Reactive Attachment Disorder: Causes, Symptoms, And Treatment

Updated May 07, 2021

Medically Reviewed By: Sonya Bruner

Reactive attachment disorder is a rare and unfamiliar mental health condition that is found in children. It occurs when strong, healthy bonds are not being formed between a caregiver and a child. There are many ways that this can affect young people negatively. This article will discuss in more detail how reactive attachment disorder manifests, its symptoms, and what kinds of treatments are available.

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What Is Reactive Attachment Disorder (RAD) And What Causes It?

As mentioned earlier, reactive attachment disorder can be summed up as a lack of an emotional bond between a caregiver and a child. This situation can happen due to the absence of a stable caregiver, neglect, and abuse (either physical or emotional). These factors can be known as pathogenic care.

Here are a few different possible scenarios that can cause RAD:

  • Failure to feed a child or infant, even after expressing their hunger
  • Neglecting a crying baby
  • Not interacting (such as talking and playing) with the baby, which results in loneliness

 

As a result, RAD may be more common among those in orphanages or foster care. These children can lack stable caregivers and homes.

Despite this, RAD is uncommon. If present, it presents itself by the age of 5 with a variety of symptoms [1]. It is one of a handful of conditions from the DSM-5 that can affect infants.

Reactive Attachment Disorder Symptoms

At its core, RAD is a disorder that impairs social functioning. Compared to those without the condition, individuals with reactive attachment disorder will display more behavioral and psychosocial issues. Here are some of the symptoms [1]:

  • impulsiveness
  • hypersexuality
  • hyperactivity
  • development delays
  • language delays
  • homicidal and suicidal ideation
  • hoarding
  • stealing
  • lying
  • vandalism
  • arson
  • animal cruelty

If you or someone you know has thoughts of suicide, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

Based on these symptoms, someone with the condition may have difficulties showing affection, have anger issues, and perhaps show signs of sociopathy because of their upbringing. Individuals may dislike being touched and have a lack of remorse for bad behavior.

Additionally, reactive attachment disorder can be described in two different ways - inhibited and uninhibited.

Inhibited RAD can be described as ‘hypervigilance.’ Children may be more wary and watchful than usual.

Uninhibited RAD is the exact opposite. Those with the uninhibited type may interact freely with strangers, and disregard the need to stay near the safety of their caregivers. This kind of behavior can also be known as indiscriminate friendliness. [2]

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Some of these reactive attachment disorder symptoms may only be more apparent past the age of 5. But there are warning signs that can be observed in infants. Even though they cannot speak coherently, infants will typically show many cues to express how they are feeling. An infant with RAD may:

  • Not smile
  • Avoid eye contact
  • Reject being picked up
  • Cry frequently
  • Not want to play with toys or games

If left untreated, the symptoms of RAD can and carry over into adulthood. They can have serious implications and consequences.

Reactive Attachment Disorder In Adults

Many of the symptoms that were listed earlier can be present in adults and can come with risks. There is also some supporting evidence that shows that RAD in childhood is associated with different personality conditions, such as borderline or antisocial personality disorders, later in life [3].

Because people with RAD have difficulties adjusting to social situations and making secure connections, this can result in a struggle to form relationships. This can include social relationships with friends or colleagues as well as intimate relationships. Since the initial bond between child and caregiver was not formed, these kinds of relationships may prove to be challenging, if not impossible.

Some of the behaviors that have been displayed by those with RAD early on in life can also result in criminal behavior. Vandalism, arson, homicide, and cruelty to animals are all serious offenses. In the worst cases, the individual may show no empathy or remorse for criminal behavior, and repeat actions may occur.

Social isolation and the sense of hopelessness can also lead to substance abuse problems and other addictions, including sex and gambling.

Treatment For Reactive Attachment Disorder

RAD is difficult to diagnose, and research into the condition is ongoing. Researchers have yet to agree upon a standardized treatment intervention. But some methods have shown strong promise.  A 2008 scientific report documents the use of behavior management training (BMT) to treat RAD. BMT involves ten steps (broken into ten different sessions) that deliver training to both the child and to the child’s caregivers. The researchers report that, in this instance, BMT was highly successful at treating the symptoms of RAD and recommend it for broader clinical testing.

Advice, help, and treatment for attachment disorders like RAD are available and easily accessible through online therapy. Online counselors at BetterHelp are just a click away. They can be reached from anywhere you have an internet connection, and are ready to work with you when you are ready. Read what others have said about their experiences with BetterHelp below.

“Mary helped me to overcome my terrible childhood which still affected me. She helped me trust my judgement, build confidence and gave me the knowledge to identify toxic people before they affect my life, I am forever grateful for that.”

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“Keisha is an amazing counselor and has helped me with issues regarding my career, childhood, and relationship with my father. She is kind, responsive, and extremely knowledgable. Keisha was able to help me look at my problems from anther perspective and shine light on positive thinking.”

https://www.betterhelp.com/keisha-trotman/

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Other types of treatment, such as play therapy and art therapy, have demonstrated effectiveness in the treatment of other attachment disorders. But few clinical trials have been carried out to measure their effectiveness with RAD.

On the other hand, spending time outside of therapy can be supplemental in reforming attachments between a caregiver and a child. Activities such as the ones mentioned before have merit outside of a therapy session because it encourages bonding.

Additional parenting strategies can include teaching them about emotions, consequences, and importantly, reassure the child that they are safe and loved. A key point to make is that while the child is the one who is affected by reactive attachment disorder, the caregivers must be willing to participate in therapy for it to be beneficial.

Since they are legally independent, and there is a chance that a caregiver may be unavailable, treatment for reactive attachment disorder in adults can be different from therapy for children.

An adult with RAD may choose to bring a friend to therapy sessions so that trust can be formed. If no friend is available, the development of social skills and the formation of a secure attachment with a therapist is also an option.

At BetterHelp, you can receive advice from licensed and qualified counselors and therapists if you have an infant or child that is displaying reactive attachment disorder symptoms. Likewise, if you are an adult who has difficulty forming meaningful relationships with others, treatment is available to you too.

Summary And Conclusion

Reactive attachment disorder (RAD) is a relatively rare condition that manifests before the age of five. Even if it is quite uncommon in the general population, there is a higher incidence of RAD in foster homes and orphanages, where neglected and abused children are likely to stay.

These negative experiences have the potential to impact a young person forever, and signs of the condition can be observed as early as infancy. For example, a child may refuse to smile, make eye contact, or play.

Later on in childhood, adolescence, and adulthood, more severe risks can occur. Dysfunctional behavior can range from lying to criminal behavior. Not all individuals with RAD are at risk for homicidal tendencies, but additional actions, such as failure to show remorse and harming animals, can be reliable indicators.

These types of behaviors can last into adulthood and have severe consequences if left unaddressed. Various forms of therapy, especially behavior management training, have shown strong promise in their ability to treat RAD. By visiting www.betterhelp.com you or someone you suspect has RAD can confide in a professional counselor and therapist.

Ideally, it is more optimal to treat RAD early on when families can be involved, and there is a higher chance to place a child in a stable environment.

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In many cases, the opportunity to reconnect with families may be impossible due to extremely abusive backgrounds. In those situations, finding a healthy living situation for a child should be prioritized. The earlier the intervention, the sooner the trajectory can be changed for a person with reactive attachment disorder.

Unlike many other mental health conditions that can develop spontaneously, RAD is entirely preventable. Parents and caregivers are responsible for tending to a child's needs at all times.

References

  1. Buckner, J. D., Lopez, C., Dunkel, S., & Joiner, T. E. (2008). Behavior Management Training for the Treatment of Reactive Attachment Disorder. Child Maltreatment, 13(3), 289-297. doi:10.1177/1077559508318396

  2. Pritchett, R., Pritchett, J., Marshall, E., Davidson, C., & Minnis, H. (2013). Reactive Attachment Disorder in the General Population: A Hidden ESSENCE Disorder. The Scientific World Journal, 2013, 1-6. doi:10.1155/2013/818157

  3. Mirza, K., Mwimba, G., Pritchett, R., & Davidson, C. (2016). Association between Reactive Attachment Disorder/Disinhibited Social Engagement Disorder and Emerging Personality Disorder: A Feasibility Study. The Scientific World Journal, 2016, 1-8. doi:10.1155/2016/5730104

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