Attachment Disorder

Attachment is a basic need for all infants and children. In order to physically, mentally, and psychologically develop, a child must develop an attachment to a primary caregiver. This adult must not only supply essential needs to the child, but also be the resource for stressful times. Patterns of early attachment establish adult feelings, thoughts, and expectations in adult relationships.

It is possible for a child to lose the ability to form secure attachments as a result of sexual abuse. This can be caused by a single traumatic event or from ongoing abuse. The following symptoms may provide evidence of an existing attachment disorder:
  • Battles for control - anger, argumentativeness, defiance
  • Resisting parental affection
  • Inappropriate demanding or clinginess
  • Overly affectionate with strangers
  • Manipulative
  • Lies frequently
  • Steals
  • Poor relationships with peers
  • Destructive to property
  • Anger/aggression with others
  • Self-destructive behaviors
  • Learning problems
  • Hyperactivity
  • Food disorders
  • Speech and language problems
  • Obsessed with fire, violence, weapons
  • Lack of conscience - no appropriate demonstration of remorse
  • Inability to refrain from acting out on impulses
  • Lack of eye contact but may look in eyes when lying  
  • Incongruent response to injury - overly concerned about small things, but ignores/brushes off large things

Because of events in early life, many children are unable to attach to a primary caregiver and are unable to process through the normal development necessary for healthy function in adult relationships. If children learn that the primary caregiver will respond to their needs and consistently meet them, they learn to trust. If this response does not occur, and needs are not met, the child learns not to trust. She learns that adults are not dependable and may be cruel, rejecting, and violent. Rage and anger may replace trust and seriously hinder healthy relationships later in life. The child learns the world is not safe and that she must take care of herself. She learns that she must be in control. 

Later on, the child may let the caregiver know what she wants. If the caregiver sets limits and responds appropriately, the child learns how to regulate emotions, develop an understanding of right and wrong, and have compassion towards others. Without appropriate caregiver response during childhood, the child will be negatively impacted in  her ability to attain and maintain adult relationships. The child, who knows that adults are not trustworthy, may try to control all aspects of their lives, including relationship partners in adulthood. They may develop characteristics of codependence and be more invested in caring for and controlling others than in healthy physical and psychological self-care and boundaries. They may also distance themselves from others, both physically and emotionally, avoiding either (or both) physical and emotional intimacy.

Within attachment theory, attachment means an affectional bond or tie between an individual and an attachment figure (usually a caregiver). Such bonds may be reciprocal between two adults, but between a child and a caregiver these bonds are based on the child's need for safety, security and protection. The type of attachment developed by infants depends on the quality of care they have received. Types of attachment:

  • Secure attachment: Caregiver responds appropriately, promptly and consistently to child's needs and has successfully formed a secure parental attachment bond to the child. Parent is child's secure base for exploration. Child may be comforted by a stranger but shows clear preference for the caregiver.
  • Avoidant attachment: Caregiver shows little or no response to distressed child, discourages crying, and encourages independence. Child feels that there is no attachment; therefore, the child is rebellious and has a lower self-image and self-esteem
  • Ambivalent/resistant attachment: Caregiver is inconsistent between appropriate and neglectful responses and generally will only respond after increased attachment behavior from the infant. Child always feels anxious because the caregiver's availability is never consistent. 
  • Disorganized attachment: Caregiver demonstrates frightened or frightening behavior, intrusiveness, withdrawal, negativity, role confusion, affective communication errors and maltreatment. This type of attachment is very often associated with many forms of abuse towards the child.

Reactive attachment disorder (RAD) is a diagnosis, and the central feature is the disturbed and developmentally inappropriate social/relational behavior, beginning prior to age 5.The condition is associated with a caregiver's persistent disregard for the child's basic emotional needs for comfort, stimulation, and affection; persistent disregard of the child's physical needs; or repeated changes of primary caregivers, preventing formation of stable attachments. It is presumed that the pathological care of the caregiver is responsible for the child's symptoms. Specific symptoms include the child's inability to respond appropriately in social situations, the child's excessive inhibition, hypervigilance, or high ambivalence and contradictory responses. The child may respond to caregivers with a mixture of approach, avoidance, and resistance to comforting. The child shows diffuse attachments, showing indiscriminate sociability and inability to appropriately select attachment (e.g., excessive familiarity with strangers). There are two types of RAD:

  • Inhibited Type: The predominant disturbance in social relating is the failure to respond to most social interactions in a developmentally appropriate way.
  • Disinhibited Type: The predominant disturbance in social relating is indiscriminate sociability or lack of selectivity in choosing attachment figures.  



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