Reactive Attachment Disorder: Causes, Symptoms, And Treatment

Updated May 09, 2019

Reviewer Sonya Bruner

Reactive attachment disorder is a rare and unfamiliar mental health condition that is found in children, and 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.


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

As mentioned earlier, reactive attachment disorder can be summed up by there being a lack of an emotional bond between a caregiver, such as a biological or adoptive parent, and a child. This situation can happen due to the absence of a stable caregiver, neglect, and abuse, whether it is physically or emotionally. 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

RAD may also be more frequently seen in those in orphanages or foster care because those individuals may have been abandoned by their parents or do not have stable caregivers and homes.

Despite this, RAD is uncommon, but it presents itself by the age of 5 with a variety of symptoms [1]. This feature means that its one of a handful of conditions from the DSM 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

Based on these symptoms, someone with the condition may have difficulties showing affection, have anger issues, and perhaps have 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]


Some of these reactive attachment disorder symptoms may only be more apparent past the age of 5; however, 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 will carry over into adulthood and can have serious implications and consequences.

Reactive Attachment Disorder In Adults

Many of the symptoms that were listed earlier in the previous section 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, such as 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 criminality and being tried as an adult. Vandalism, arson, homicide, and cruelty to animals are all serious offenses. In the worst cases, there may be no empathy or remorse for his or her 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

While there currently is no standard, the most common course of treatment for someone with RAD is attachment-based therapies [1]. One of the most used techniques is a type of psychological intervention known as holding therapy. It designed to help reattachment with a mother or foster parent.

Although it is popular, holding therapy is also somewhat controversial since it is forced. The child is restrained and exposed to unwanted stimuli for a prolonged period. This stimuli can include, but is not limited to: [1]:

  • tickling
  • poking
  • tapping
  • yelling

The goal is to expose the child to the stimuli until there is no resistance or attempt to escape it. Following this, the child is returned to the caregiver because of the suppressed rage towards these actions is released which allows for a new healthy attachment to form.

Studies show that those who received holding therapy displayed a substantial decrease in aggressive behaviors in comparison to those who have never undergone treatment [1].


Other types of reactive attachment disorder treatment such as play therapy and art therapy have demonstrated effectiveness in the treatment of other attachment disorders; however, not very many clinical trials have been carried out to measure its 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. Another way that holding therapy has been controversial is because some patients have been exposed to severe abuse and this type of treatment can perpetuate the past trauma [1].

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.

Rather than a parent, 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 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 can begin before the age of 5 years old. 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 extremely negative experiences have the potential to impact a young person forever, and signs of the condition can be observed as early as infant-hood. For example, a child may refuse to smile, make eye contact, or play.

Later on, in later childhood, adolescence, and adulthood more severe risks can occur. Dysfunctional behavior can range from lying to killing. 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 until adulthood and have severe consequences if left unaddressed.

Holding therapy is the most studied reactive attachment disorder treatment method. While controversial, it has shown effectiveness in many children because it alters his or her feelings towards negative stimuli, such as touch.

This type of therapy might not be optimal for adults though, and instead, different methods that involve trust and relationship building are emphasized. By visiting 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.


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.

In reality, unlike many other mental health conditions that can happen for seemingly no reason, RAD is entirely preventable, and parents and caregivers are responsible for tending to a child's needs at all times.


  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
  1. 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
  1. 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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