Additionally, reactive attachment disorder is caused by some type of issue with care, such as caregivers being unable to fully provide for the needs of the child, not fulfilling physical and emotional needs, inconsistency, or too many primary caregiver changes.
The term “reactive attachment disorder” is sometimes shortened to “attachment disorder,” but reactive attachment disorder is actually a type of attachment disorder,
Reactive Attachment Disorder vs. Disinhibited Social Engagement Disorder
Attachment disorders are sometimes described as being inhibited or disinhibited. These terms are used to describe the behaviors of babies and young children.
Children who fall into the category of inhibited struggle to regulate their emotions, do not prefer any specific adult or caregiver, do not seek caregiver comfort, or do not show much affection, or they display a combination of these behaviors. On the other hand, children who fall into the category of disinhibited may engage or overly engage with all adults evenly, including strangers, and they do not prefer primary caregivers.
Reactive attachment disorder is the inhibited type of attachment disorder. There used to be only one diagnosis for both inhibited and disinhibited attachment, but that has changed with more recent research. The disinhibited type of attachment disorder is called disinhibited social engagement disorder, or DSED.
Characteristics
The characteristics of reactive attachment disorder are the inhibited type, meaning that the child behaves in ways that show little or no attachment to parents or other caregivers. This is seen in babies and young children. They are not able to bond with their parents or primary caregivers in a way that is healthy and secure.
Diagnosis
Reactive attachment disorder can be diagnosed by a mental health professional such as a psychiatrist or psychologist specializing in children. They do this by assessing the child based on the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5) diagnostic criteria. Then they assess the child in terms of how the symptoms affect their ability to function.
Avoidance of comfort when distressedAvoidance of physical touchDifficulty managing emotionsNot being affected when left aloneNot making eye contact, smiling, or engagingEmotional detachmentExcessive rocking or self-comfortingInability to show guilt, remorse, or regretInconsolable cryingLittle or no interest in interaction with othersNeed to be in controlTantrums, anger, sadness
Causes
The specific causes of reactive attachment disorder are not as simple as they may seem. While child abuse and neglect can lead to attachment disorders, there is more to it than that. Children who receive inconsistent care or who are placed with new primary caregivers are also at an increased risk of reactive attachment disorder. This can happen even when parents and other caregivers mean well and are doing their best.
Children may experience an event or challenge that is not overtly harmful, such as a geographical move, or something that cannot be avoided, such as the death of a family member. Even though they may be too young to understand what is happening, they may feel as though they are not loved, they are unsafe, or they are unable to trust their caregivers.
Treatment
Treatment for reactive attachment disorder goes beyond the child alone. The entire family may be included in order to support healthy bonding. The process involves a combination of talk therapy, other therapies, and education that benefit children as well as parents and other caregivers.
Attention only when the child misbehaves (negative attention only)Being left alone for hours without interaction, touch, or playEmotional needs not being met consistentlyExperiencing a trauma or very scary, difficult eventHaving an emotionally unavailable parentHospitalizationInconsistent care or response to needsLoss of a caregiver or other family member, such as a siblingMultiple primary caregivers or changes in caregiversNeglect or abuse from parents, caregivers, or othersNot being comforted when crying or distressedNot being fed when hungry for hoursNot having a diaper changed for many hoursOnly some needs being met, or needs being met only sometimesPhysical needs not being met consistentlySeparation from parents or other primary caregivers
Coping
Coping with reactive attachment disorder involves strategies to support both the child and the adults who interact with the child. This is because bonding between children and their caregivers involves two or more people, and their interactions can help to form more secure attachment. For this reason, coping includes support, self-care, and stress management for the adults, as well as healthy nutrition and adequate sleep and physical activity for both children and adults.
Family therapy with the child and caregiversParenting classes to learn effective strategiesPlay therapy with the child to teach social and other skillsTeaching social skills in other waysSpecial education services in schoolsTalk therapy with the child, caregivers, or both
For more mental health resources, see our National Helpline Database.
A Word From Verywell
If your child or a child you know is struggling with attachment, help is available. Even if your child is diagnosed with reactive attachment disorder, it doesn’t mean this was brought on by you or was your fault. Sometimes things happen that are beyond one’s control, no matter how hard we try. The greatest concern is that the child gets the care they need.
Contact a family physician, primary care provider, or mental health professional for support for the child. It is also important that you and other primary caregivers for the child receive any needed support in order to care for the child.
