What is an Attachment Disorder?
Attachment Disorder is a condition in which individuals have difficulty forming loving, lasting, intimate relationships. The words “attachment” and “bonding” are generally used interchangeably. Attachment Disorders vary in severity, but the term is usually reserved for individuals who show a nearly complete lack of ability to be genuinely affectionate with others. They struggle to trust and develop a healthy conscience.
What are the diagnostic criteria for Attachment Disorder? (DSM-IV-TR)
- Markedly disturbed and developmentally inappropriate social relatedness in most contexts.
- The disturbance is not account for solely by development delay and does not meet the criteria for Pervasive Developmental Disability.
- Onset before 5 years of age.
- Requires a history of significant neglect.
- Implicit lack of identifiable, preferred attachment figure.
There must be a history of ‘pathogenic care’ defined as disregard of the child’s basic emotional or physical needs or repeated changes in primary caregiver that prevents the formation of a discrimination or selective attachment that is presumed to account for the disorder. Unusually, therefore, part of the diagnosis is history of care rather than observation of symptoms.
In DSM-IV-TR the inhibited form is described as: “Persistent failure to initiate or respond in a developmentally appropriate way to most social interactions, as manifest by excessively inhibited, hypervigilent, or highly ambivalent, or contradictory responses, eg: the child may respond to caregivers with a mixture of approach, avoidance and resistance to comforting, or may exhibit frozen watchfulness.
Such infants do not seek and accept comfort at times of threat, alarm or distress thus failing to maintain ‘proximity’, an essential element of attachment behavior.”
What causes Reactive Attachment Disorder (RAD)?
Material ambivalence toward pregnancy; neglect; genetic disposition; sudden separation from primary caretakers; birth trauma; primary caretakers; undiagnosed and/or painful illness such as colic or ear infections; abuse; frequent moves and or placements; inconsistent or inadequate day care; traumatic prenatal experience in-utero exposure to alcohol/drugs or unprepared mothers with poor parenting skills.
Why is Attachment so important?
Attachment is essential for the foundation of a healthy personality and is necessary for:
- The attainment of full intellectual potential
- The ability to think logically
- The development of a conscience
- The ability to cope with stress and frustration
- Becoming self-reliant
- The development of relationships
- The ability to handle fear and worry
- The ability to handle perceived threats to self
What are the affects of Unhealthy Attachment?
The affects of unhealthy attachment include problems with: interpersonal relationships; self-destruction; self-harm; withdrawal; impulse control; chaos; anger and rage; sabotage; emotional regulation and cognitive functioning.
The ramifications of the inability of children with RAD to form normal attachments are best illustrated through the many maladaptive behaviors associated with the disorder. Such behaviors include: stealing, lying, cruelty to animals and other people, avoidance of eye contact, indiscriminate affections with relative strangers and a refusal to express affection with family members, destruction of property, gorging on food, abnormal speech patterns, lack of remorse, impulsivity, inappropriate sexual behavior, role reversal and over activity. (Kay Hall & Geher, 2003).
Written by: Helen B. Johnson, LPC
Date: October 1, 2010