect and abuse, inconsistent caregiving, and living in institutional or foster care settings are the most common causes of attachment disorders.
What are the treatment options for attachment disorders?
Treatment for attachment disorders typically involves therapy, counseling, parenting skills classes and, in some cases, medication or mental health support.
These treatments are designed to help the child learn to form healthy attachments and develop better coping skills. They may also help the child better understand and manage their emotions. The goal is to help the child develop a secure environment.