Reactive Attachment Disorder (RAD)

By Mary Elizabeth Dean|Updated April 20, 2022
CheckedMedically Reviewed By Wendy Boring-Bray, DBH, LPC

Reactive attachment disorder (RAD) is a condition that is typically seen in infants and children. Reactive attachment disorder and RAD symptoms are believed to develop during infancy and early childhood if a child is unable to form a secure attachment with a caregiver, often because of unmet physical or emotional needs. Bonds of attachment to caregivers begin in infancy and usually broaden as the child learns to develop emotional attachments with other family members, such as grandparents or siblings. However, if a child does not experience a normal bond with a caregiver, or if physical needs such as food and shelter are not met, they may be at risk of developing RAD. As a result, the child may not turn to a caregiver for love, comfort, or protection.

Although RAD is observed more often in children under five years of age, it can persist into adolescence and even adulthood if left untreated. Fortunately, reactive attachment disorder can be treated in both children and adults. Treatment should be implemented as soon as symptoms are noticed and a diagnosis is confirmed.

Criteria for Reactive Attachment Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the criteria for diagnosing someone with reactive attachment disorder include:

  • The presence of persistent social and emotional disturbance
  • A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
  • A pattern of extremes of insufficient care
  • The child has a developmental age of at least 9 months
  • The disturbance is evident before the age of 5 years
  • The criteria for autism spectrum disorder is not met

There Was Trauma In My Childhood - Do I Have Reactive Attachment Disorder?

Understanding The Facts

Reactive attachment disorder affects the development of healthy bonds. It causes individuals to believe they must provide for themselves, even if they don’t have the means or knowledge to do so. Individuals with reactive attachment disorder experience difficulty forming stable relationships. Their inexperience with receiving genuine love and affection makes them less likely to show compassion or empathy toward others. 

Symptoms Of RAD

Have you ever met a person who seems to lack any desire or ability to connect with others? Was it a child who seemed unconcerned about the absence of familiar people or caregivers? Perhaps you know an adult who has had a history of troubled relationships and seems to prefer being alone than with others. Although some people naturally prefer to be independent, there are times when a lack of ability to connect with others or form healthy relationships can signal the presence of a mental health disorder known as reactive attachment disorder.

Reactive attachment disorder usually involves a broad range of symptoms and is often called an condition of “extremes.” A person with reactive attachment disorder may live what appears to be a superficial or imaginary life. They are generally unable to express their true emotions and may isolate themselves from others to prevent feeling embarrassed or hurt. They may show signs of hostility or aggression toward others, which can negatively impact their ability to develop healthy relationships.

The attachment issues that children with RAD experience typically develop because they were not provided for, either physically or emotionally, early in life. Children with RAD often find it difficult to trust any adult to provide for or protect them. Their behavior may involve manipulation, stealing, lying, aggression, or impulsiveness. These appear to be coping mechanisms that make them feel safe. If left untreated, symptoms can extend far beyond early childhood.

Parents of children with RAD often struggle with feelings of guilt or helplessness. Without therapeutic approaches and a responsible caregiver to provide for the emotional and physical needs of the child, symptoms of RAD can worsen over time. Adults with reactive attachment disorder have difficulty experiencing complex emotions like empathy, trust, compassion, and remorse. Therefore, they generally have a harder time developing healthy relationships. 

Adults with RAD often deny personal responsibility for their behavior and resort to the lies and manipulative behavior they learned in childhood. It’s not uncommon for adults with reactive attachment disorder to feel helpless, hopeless, or anxious because they often believe others blame them for their inability to connect with or relate to them. Anger, isolation, and insecurities can lead adults with RAD to resort to risk-taking and negative addictive behaviors, including alcoholism, substance use, or dependence on gambling or pornography. What may appear to be a personality flaw actually has a deep-rooted source, and it’s important to recognize that help is available, even later in life. 

Types of RAD and Their Symptoms

The symptoms of reactive attachment disorder are typically divided into two sub-categories: avoidant (inhibited) attachment disorder and ambivalent (disinhibited) attachment disorder. Avoidant attachment disorder is characterized by wanting a high level of independence and autonomy. Even if a person with avoidant RAD needs help, they may believe they are not vulnerable to the feelings that are generally associated with attachment to others, may deny needing close personal relationships with others, and may even view relationships as unimportant altogether.

Symptoms of avoidant reactive attachment disorder include:

  • Compulsive self-reliance
  • Preference to working or playing alone
  • Tendency to be overly critical of others
  • Oversensitivity to blame
  • Self-criticism
  • Lack of belief in the idea of a truly romantic relationship
  • Belief that they are unlovable
  • Avoidance of intimacy

Ambivalent reactive attachment disorder results from unhealthy attachments usually associated with an unpredictable or unstable home life during early childhood. Children who are not nurtured and who do not learn how to respond appropriately to others or situations may detach from their emotions and cease forming any type of emotional attachment. 

Symptoms of ambivalent reactive attachment disorder include:

  • Tendency to idealize others
  • Jealousy
  • Difficulty developing or maintaining healthy or long-term relationships
  • Overdependence on relationships
  • Depression
  • Possessiveness
  • Feeling unlovable or undesired by others

Treatment For Reactive Attachment Disorder

Early intervention appears to improve the outcome of treatment for people with RAD. The primary goal of treatment is to stop the cause of attachment disruption and offer an atmosphere that is conducive to developing healthy attachments. Children with reactive attachment disorder should be provided with a stable and safe living environment and efforts to develop positive interactions with parents and caregivers can help strengthen the child’s attachment ability.

Adults with reactive attachment disorder may experience sadness and fear of the unknown. Although they may not admit it or may appear to hide behind their attachment issues, these adults often crave love and affection from others. However, their inability to form healthy attachments often causes them to avoid reaching out. Because adults with RAD have trust issues as well as difficulty connecting with their own emotions, talk therapy is frequently a first step in treatment.

How Can You Evaluate Reactive Attachment Disorder In Adults Or Children?

The DSM-V criteria describe the symptoms common in people of all ages with RAD. Although there is no specific diagnostic test for RAD, thorough psychiatric evaluation can tell clinicians much about whether an adult or a child has the disorder.

The Connection Between RAD And "ACEs Too High"

The “ACEs Too High test,” a straightforward questionnaire that scores the impact of toxic stress, reveals information about the effects of adverse childhood experiences, which can help diagnose reactive attachment disorder. The acronym ACE stands for "adverse childhood experience," such as abuse, trauma, or neglect. ACEs can harm a developing brain, though the symptoms are sometimes delayed until adolescence or adulthood. The higher an individual's ACEs score, the greater the risk of serious health problems like chronic disease, mental illness, or violence.

A licensed therapist can assess your ACEs score when evaluating potential symptoms of RAD. The goal in the early stages of treatment is to gather as much information as possible to find the right individualized treatment plan.

Ways To Cope With RAD

If you someone you or someone you know has RAD, it can feel overwhelming and stressful. At times, you may feel angry or hurt. Implementing measures to cope with the symptoms may help make life less stressful. Here are some steps you can take:

Practice Stress Management. For example, learning meditation techniques or practicing yoga can help you relax and relieve feelings of being overwhelmed.

Acknowledge Your Feelings. Recognize that feelings of frustration, anger, grief, loneliness, and more are reasonable responses to dealing with RAD. Your emotional reactions are valid, and you don’t need to hide them, especially from a trained mental health professional.

Practice Self-Care. Taking care of yourself is an important approach to dealing with any mental health issue, including RAD. Do your best to make sure you are sleeping enough, getting enough to eat, and taking time to do things you enjoy. These steps will give you energy as you heal.

Pursue Physical Activities Regularly. Exercise releases endorphins in your brain to produce positive feelings. Clearing your thoughts through physical activity can help you feel more emotionally peaceful as well as physically healthier.

Educate Yourself. When it comes to mental health issues, knowledge really is power. Talk to a counselor or mental healthcare provider. Consider joining a support group for people who have RAD or for their loved ones. 

Develop A Support System. Build a base of trusted loved ones in whom you can confide. If you're struggling with tough emotions, reach out to one of them and share your feelings. This will help relieve pressure and make you feel more supported.

Conclusion: RAD And Online Therapy

If you think you may have developed an insecure attachment style as a result of trauma, neglect, or other difficulties early in life, please know that you are not alone, and attachment issues are absolutely not your fault. Regardless of whether you currently have a supportive partner, the single most important thing you can do for yourself if you are experiencing symptoms of any attachment disorder is to seek professional help. A recent peer-reviewed study found that psychotherapy can decrease attachment anxiety while increasing attachment security, and you deserve to experience strong feelings of security and attachment in your life. Online therapy, like the services provided by BetterHelp, can be a great way to approach treatment for an attachment disorder.

There Was Trauma In My Childhood - Do I Have Reactive Attachment Disorder?

One of the best features of online therapy with BetterHelp is its flexibility. You will not have to confront any feelings of anxiety about making it through traffic to get to an in-person appointment on time when you can meet from the comfort of your own home on your schedule. A licensed counselor will work with you in whatever format is most comfortable for you—video chats, phone calls, emails, or text messages—to give you greater feelings of control and support. As your therapist helps you to develop self-esteem, self-worth, and self-confidence through confidential sessions, you can return to your home life, workplace, and social life with renewed hope and attachment security. Here are some reviews of BetterHelp counselors from other individuals who have found support for attachment issues.

Counselor Reviews

"Baruch has been helping me sort out issues in dealing with my elderly father who was distant, very critical, and emotionally unavailable during my childhood and beyond. My father is currently verbally abusive to me and other family members in many instances. Baruch is wonderful. He has helped me with concrete and practical suggestions to help me deal with the immediate situation with my father and also more in-depth analysis of the whys and wherefores of the past… I felt immediately at ease with Baruch at our first session. He is an amazing listener and responds with such clarity and insight. In just a few sessions, he has helped me greatly. Highly recommend!"

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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