Reactive attachment disorder

Reactive attachment disorder (RAD) is a diagnosis described in DSM-IV (fourth edition of Diagnostic and Statistical Mannual of Mental Disorder – a psychiatric classification standard, prepared by the American Psychiatric Association), which refers to disorders that emerge in infancy and early childhood.

This disorder has its own diagnostic criteria. This violation does not cover many of the behavioral problems observed in a time when the process of attachment is interrupted by the parting, illness, unprofessional or improper conduct of educator parents.

What is reactive attachment disorder?

The conditions of the environment are often the harbingers of reactive attachment disorder. The diagnosis of RAD defines the criteria for behavioral characteristics and problems of the environment, which are the precursors and necessary for the diagnosis of reactive attachment disorder.
In reactive attachment disorder, DSM-IV considers two basic types of behavior. Representative of the hindered type of attachment disorder, is a child who “constantly refuses to initiate or respond to social activity, as it is expected of children in his age and level of development. It’s expressed in too depressed, too sensitive or highly controversial reaction, for example, a child may respond differently to the teacher: to avoid and refuse caress or to express increased vigilance (“frozen vigilance”).

Reactive Attachment Disorder Diagnostic Criteria

Reactive attachment disorderDiagnostic criteria for disinhibited type of attachment disorder describe the type of children with “diffuse affection, which manifests itself in indiscriminate sociability with the apparent inability to demonstrate the required selective attachment (eg, excessive familiarity with strangers, or carelessness in the choice of objects of attachment)”. (DSM IV)

In both types there must be evidence of “clearly violated social relationships of the child in different situations, which is manifested before the age of five years”. (DSM IV) It should be noted that the criteria for impaired attachment include the following factors:

- In most cases, the child exhibits inappropriate level of his development of social relationships.
- In most cases the signs of the disorder are manifested in the child in all situations, and while interacting with various teachers.

13 Possible Causes of RAD

Reactive attachment disorder can be caused by one or a combination of the following factors:

- Premature birth;
- Prenatal alcohol or drug poisoning, (if mother made use of them during pregnancy);
- Pregnancy, which has been extremely reluctant to biota;
- Postpartum depression in biological mother;
- Early separation from biological mother;
- Emotional detachment of biological mother due to mental disorders, alcohol or drug addiction;
- Cruel treatment or extreme neglect in the first years of kid’s life;
- The extreme pedagogical incompetence of biological parents (for example, if his mother was too young and wasn’t interested in raising a child);
- Frequent changes of adults, caring for the child (e.g., frequent changes of caregivers or nannies in the child’s home, or transfer from group to group within the same institution or transfer from one institution to another);
- Hospitalization of the child, even on relatively short (from the point of view of adults) period of time;
- Undiagnosed and therefore uncured acute pain or chronic illness (e.g., a severe colic or ear infection in infants);
- Serious injury;
- Painful and extensive medical procedures.

Violation of attachment may develop even in the first months of life when a child does not seem to realize himself. You should know that if in infancy the child is subjected to abuse or neglect, his body permanently produces increased number of stress hormones. As a result, the lesson that this world is terrible and cruel place will be fixed in his brain at the biochemical level.

Usefull links:
Reactive attachment disorder on Wikipedia

What Complications It May Cause

Complications of RAD can continue in adulthood and often include the following problems:
- Poor self-esteem;
- Delayed learning or physical development;
- Antisocial or delinquent behavior;
- Temper or anger problems;
- Problems in relationships;
- Depression;
- Eating disorders, which can cause malnutrition in severe cases;
- Academic problems;
- Anxiety;
- Unemployment or frequent job changes;
- Alcohol and/or drug addiction;
- Inappropriate sexual behavior.

Behavioral Signs of Reactive Attachment Disorder

Children with diagnosis “reactive attachment disorder” suffer from an inability to love and be loved. They may poison relations in a normal, healthy family so much, that it will affect all its members. They are excellent manipulators, and their effects are subtly and cleverly directed to each family member. Outsider people commonly can’t understand the pain and anger of parents complaining about the behavior of their child, because these children may very charm with others.

Lack of communication with others is manifested in the form of cruelty to other people and animals, which is sometimes even hard to believe.
Children with reactive attachment disorder avoid eye contact, if they not lie, hostile to others, blame others for own mistakes or problems, have a lack of trust, compassion and conscience. They have broken speech development, and often have problems with learning, indicating a general retardation in development.

They steal, identify themselves with negative characters and the dark side of life in general. They avoid tactile contact, take a protective position, they are drawn to fire and blood, they want to control everything, trying to attract attention.
In order to set the reactive attachment disorder diagnosis for the child, he doesn’t need to have all of the above symptoms. Some of the symptoms are observed in children who have problems with attachment, but not suffering from RAD. Ability to form attachments, setting healthy relationships with others and the existence of the mutual relationships with others makes everyone part of people community.

Reactive Attachment Disorder in Adults

Reactive attachment disorder is also quite common in adults. Symptoms of adult RAD are a little bit different than in childhood. They are usually divided into 2 categories: ambivalent and avoidant attachment.

Ambivalent RAD symptoms:
- Passion to intimate contact and declarations of love at all times from their partners;
- Show inveterate care giving nature;
- Tend to idealize others;
- Feel themself uncomfortable with anger;
- Show too extreme emotions;
- Very jealous;
- Frequent mood swings;
- Imbalanced relationships with others;
- Never have prolonged relationships;
- Too possessive;
- Feel that their partner is unpredictable;
- Tend to be concerned or have dependence on relationship;
- May show suicide attempts;
- Have a tendency of frequent depression;
- Often feel themself unlovable or undesired by others.

Signs of avoidant attachment disorder:
- Avoid intimacy;
- Hostile behavior;
- Fear of closeness in relationships;
- Compulsive self-reliance;
- Passive alienation;
- Tend to be excessively critical of others;
- Consider themselves unlovable or too good for others;
- Truly believe in idealizing the love relationship;
- Lack of empathy;
- Show intense anger;
- Have a tendency to self-criticism;
- Have very low levels of perceived support;
- Painfully sensitive to blame;
- Find relationships as a danger to their sense of control;
- Avoid personal relationships by inventing work reasons.

Relationship with Mother is the Key for Attachment Development

Symptoms of reactive attachment disorder usually become apparent before the age of five years. Attachment to the mother (main caregiver) is born in her womb and occurs at the neurological, psychological and emotional level. This is the time when mother is the only person who cares for the needs of baby food, comfort and love. When a child has the above behavior problems, you need to pay attention to the possible “gaps” in the early formation of the relationship between mother and infant. It may be, for example, separation from the mother by adoption, mother’s death, hospitalization of the child or the mother, emotional coldness of caregiver at the time of mental or physical illness of a child, chronic pain, such as colic or ear infections, prenatal drug abuse, abuse of parents after the birth, or violent situation at home. Usually there is a combination of factors that make children to relate towards others with distrust, especially to adults.
Kids with reactive attachment disorder need our love and care – don’t forget about it.