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What Is Reactive Attachment Disorder?

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REACTIVE ATTACHMENT DISORDER :

 

REACTIVE ATTACHMENT DISORDER may occur when a child is severely neglected where the neglect involves being deprived of close, consistent, stable care and nurturing from those who would normally provide it (i.e. a parent or primary caregiver). For example, a child who is raised in an orphanage in which the child has no sole, main carer, but, instead, a variety of overworked carers who work in shifts would be at increased risk of developing the disorder.

There are two types of REACTIVE ATTACHMENT DISORDER ; these are :

  1. INHIBITED REACTIVE ATTACHMENT DISORDER
  2. DISINHIBITED REACTIVE ATTACHMENT DISORDER

Let’s look at each of these in turn :

 

THE TWO TYPES OF REACTIVE ATTACHMENT DISORDER : INHIBITED AND DISINHIBITED :

INHIBITED REACTIVE ATTACHMENT DISORDER :

A child suffering from inhibited reactive attachment disorder may commonly suffer a range of symptoms which include :

  • a preference for solitary play / no interest in games that involve interaction with others
  • avoidance of / detachment from others (including an avoidance of any physical contact with others)
  • avoidance of eye contact
  • appears sad and lethargic
  • lack of any positive response to attempts by others to give comfort / does not seek comfort from others
  • does not smile
  • failure to reach out when picked up

DISINHIBITED REACTIVE ATTACHMENT DISORDER :

A child suffering from disinhibited reactive attachment disorder may commonly suffer a range of symptoms which include

  • high anxiety level
  • unusually eager to interact with strangers /rarely socially distinguishes between caregiver and unfamiliar adults
  • exaggerating a need for help with basic daily tasks
  • behaving much younger than chronological age / taking part in activities appropriate to much younger children

 

MORE ABOUT THE CAUSES OF REACTIVE ATTACHMENT DISORDER :

I have already touched on the causes of reactive attachment disorder in the opening paragraph of this article. However, to elaborate further, a baby / young child does not only require his/her physical needs to be met (such as being fed or having his/her nappy changed) but also requires SIMULTANEOUS WARM EMOTIONAL INTERACTION WITH THE CAREGIVER WHO IS PERFORMING THESE PHYSICAL TASKS. 

Such warm, emotional interaction is less likely to occur in underfunded and under-resourced orphanages (as already mentioned above). Also, however, young children who are forced to undergo frequent changes in foster homes, or who live with severely mentally ill parents, or with parents with serious substance misuse problems, are also at higher risk of extreme emotional neglect and, consequently, at increased risk of developing reactive attachment disorder.

 

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WHO SUFFERS FROM REACTIVE ATTACHMENT DISORDER ?

Research into reactive attachment disorder has focused on babies / young children between the ages of 0 and 5 years of age. It is not certain if the disorder exists in children over the age of 5 years ; more research needs to be conducted in order to establish whether or not it does.

However, some preliminary research suggests that older children and adolescents may express symptoms of reactive attachment disorder through :

  • callousness
  • lack of emotional responsiveness
  • cruelty towards animals
  • cruelty towards people
  • general problems relating to their behavior

CAN REACTIVE ATTACHMENT DISORDER BE SUCCESSFULLY TREATED?

Although there is currently no one, specific, specialized treatment or therapy for reactive attachment disorder, the evidence is that, with the right kind of intervention, children suffering from the disorder can learn to form healthy relationships with others.

As with all psychological problems, the earlier the therapeutic intervention is made, the higher its probability of success.

Therapies likely to be helpful include :

  • individual counselling
  • classes in parenting skills
  • family counselling
  • education of caregivers about the disorder
  • education of parents about the disorder

 

NOTE : The DSM IV refers to the inhibited and disinhibited forms of the disorder as :  emotionally withdrawn and indiscriminately social/disinhibited subtypes  , whilst the DSM 5 refers to them as two separate disorders, namely, reactive attachment disorder and disinhibited social engagement disorder. SEE TABLE BELOW :

 

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

 

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Reactive Attachment Disorder

 

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Those of us who experienced a dysfunctional relationship with our primary carer (e.g. our primary carer was abusive or neglectful, including having deprived us of affection/nurturing) when we were young may have developed REACTIVE ATTACHMENT DISORDER. This can mean that our brain development (both structural and functional) was adversely affected, leading to emotional and behavioural problems both in childhood and, later, in adulthood. (CLICK HERE to read my article on how early life trauma can physically harm the developing brain).

One of the most common outcomes resulting from this is that our ability to form healthy adult relationships is significantly impaired, leading to a great deal of personal suffering and loneliness.

Because of our problematic relationship with our primary carer, it is likely that, as children, we learned to believe that others cannot be trusted and that they pose a threat to our emotional well-being. We may well, therefore, be acutely suspicious of others and be quick to perceive faults in them (both real and imagined).

THE TRIGGERING OF MEMORIES OF OUR ORIGINAL DYSFUNCTIONAL RELATIONSHIP WITH OUR PRIMARY CAREGIVER :

The reason that we are likely to continue to have difficulties in other relationships is that new relationships frequently trigger memories of our original dysfunctional relationship with our primary caregiver. This, in turn, gives us a propensity to react negatively to those who have INADVERTENTLY REMINDED US OF OUR CHILDHOOD ORDEAL (very often this will occur on an UNCONSCIOUS LEVEL).

BELIEFS OUR DYSFUNCTIONAL RELATIONSHIP WITH OUR PRIMARY CAREGIVER MAY HAVE CAUSED SUFFERERS OF REACTIVE ATTACHMENT DISORDER TO DEVELOP:

The psychologist May identified several beliefs that sufferers of reactive attachment disorder are at risk of developing; I list these below:

1) That they must have somehow ‘deserved’ their treatment at the hands of the caregiver and, therefore, must be ‘bad’ or in some way ‘deficient’

2) Have a strong belief that they must be in control in order to survive and avoid further profound emotional hurt

3) That they can ‘never get anything right’

4) That they are ‘fully deserving’ of being thought of badly by others

5) Other people are essentially malevolent and to be despised

6) Others cannot be trusted (particularly those in authority as these people are especially likely to trigger memories of how they were treated by their primary caregiver in childhood)

7) That they will always behave badly as they are ‘an intrinsically bad person’ – this belief is the view their primary caregiver took (at least at times) which they have INTERNALIZED (i.e. they have absorbed this negative view of themselves, as if by osmosis, into their own belief system)

A CLOSER LOOK AT THE POSSIBLE CAUSES OF REACTIVE ATTACHMENT DISORDER : 

Possible causes of reactive attachment disorder include :

1) Abuse in early life (physical/sexual/emotional)

2) Early separation from the primary caregiver

3) Being brought up in a chaotic/dysfunctional family (click here to read my article on the signs of a dysfunctional family. Or to read my article about how dysfunctional families can select and victimize a ‘scapegoat’ (often the most sensitive and vulnerable child of the family) click here).

4) Extremely inconsistent parenting

5) Repeated change of foster parents

6) Many house moves in early life

7) Maternal substance abuse (alcohol/drugs).

8) Severe maternal depression

9) Lack of emotional bonding between the mother and child (e.g. the mother lacks a maternal instinct, rejects the child or does not have sufficient mothering skills – in relation to the  latter, this can sometimes be the case with extremely young mothers)

BELOW : A SIMPLIFIED MODEL OF THE FORMATION OF REACTIVE ATTACHMENT DISORDER:

index - Reactive Attachment Disorder

POSSIBLE SYMPTOMS OF REACTIVE ATTACHMENT DISORDER :

Possible symptoms include :

– avoidance of eye contact

– extreme tantrums

– resistance against affectionate physical contact

– age regression (click here to read my article on age regression)

Reactive attachment disorder has the greatest chance of being successful treated if THERAPEUTIC INTERVENTIONS ARE MADE AS EARLY AS POSSIBLE.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

 

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Copyright 2014 Child Abuse, Trauma and Recovery