Reactive Attachment Disorder And Its Impacts On Relationships And Mental Health
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Key takeaways
- Reactive attachment disorder is an attachment-related disorder that can develop in cases of childhood abuse and neglect.
- In reactive attachment disorder, a child does not develop a healthy bond with a caregiver; signs can include a lack of positive emotions, not exhibiting emotional reactions to others, and being emotionally dysregulated in the presence of caregivers.
- Adults with reactive attachment disorder may have difficulty with emotional regulation, emotional intimacy, and trusting others, but seeking therapy can help.
Reactive attachment disorder (RAD) is related to attachment theory, which posits that insecure attachments to caregivers in early childhood can lead to emotional and behavioral difficulties later in life. Reactive attachment disorder is typically diagnosed when a young child has little emotional affect and an inappropriate response to adult caregiving. It can lead to relationship problems later in life. That said, therapeutic interventions can help both children and adults with this disorder, potentially leading to healthier relationships.
What is attachment theory?
John Bowlby developed attachment theory, a psychological framework with a fundamental premise that human emotions and behavior are based on human social and emotional bonds. According to Bowlby, the most important bonds are those between an infant or child and their caregivers.
How attachment works, according to Bowlby’s theory
Bowlby claims that the ways in which young children bond with a primary caregiver in early childhood form their attachment style into adulthood. He also posits that secure attachment to a caregiver is required for secure relationship attachments throughout a person’s life.
What are the different types of attachment?
Attachment theory states that there are four different types of attachment. These include secure, anxious, avoidant, and disorganized attachment styles.
Secure attachment
Secure attachments are usually characterized by safety, comfort, and ease in relationships. In a secure romantic relationship, both partners usually feel secure and emotionally safe, trust one another, and experience a balance between emotional closeness and autonomy or independence. Both partners may be able to set boundaries, communicate effectively, and resolve conflicts healthily. A secure childhood attachment generally allows a child to develop healthy relationships throughout their life.
Insecure attachment
Insecure attachment types fall into three categories, as detailed below.
- Anxious: The anxious attachment style is primarily characterized by a child’s constant fear of abandonment by their caregivers, which can lead to clingy behavior.
- Avoidant: With the avoidant attachment style, a child often resists physical contact, appears unfazed when a caregiver leaves or returns, and does not seek comfort from caregivers when upset.
- Disorganized: A child with disorganized attachment tends to vacillate between seeking comfort from a caregiver and being emotionally distant.
How does insecure attachment develop in a child?
Insecure attachment issues often begin in infancy and early childhood in cases where the child’s relationship with their caregiver does not promote secure and healthy bonding. Certain circumstances can make this more likely to occur, and insecure attachment styles can negatively affect children’s lives, even into adulthood.
Risk factors for insecure attachment in children
Disorganized attachment, a type of insecure attachment, typically develops when certain risk factors are present. These include abuse, chaos, severe neglect, domestic violence, or trauma in the child’s home. Being in foster care can also be a risk factor for disorganized attachment.
How insecure attachment affects a child
Insecure attachment can affect children emotionally, psychologically, cognitively, and socially. Children with insecure attachment styles may experience anxiety, depression, aggression, withdrawal, behavioral challenges, and poor social relationships. These difficulties can persist into adolescence and adulthood if left unaddressed.
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What is reactive attachment disorder?
Insecure attachment can contribute to various mental health disorders. One notable attachment-related disorder is reactive attachment disorder (RAD). A 2016 article in the Journal of the American Academy of Child and Adolescent Psychiatry explores the diagnosis, course, and treatment of RAD, which can develop in cases of childhood abuse and neglect.
In reactive attachment disorder, a child doesn’t develop a healthy bond with their caregiver. While symptoms can vary, a few potential signs of RAD include the following:
- Avoidance of physical touch and eye contact
- A lack of positive emotions
- A tendency to break rules due to a desire to control the environment
- Frequent tantrums or other behavioral signs of unhappiness
- A lack of emotional response to things happening around them
- Avoidance of caregivers
- A preference to be alone
Reactive attachment disorder diagnostic criteria
The American Psychiatric Association references reactive attachment disorder as being characterized by “disturbed and developmentally inappropriate patterns of social relating.”
The DSM requires that these symptoms be present before the age of five, and these symptoms cannot be explained by having autism spectrum disorder.
Other types of attachment disorders
Other mental disorders related to attachment include disinhibited social engagement disorder and inhibited reactive attachment disorder. While they aren’t directly related to attachment, conditions like depression and anxiety disorders can arise in people with insecure attachment styles.
How does reactive attachment disorder affect adult relationships?
Adults with reactive attachment disorder usually have difficulty with emotional intimacy, emotional expression, emotional regulation, and trusting others. They may also experience anxiety disorders, depression, and other mental health conditions. All of these difficulties can lead to challenges with forming and maintaining healthy relationships.
How can you treat attachment disorders and support mental health?
If you suspect that you have an attachment disorder or an insecure attachment style, therapy can be helpful. A licensed therapist can guide you in identifying the root of your attachment style, and they can also help you adjust your current beliefs, emotions, and behaviors. Online therapy can be a convenient way to receive support, whether individually or with your partner. It allows you to choose between video and audio sessions, and you and your partner can even attend appointments from separate locations.
Research supports the use of online couples therapy, reporting that it can reduce conflict and increase relationship satisfaction. Not only can online mental health care be effective, but it also can be less expensive than in-person treatment without insurance coverage.
Diagnosing and treating reactive attachment disorder in children
In general, reactive attachment disorder diagnosed in a child requires intervention. Reactive attachment disorder treated with a multi-pronged approach tends to result in the best outcomes. This multi-pronged approach can include family therapy, parent education, a predictable and stable routine, a safe environment, nurturing caregivers, and possibly special education services.
How can you build a more secure attachment with your partner?
If you want to develop a more secure attachment with your partner, you can attend relationship counseling with them. Each partner can also attend individual therapy or otherwise pursue self-improvement to further enhance mental health and relationship health.
Find the right therapist for your relationship.
Would you like to begin therapy as a couple?
Couples counseling for attachment challenges and mental health
Couples counseling can help you and your partner:
- Learn to regulate emotions healthily
- Actively listen to each other’s experiences, feelings, and viewpoints
- Communicate with each other more effectively
- Learn conflict resolution skills
Practicing the skills you and your partner learn in therapy regularly outside of sessions can lead to a more harmonious and satisfying relationship.
Takeaway
Attachment issues usually begin in early childhood when a child does not develop a secure attachment to their caregivers. Reactive attachment disorder (RAD) can arise when a child experiences severe neglect or abuse, and it typically leads the child to respond inappropriately to adult caregiving. This disorder can lead to insecure attachments in adult relationships as well, which can contribute to various relationship difficulties. However, attending therapy as an individual and as a couple can help people with insecure attachment styles or RAD develop more security in relationships, as well as improved mental well-being.
What mental illness is associated with attachment issues?
The two main disorders directly related to attachment concerns include reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), both of which can greatly impact a child’s behavior and certain developmental milestones, such as physical growth. Children diagnosed with these conditions have often experienced traumatic experiences like emotional neglect and abuse, rather than growing up in a nurturing environment.
How do you treat reactive attachment disorder?
Treatment strategies typically involve both the child and their caregivers, with the goal being to foster the child’s ability to form secure attachments with the help of mental healthcare providers. Treatment may ensure the child has a safe, stable living situation, and it may also foster positive child-caregiver interactions, as well as strengthen the child-caregiver attachment. Depending on the child’s situation, it may be necessary to place them with other caregivers to prevent unsafe or abusive treatment. This practice parameter from an American psychiatric publishing journal offers more information about treating RAD.
What are signs of reactive attachment disorder?
A few signs of reactive attachment disorder include the following:
- Lack of positive emotions when interacting with others
- Avoidance of physical touch and eye contact
- Tantrums or frequent unhappiness
- Rule-breaking and a need for control
- Rigid or flat facial expressions
When a child shows these signs, it can be important for them to receive professional support.
Can people with reactive attachment disorder love?
People with reactive attachment disorder, a rare but serious condition, can experience love, but their ability to give and receive love tends to be impaired due to early childhood experiences. However, treatment for RAD can help these individuals develop healthier attachment behaviors.
What does RAD turn into in adulthood?
Reactive attachment disorder doesn’t go away or turn into a different disorder once a person reaches adulthood. Instead, if left unaddressed, people with RAD typically continue to experience challenges with interpersonal relationships.
What are the four types of attachment disorder?
There are two main attachment disorders. They are reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).
What therapy is best for RAD?
Parent-child interaction therapy (PCIT) is often helpful for reactive attachment disorder. Trauma-focused cognitive behavioral therapy (TF-CBT) can also be effective, particularly for older children, adolescents, and adults.
Does RAD turn into BPD?
Reactive attachment disorder does not turn into borderline personality disorder. However, both RAD and BPD typically develop in response to a child’s history of trauma. This may include exposure to substance use disorder, abuse, social neglect, a caregiver’s inability to meet a child’s basic emotional needs, or growing up in institutional settings. RAD and BPD can be comorbid disorders in some cases.
How rare is reactive attachment disorder?
The prevalence rate of RAD is thought to be between 1% and 2%. While many children may develop insecure attachment styles, it’s less common to develop an attachment disorder.
What is similar to reactive attachment disorder?
Although it has different symptoms from reactive attachment disorder, disinhibited social engagement disorder (DSED) is also an attachment disorder. It typically involves a child displaying a lack of appropriate social boundaries with strangers. For example, they may seek comfort from strangers and lack social inhibitions.
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