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February 2015 HSE 145-0001 Safran 1

Reactive Attachment Disorder

Amongst the various disorders outlining changes in an adolescent’s mood, behavior, and

personality, including Borderline Personality Disorder and Oppositional Defiance Disorder,

(which are relatively elementary procedures to diagnose, given that a child is examined by the

proper medical professional), Reactive Attachment Disorder is one of which a first-impression

medical diagnosis is difficult to come by. The best evidence-based definition of an accurately

diagnosed patient is the failure of an adolescent to form a healthy attachment with their primary

caregiver, which may have resulted from a preceding case of child abuse involving neglect,

which is mostly a psychological form of abuse. In addition, the child will fail to develop an

affectionate relationship with their caregiver, and will most often than not, fail to form a trusting

relationship which will prohibit them from having a normal development relationship, and can

possibly lead to becoming a social outcast later on in life, due to the inability of forming any type

of affectionate relationship. The reason for its uncommon difficulty in documenting a true

diagnosis is due to its lack of recognizable psychological symptoms required by the DSM in

order to make a proper diagnosis, and most often than not, if a child is taken to a physician in an

attempt to make a diagnosis, the physician will recommend that the child is sent to a

psychologist or related mental health expert in attachment disorders. The symptoms of Reactive

Attachment Disorder are not only the signs of one disorder, as attachment disorder can classify a

variety of sub-disorders, much like the utilization of an umbrella term in psychology. In addition,

attachment disorder can be classified into two types of attachment by its grouping of symptoms:

inhibited and disinhibited attachment.

In legitimacy, there are two very distinguishable areas of study in attachment disorders.

The first area of practice pays an extreme amount of attention to the scientifically proven aspects


of attachment disorder, which are elaborately noted and defined in academic journals and

medical books. Referencing the International Statistical Classification of Diseases and Related

Health Problems (ICD), in the 10th revision, category F94 entitled, “Disorders of social

functioning with onset specific to childhood and adolescence,” the symptoms and possible

methods of diagnoses of attachment disorder are distinguished by the inhibited form, also known

as “RAD” (P94.1), and the disinhibited form known as “DAD” (P94.2). However, in the

Diagnostic and Statistical Manual of Mental Disorders (DSM), Reactive Attachment disorder is

solely classified by the “RAD” acronym, covering both inhibited and disinhibited forms. The

second area of practice is the most controversial, as it is clinically based off of theoretical

knowledge with little or no evidence of factuality.

In its inhibited form, which is most common, the typical symptoms of reactive

attachment disorder discussed in the ICD start in the child’s toddler years, and are described by

abnormal inconsistencies in relationships with their guardian and relationships that involve a

resistance to affection and the lack of a sense of comfort from their primary caregiver. The

various causes of inhibited attachment may involve the neglectfulness of a child’s needs for

affection, the child’s basic human needs, and/or the constant change of guardians that can create

the inability to develop a stable and long-lasting healthy relationship with their caregiver. In its

disinhibited form, the DSM-IV characterizes its symptoms as the non-existence of a preferred

figure of emotional attachment, an inappropriate feeling of independence from their caregiver,

and an awkward social connection with everyday strangers and/or friends.

Treating a believed diagnosis can be accomplished utilizing either method of clinical

practices. In the more scientifically-based, and probably more accurate area of study, a very

common treatment involves the use of certain programs that may successfully penetrate the


existing barrier between the guardian and child. These programs include the manipulation of

responsiveness to sensitivity, a modification of “Interaction Guidance,” and “Preschool Parent

Psychotherapy. Treatment options also typically include counseling for parenting, therapy for the

child, and parent education in dealing with “RAD”. The goal of these programs is to establish a

healthier relationship and safer atmosphere for the child to live in. Unfortunately, in the

pseudoscientific area of study, due to the fact that the study, itself, is unproven and based solely

on educated scientific assumptions, treatments don’t often take place or exist. The more

commonly known solution in the theoretical study is to simply claim that disorder was over-

diagnosed and to experiment with other possible disorders that may also be verified with the

requirements of the ICD or DSM.

In conclusion, reactive attachment disorder is one of the most commonly misunderstood

disorders, as there is really no fully legitimate diagnosis unless every requirement is met, or the

diagnosis has viable evidence to rely on, such as a history of psychological child abuse and

neglect. In amplification, due to the vast array of possible symptoms and conclusions that can be

assumed from academic journals and medical encyclopedias (such as the IDC and DSM), it is

extremely difficult to differentiate between the possible diagnosis of a reactive attachment

disorder or another type of closely related personality disorder such as Borderline Personality or

Oppositional Defiance Disorder.

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