The absence of adequate caregiving during childhood is a diagnostic requirement of reactive attachment disorder. That is why it is now grouped under “Trauma- and-Stressor-Related Disorders” in the updated 2013 Diagnostic and Statistical Manual of Mental Disorder (DSM-5). However, even in populations of severely neglected children, the disorder is uncommon, occurring in less than 10% of such children.
The essential feature is that the child exhibits an absent degree of- or grossly underdeveloped level of attachment towards caregiving adults compared to what is normal or expected. For example, an infant or very young child would be observed as rarely or minimally turning to their adult caregivers for comfort, support, protection, or nurturance.
Children with reactive attachment disorder are believed to have the capacity to form selective attachments; that is, there is nothing neurobiologically or medically wrong that can explain a child’s failure to form a secure relationship with parents or other caregivers. However, because of limited healthy physical contact and nurturance during early development (e.g, neglect), they fail to show the behavioral manifestations of selective attachments. That is, when distressed, they handle their emotions independently. They do not look for or reach for caregivers for support, nurturance, or protection. Furthermore, when caregivers do sporadically make the effort to comfort the child, the child with this disorder will not respond reciprocally. For example, if a parent were to go to hold their child when he/she is distressed, the child may appear confused, aloof, or fail to hug the adult back. Essentially, the child has not learned to accept or expect a comforting response. As such, children with reactive attachment disorder show diminished or absent expression of positive emotions during routine interactions with caregivers. In addition, these children have difficulty regulating distressing emotions, resulting in their displaying pervasive patterns of negative emotions, such as fear, sadness, or irritability in instances that are not called for. A diagnosis of reactive attachment disorder should not be made in children who are developmentally unable to form selective attachments. For this reason, the child must have a developmental age of at least 9 months.
There are several new specifiers of reactive attachment disorder in the updated 2013 DSM-5:
- According to this specifier, the disorder has been present for more than 12 months.
- This specifier is used when the child meets for all symptoms of the disorder, with each symptom manifesting at relatively high levels.
DSM-5 Diagnostic code 313.89
Medina, J. (2014). Reactive Attachment Disorder Symptoms. Psych Central. Retrieved on September 18, 2014, from http://psychcentral.com/disorders/reactive-attachment-disorder-symptoms/
Symptom criteria summarized from:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Washington, DC: American Psychiatric Association.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.
Last reviewed: By John M. Grohol, Psy.D. on 4 Jun 2014
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