Reactive Attachment Disorder: Causes, Symptoms, And Treatment

Updated February 27, 2023by BetterHelp Editorial Team

Content note: This article contains discussions of child abuse and other potentially sensitive topics. If you or someone you know needs help, please contact one of the following hotlines.
Childhelp National Child Abuse Hotline: Call 1-800-422-4453
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Reactive attachment disorder is a rare and relatively unknown mental health condition that occurs in children. The Diagnostic and Statistical Manual 5th Edition (DSM-5-TR) classifies this attachment disorder as a stressor- and trauma-related disorder caused by maltreatment and neglect during childhood. Children develop 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 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, the general disregard for a child’s basic emotional needs that leads to severe cognitive and psychosocial dysfunction.

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. 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, among other symptoms that greatly interfere with a child’s ability to function with ease. Compared to those without the condition, individuals with reactive attachment disorder will display more behavioral and psychosocial issues. Symptoms of reactive attachment disorder include the following:

My Child Has Reactive Attachment Disorder, What Can I Do?

  • Impulsivity

  • Problematic eating behaviors

  • Delayed language and motor skill development

  • Anxiety and/or depression

  • Excessive self-monitoring

  • Emotional lability

  • Lack of empathy

  • Problems with concentration and attention

  • Hyperactivity

  • Oppositional behaviors

  • Mal-adaptive behaviors, for example destroying property, lying, and stealing

  • Suicidal or homicidal ideation

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 negative 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. 

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 reactive attachment disorder 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.

Adults with RAD that have difficulties adjusting to social situations and making safe connections may also 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 use 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  describes several treatment options for children managing RAD, including pharmacological interventions and behavior management training (BMT). BMT assists caregivers by providing education about their child’s behavioral problems while teaching them parenting skills that encourage health behavior. Behavior management training 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.

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.

Therapy Can Help

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 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. 

If you are concerned that your child or a child you know is managing reactive attachment disorder, make an appointment with a qualified healthcare provider or mental health therapist who can provide psychological interventions. 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. While this diagnosis requires intensive therapy, it is important your family receives the support they need, which is possible with family and relationship therapy. 

Licensed family therapists have the tools, experience, and ability to help support you and your child on your journey to improved mental health. There are several options for you to choose from, including online therapy from licensed professionals. While for some it is more beneficial to have in-person conversations, that may not be the case for everyone, and your comfort level should come first. 

A growing body of evidence is revealing that online therapy is an effective option for mental health treatment. For example, a study published in Clinical Child and Family Psychology Review explored the efficacy of online family therapy, especially as compared to in-person therapy. The review reported that research supports telehealth-delivered therapeutic sessions as an effective delivery of family therapy services. Furthermore, the study concluded that evidence shows equivalent efficacy for mental health and relational outcomes from online relative to in-person delivery. 

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. By visiting you or someone you suspect has RAD can confide in a professional counselor and therapist.

My Child Has Reactive Attachment Disorder, What Can I Do?


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. 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.

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.”

“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.”

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