Over the last three decades, the term ‘attachment disorder’ has entered into common usage among professionals and carers who interact with children who display markedly disturbed and developmentally inappropriate relatedness to others. With greater awareness of the consequences of attachment disruption has come endeavours to develop interventions for children who have an attachment disorder and supports for those who care for them. In any such endeavour it is important that the children involved are representative of the condition. This allows for the development of specific interventions that can be tested for their effectiveness without the potentially confounding influence of children who do not have the condition being included in the recipient client group.

In the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013) two diagnoses are relevant to the discussion of what an attachment disorder is, what it looks like and when the diagnosis should be used. The first diagnosis is Reactive Attachment Disorder (RAD). RAD might be considered when children show limited dependency on others for comfort, support, protection and nurturance, and limited response to comfort from an adult in a caregiving role. That is, these children are observed to be inhibited, emotionally withdrawn and inordinately self-reliant. Children with RAD must also show disturbances of emotion and emotional responsiveness to others. They are prone to unexplained irritability, sadness and fearfulness, even during nonthreatening interactions with adult caregivers, and are not readily comforted by adult caregivers.

A second diagnosis, Disinhibited Social Engagement Disorder (DSED), is also relevant to any discussion of attachment disorders. DSED might be considered when a child displays culturally inappropriate, overly familiar behaviour with relative strangers. They may display reduced or absent reticence to engage or even go off with unfamiliar adults, overly familiar verbal and physical behaviours and diminished or absent checking back with an adult caregiver, including in unfamiliar situations. Whereas children with RAD appear to avoid dependency on others, children with DSED treat everyone as if they are a potential source of care.

Notwithstanding the differences in the presentation of children that might be diagnosed with either of these disorders, there is a common feature. The condition is understood to have arisen as a result of grossly deficient care, as evidenced by at least one of the following:

• A persistent lack of having basic emotional needs for comfort, stimulation and affection met by caregiving adults;
• Repeated changes of primary caregiver, with limited opportunity to form stable, selective attachments (as happens with frequent changes in foster-care arrangements); or
• Rearing in settings that severely limit opportunities to form selective attachments (as happens in institutional care environments with high child-to-caregiver ratios).

Source: Pearce, C. (2016). A Short Introduction to Attachment and Attachment Disorder – Second Edition. London: Jessica Kingsley

For more information about attachment disorders, including about the conditions under which is arises, therapeutic re-parenting, and treatment, continue reading via A Short Introduction to Attachment and Attachment Disorder (Second Edition), details of which can be accessed via the link or by clicking on the image below.