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According to the American Academy of Child and Adolescent Psychiatry (AACAP), reactive attachment disorder (RAD) is a complex psychiatric illness that can affect children. It might start in infancy or early childhood when the physical and emotional needs of the child are neglected by the parents or caregivers. It is the bond that is shared between a mother and her child that makes the child aware of love. Soon, the child begins to connect with the father, grandparents, siblings, friends, and others. However, when a child cannot feel the bond with his/her parents or primary caregiver, it could cause an attachment disorder. Under such circumstances, the child might not turn to the caregiver for the love, protection, or comfort. RAD is more likely to be observed in children below the age of 5 years. It is believed that it might persist into adolescence or adulthood, if it goes undiagnosed.

Reactive Attachment Disorder

RAD has been listed in the Diagnostic and Statistical Manual of Mental disorders (DSM). According to the DSM-V, the criteria for RAD is:

A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers
A persistent social and emotional disturbance
A pattern of extremes of insufficient care
The care described in the third criterion is presumed to be responsible for the disturbed behavior described in the first criterion
The criteria for autism spectrum disorder are not met
The disturbance is evident before age 5 years
The child has a developmental age of at least 9 months

RAD is an acute psychiatric illness in which an individual experiences difficulty in forming loving, lasting, and intimate relationships. Individuals affected by this disorder believe that they are capable of looking after themselves and providing for their own needs. Individuals with RAD might fail to show empathy and genuine affection, because that makes them extremely uncomfortable. However, RAD includes both inhibited and dis-inhibited behavioral subtypes, wherein the dis-inhibited subtype behavior, makes the individual demand attention and affection from familiar people as well as complete strangers. In case of inhibited subtype, the affected individual cringes away from any form of human contact.

These individuals lack the ability to trust others wholeheartedly. Therefore, they might not allow anyone to control them or make them feel vulnerable to hurt. This disorder is believed to develop in an infant or child, when the primary caregiver, is not physically or emotionally present to provide the necessary love, security, nurturing, and safe environment to the child. Abuse of the child during his/her first 5 years, at the hands of the caregiver is usually the underlying cause. It could affect a child who:

Lives in an orphanage or institution
Has to frequently change foster homes or caregivers
Has parents who are inexperienced
Has stayed away from his parents/caregivers for a long period due to hospitalization
Has a mother with postpartum depression
Is a part of a very large family, due to which parents are unable to spend time with him/her

According to Magid & McKelvey (1988), if a child cannot develop a bond of love with the mother, the child will find it extremely difficult to develop meaningful relationships with any person throughout his/her life. An individual who is affected by RAD is more likely to remain detached.

Symptoms

RAD is an illness of extremes. Sometimes, the affected individual may show hostility towards others, which in turn might affect his/her ability to form strong, intimate relationships. At times, the affected individuals may live superficial lives, never being able to express their true emotions and secluding themselves from the company of others.

The symptoms of RAD are divided into two categories: avoidant attachment (inhibited) and ambivalent (dis-inhibited) attachment.

Symptoms of Avoidant Reactive Attachment Disorder

Avoiding intimacy
Showing compulsive self-reliance
Difficulty in getting along with co-workers; preference for working alone rather than begin a team player
Fear of closeness in relationships
Lack of empathy
Tendency to be overly critical of others
Passive withdrawal
Considering relationships as a threat to his/her sense of control; considering relationships not being worth the effort
Being overly sensitive to blame
Tendency to become intensely self-critical
Tendency to not believe in idealizing a romantic relationship
Finding others untrustworthy or undependable
Thinking of himself/herself as an unlovable person
Avoiding personal relationships by citing work reasons
Being passive-aggressive

Symptoms of Ambivalent Reactive Attachment Disorder

Showing compulsive care-giving nature
Desiring excessive intimate contact and declarations of affection from his/her partner
Tendency to either feel over-involved and under-appreciated in his/her work or relationships
Tendency to idealize others
Jealousy
Experiencing mood swings and extreme emotions
Finding it hard to maintain a long-term relationship
Tendency to be emotionally overindulgent in a relationship
Feeling that others are very difficult to understand
Possessiveness
Tendency to be exceedingly dependent on his/her relationships
Feeling a sense of security only when in a relationship
Being sensitive to any form of rejection
Depression
Suicidal tendencies
Finding his/her partner unpredictable
Feeling unlovable or undesired by others

Individuals affected by RAD require professional guidance and therapy to help them cope with their problems. Give them all your support while they are undergoing therapy.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.