Reactive Attachment Disorder: Causes, Symptoms, Treatment and Diagnosis

Reactive Attachment Disorder, referred to as RAD, is quite a rare mental health disorder where people find it difficult to get attached to someone whether it is family or friends. A childhood trauma is believed to be the primary cause of it. According to the DSM criteria, Reactive Attachment Disorder is classified as a stress related condition coupled with trauma in early childhood as a result of social neglect and physical or sexual abuse. This makes the affected child to become socially withdrawn and finding it tough to make friends and connect with relatives. Such children find any type of physical or emotional closeness very irritating and annoying to the extent that they may react violently to it^{[1. 2]}.

The overall behavior of children with Reactive Attachment Disorder is extremely unpredictable and is very difficult to control when angry. These behaviors go on well into adulthood where people with Reactive Attachment Disorder are not able to make their own decisions and behaviorally are dominant and always wanting to control their environment. Any change in the routine or being at a place which is out of their comfort zone can result in severe mood changes with the person getting angry to the extent that they may indulge in self-injurious behaviors^{[1, 2]}.

In adolescents, these behaviors become one of the primary reasons for them to be rejected by teachers and peers alike. It is not uncommon for teenagers and adolescents with Reactive Attachment Disorder to indulge in substance abuse or have problems with incarceration^{[1, 2]}.

Trauma primarily in childhood is the primary cause of Reactive Attachment Disorder. The trauma is basically in the form of emotional neglect which is quite common in orphanages, foster homes, or in places where one or both the parents are battling mental health conditions and are not able to take care of the child properly. With time because of the neglect such children face day in and day out, they tend to become withdrawn and do not have enough interaction with people making them detached with the outside environment. These children with time go on to develop Reactive Attachment Disorder^[1].

These children tend to have significant deficiency in learning and cognitive development which ultimately results in behavioral disorder as seen with Reactive Attachment Disorder^[1].

The symptoms of Reactive Attachment Disorder are a bit different from that seen in adolescents and adults. The symptoms seen in children include:

• Inconsolable when angry or distressed
• Minimal smile and avoiding eye contact
• Frequent crying episodes
• Feeling anxious and fearful for no reason
• Lack of interest in playing with peers
• Cognitive difficulties
• Hyperactivity^[2]

It should be noted that the above mentioned symptoms should be seen below the age of 5 for the child to be diagnosed as having Reactive Attachment Disorder^[2].

If no proper treatment is given, children with Reactive Attachment Disorder may continue to experience symptoms well into adolescence and adulthood. These symptoms include:

• Avoiding any form of physical contact
• Lack of empathy towards others
• Poor social skills
• Problems with having stable relationships
• Memory problems
• Problems with rage and anger
• Problems at school/college and workplace
• Substance abuse
• Anxiety and depression^[2]

The diagnosis of Reactive Attachment Disorder is made as classified in the DSM-V guidelines. For a child to be diagnosed as having Reactive Attachment Disorder the following criteria should be met^[2].

There should be a consistent pattern of emotional withdrawal towards parents or caregivers which can be evidenced by complete lack of comfort when consoled by the parents or caregivers when the child is in distress.

• There is minimal emotional and social response to other people
• Lack of any type of positive emotions
• Frequent episodes of irritability, rage, violent behavior towards caregivers
• History of trauma in the form of social neglect, frequent changes in caregivers, growing up in a setting where the child has limited or no interaction with other people
• The child is under the age of 5^[2].

Some of the symptoms of Reactive Attachment Disorder are quite similar to other psychiatric conditions like ADD or certain behavioral disorders. The physicians thus will have to rule out other condition before arriving at a diagnosis of Reactive Attachment Disorder^[2].

Children with Reactive Attachment Disorder have significant behavioral and emotional problems. However, this is a condition which can be treated if proper attention is given. Once a confirmed diagnosis of the condition is made, the treatment begins with the child’s current caregivers. Psychotherapy and special education are preferred way of treating Reactive Attachment Disorder. The caregivers will also receive education on good parenting and ways to provide good support to the child^[2].

It should be noted here that parents of children with Reactive Attachment Disorder should have realistic expectations, should remain positive, and remaining patient is an absolute must. Parents with underlying mental disorders should take proper medications and undergo counseling which will help them deal with the condition and take care of their child properly^[2].

For adolescents and adults with Reactive Attachment Disorder, treatment involves psychotherapy for the patient and the caregivers wherever necessary. The therapy may involve group session with patient as well as the caregivers or the patient and the caregivers separately. During the session, the consequences of the behavior displayed by the patient will be discussed in detail and ways to cope up with them will also be given a look at^[2].

How to build a strong relationship is also something that is discussed with adults who have Reactive Attachment Disorder and have problems having and maintaining relationships. The patients may also require medications to treat anxiety and depression^[2].

In conclusion, Reactive Attachment Disorder is a rare psychiatric condition characterized by problems getting attached to people, either family or friends or both. Neglect and abuse during childhood is the primary cause of Reactive Attachment Disorder. If not diagnosed and treated in childhood, the patient with Reactive Attachment Disorder will continue to experience symptoms of this condition well into adolescence and even adulthood^{[1, 2]}.

Reactive Attachment Disorder is treatable if proper care and treatment is provided. This is done with therapy as well as medications to treat symptoms like anxiety and depression. Parents are recommended to consult with a physician if they suspect that their child may have Reactive Attachment Disorder^{[1, 2]}.

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