Effects of Attachment Disorder in Children and Adults

Medically reviewed by Elle Markman, PsyD, MPH

Attachment disorders are psychiatric conditions that can develop in early childhood and may have lasting impacts into adulthood. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) lists two types of attachment disorders: reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).

Symptoms of attachment disorders often show up in early childhood. Though symptoms differ between the two types of attachment disorders, they share an overarching theme of attachment issues with others, especially with that of a primary caregiver, such as a parent. For example, a child with DSED may be willing to approach strangers without fear and lack appropriate social and physical boundaries around unknown adults.

The exact cause of attachment disorders isn’t known, but inadequate caregiving, such as from living in foster care or a similar institution, is thought to play a significant role.

This article talks about the different types of attachment disorders, risk factors for developing an attachment disorder, and coping with its lasting effects as an adult.

Types of Attachment Disorder in Childhood

Attachment disorders are psychiatric disorders that require a healthcare provider's or mental health professional's evaluation to diagnose. The DSM-5 recognizes two types of attachment disorders in children:

• Reactive attachment disorder (RAD)

• Disinhibited social engagement disorder (DSED)

RAD is characterized by withdrawn or inhibited behavior toward a caregiver. DSED is characterized by a lack of inhibition around strangers, such as a willingness to approach and interact with unfamiliar adults and not seek the safety of their primary caregiver. Symptoms of attachment disorders often show up in early childhood. For example, RAD symptoms often appear before 5 years of age.

Though RAD and DSED are both characterized by significant issues around attachment, one of the key distinguishing features between them is that RAD is thought to be associated with emotional problems, whereas DSED is thought to be associated with behavioral problems.

Symptoms of RAD in young children may include:

• Failure to seek or respond to comfort when distressed

• Not showing attachment toward a preferred caregiver

• Inadequate response to emotions or social cues

• Lack of emotional regulation, such as unexplained fear or irritability

Symptoms of DSED may include:

• Not appearing wary of strangers (lack of “stranger danger”)

• Approaching adults they don’t know without fear

• A willingness to walk off with strangers

• A lack of physical and social boundaries, such as seeking close physical contact with adult strangers

Living with an attachment disorder may cause one to feel emotionally or socially out of touch. Children with attachment disorders may also experience emotional symptoms like depression and anxiety as well as behavioral symptoms like those of conduct disorder, oppositional defiant disorder, or attention deficit hyperactivity disorder (ADHD).

RAD and Autism Spectrum Disorder

Research has suggested that children with RAD are more likely to have other conditions as well, such as autism spectrum disorder (ASD), ADHD, and post-traumatic stress disorder (PTSD). Key similarities between RAD and ASD, such as a lack of social reciprocity, have led some researchers to investigate whether there is some overlap. However, research has shown that RAD and ASD are mutually exclusive due to some key differences, such as the fact that, unlike ASD, RAD is not associated with atypical language development. And unlike RAD, children with ASD do show focused attachment.

Effects of Attachment Disorder Into Adulthood

The social, emotional, and physical problems of attachment disorders can persist into adulthood. Most research on attachment disorders is around young children and adolescents, thus more research on how attachment disorders affect adults is necessary. However, because attachment disorders affect social boundaries and how one relates to others, adults with a history of attachment disorder may experience difficulties with boundaries or creating emotional bonds with others.

What Causes Attachment Disorder?

People may have attachment issues for a variety of reasons. In severe, rare cases, attachment issues may stem from an attachment disorder, which can go undiagnosed.

Though there is no known single cause of attachment disorders, inadequate caregiving is thought to play a role in the development of one. Inadequate caregiving may stem from foster care, orphanages or similar institutions, or parents who were struggling with physical or mental illness.

In addition, the following childhood experiences are considered risk factors for an attachment disorder:

• Maltreatment

• Neglect

• Abuse

Childhood Trauma and Attachment Disorders

Among children with attachment disorders, most have faced problems in their early relationships. Trauma during childhood, including not receiving adequate care from a parent or caregiver as well as maltreatment, neglect, or abuse, may increase the risk of developing an attachment disorder. Childhood is a crucial time to develop emotional bonds and attachment with others, and if this opportunity is significantly disrupted by parents or foster care or similar institutions, attachment issues may ensue.

What Is the Link Between Attachment Disorder and Attachment Theory?

Though attachment theory and attachment disorders both describe how one relates to others, they are two different things.

Attachment theory assumes that a child’s early experiences of caregiving (such as from a parent or other primary caregiver) affect how they perceive themselves and others. These mental models for self and others impact a child’s behavior and future relationships. They also affect how one perceives themselves in relation to others. Attachment theory poses four different attachment styles: secure, avoidant, ambivalent, and disorganized attachment.

Attachment disorder is a clinical condition characterized by significant issues in a child’s behavior toward caregivers and unfamiliar adults.

Though it may seem like attachment disorders would impact attachment styles, research has shown that attachment styles are not significantly associated with attachment disorders. For example, one study found that children with attachment disorders exhibited a range of attachment styles, which were fairly balanced across the different types. In other words, children with attachment disorders didn’t show one particular attachment style over another.

What Helps Children With Attachment Disorder?

Treatment for children with attachment disorders often involves the child and their family or caregiver, with the goal of improving the child’s social and emotional development. A therapist will aim to understand the relationship between the child and their main caregiver and work with the child and caregiver to strengthen their relationship.

For children with a history of inadequate caregiving, a return to adequate caregiving may be their best hope of recovering from attachment disorder. Research has shown that when a child experiences enhanced caregiving, such as getting adopted by a family after living in foster care, signs of RAD decline and often disappear.

Similarly, research has shown that enhanced caregiving reduces symptoms of DSED for some children, though more therapeutic approaches may be necessary to keep symptoms from coming back. More research on how much enhanced caregiving can help with social and behavioral issues over the long term is also necessary.

Coping Through Attachment Disorder as an Adult

Having a history of an attachment disorder or an attachment disorder that persists into adulthood can be painful and significantly affect one’s quality of life given that relationships—with family, friends, or intimate partners—are part of daily life.

Because attachment disorders may have stemmed from inadequate caregiving during childhood, seeing how one can cope with them as an adult many years later can be difficult. However, people can work on attachment even in adulthood, and psychotherapy may help. Keep in mind that changes in behaviors that were learned or developed due to inadequate caregiving may take time, and having patience and understanding with yourself is important.

Attachment Disorder Resources

If you think you or your child may have an attachment disorder, you’re not alone and help is available. Reach out to a healthcare provider to talk about your or your child’s symptoms and any concerns about attachment issues. They may refer you to a mental health provider for an evaluation and specialized treatment plan to help you and/or your child through their attachment issues to improve emotional and social well-being.

Diagnosis Is the Key to Appropriate Treatment

Getting an official diagnosis is important to receive appropriate treatment for an attachment disorder. See a healthcare provider or mental health provider for an evaluation of symptoms before jumping to conclusions about a diagnosis. If and when you have a diagnosis, getting help to manage symptoms will not be far behind.

Specialists to See for an Attachment Disorder

There are many mental health providers who can treat attachment disorders, such as psychologists, marriage and family therapists, social workers, and other licensed mental health providers. Mental health providers often list the types of mental health issues they specialize in, and you can check to see if attachment issues are among them.

When looking for a mental health provider, keep in mind that finding one with whom you feel comfortable may take some trial and error. Finding a therapist that both specializes in attachment issues and makes opening up feel safe is important for getting the most out of therapy.

Summary

Attachment disorders usually develop in early childhood and may have lasting impacts into adulthood. Symptoms of attachment disorders in children may include withdrawn or inhibited behavior toward a caregiver or a lack of wariness or boundaries with strangers. The exact cause of attachment disorders is unknown, but inadequate caregiving during childhood is thought to play a major role. It’s important to seek help from a mental health provider for attachment disorder treatment to improve your emotional and social well-being.

Read the original article on Verywell Health.