Reactive Attachment Disorder (RAD)

Updated April 26, 2023by BetterHelp Editorial Team

Reactive attachment disorder (RAD) is among the mental disorders that can be diagnosed in infants, children, and adults. Reactive attachment disorder in adults often occurs if a person had RAD as a child and did not get effective treatment. Reactive attachment disorder in adults and RAD symptoms are believed to develop during infancy and early childhood if a child is unable to form a secure attachment with their primary caregiver, often because of unmet physical or emotional needs or childhood trauma. Attachment theory suggests that forming a close and loving bond early in life is essential for good mental health outcomes later in life.  However, if a child does not gain a positive sense of bonding with a caregiver, or physical needs such as food and shelter are not met, or the individual suffers trauma, the person may be at risk of developing RAD. This condition makes it difficult to maintain significant relationships as an adult. 

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 by a healthcare professional.

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  • A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers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 and attachment to others and impacts overall mental health. 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 and are more likely to engage in negative behaviors such as substance abuse. Attachment disorder in adults is characterized by a limited ability to receive genuine love and affection and a lack of compassion and empathy toward others that can significantly affect relationships. Online therapy can be helpful for treating reactive attachment disorder in adults.

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 mental health disorders, including reactive attachment disorder.

Reactive attachment disorder usually involves a broad range of symptoms and is often called a ‘condition of extremes.’ A person with reactive attachment disorder may live what appears to be a superficial or imaginary life of emotional experiences. They are generally unable to express their true emotions, feelings, and needs and may isolate themselves from relationships 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 friendships or romantic relationships.

The attachment issues that children with RAD experience typically develop because they were not provided for by a primary caregiver, either physically or emotionally, as a young child or experienced extreme abuse or neglect. . Their behavior may involve manipulation, stealing, lying, aggression, or impulsiveness. These behaviors 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. Symptoms of attachment disorder in adults include difficulty experiencing complex emotions like empathy, trust, compassion, and remorse and an inability to fully grasp emotions. Therefore, reactive attachment disorder in adults results in extreme difficulty in 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. 

Here are some questions that you can ask your health care professional about reactive attachment disorder in adults:

Here are some questions that you can ask your doctor:

Symptoms And Types of Reactive Attachment Disorder In Adult

The symptoms of reactive attachment disorder are typically divided into two sub-categories: avoidant (inhibited) attachment disorder and ambivalent, or disinhibited social engagement disorder (DSED). 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.

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

DSED 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 to situations may detach from their emotions and cease forming any type of emotional attachment. 

Symptoms of DSED include:

  • Indiscriminate friendliness

  • 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

Some peer reviewed studies suggest that RAD might be linked to personality disorders and dissociative disorders such as borderline personality disorder and multiple personality disorder. These other disorders have overlapping symptoms and characteristic early life experiences that are similar to RAD.

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. An infant or young child with reactive attachment disorder should be provided with a stable and safe living environment. In addition, efforts to develop positive interactions with parents and caregivers can help strengthen the child’s attachment ability and overcome this childhood disorder.

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 and attachment problems 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 attachment disorders. Although there is no specific diagnostic test for RAD, thorough psychiatric evaluation can tell wellness professionals much about whether an adult or a child has connections inability consistent with 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 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 think 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 to address this disorder in adults:

Stress Management. For example, learning meditation techniques or practicing yoga can help a person with a social engagement disorder relax and can relieve feelings of being overwhelmed.

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

Self-Care: Taking care of oneself is an important approach to dealing with any mental health issue, including RAD. Sleeping enough, getting enough to eat, and taking time to do enjoyable and relaxing activities are all part of self-care.

Regular Physical Activity: Exercise releases endorphins in the brain and produces positive feelings. Clearing out thoughts and emotions through physical activity can help a person feel more emotionally peaceful as well as physically healthier.

Self-Education: When it comes to mental health issues like attachment disorder in adults, knowledge really is power. Talking to a counselor or mental healthcare provider or joining a support group for people with RAD or for their loved ones can be extremely helpful. 

Developing A Support System: Building a base of trusted loved ones in whom you can confide can help tremendously when struggling with tough emotions and help a person gain a more positive sense of themselves.

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 or want to heal for future relationships, 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 an invaluable service and convenient 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 these 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.

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