PSYC 314-01: Psychopathology
Rick Shillabeer, Psy.D.
To help us to identify what reactive attachment disorder is we will first need to define what attachment is. For the purpose of this paper, attachment will be defined as the reciprocal relationship between a child and caregiver (Robertson, 2000). The development of this relationship is dependent on the caregiver’s response to the child’s needs (Robertson, 2000). In order for a child to form a secure attachment, the child can “reliably experience security, comfort, and safety (Smith, 2006). This attachment is dependent upon the child “perceiving the attachment figure as predictable, available and competent” (Smith, 2006). Nancy Geoghegan from the Attachment Disorder Site, 2000, illustrates what a healthy and secure attachment cycle should look like as well as what a disturbed attachment cycle looks like.
Children with a disturbed attachment cycle will most likely be diagnosed with a reactive attachment disorder. Children with reactive attachment disorder have a different view of the world than we do. They did not learn that they could trust adults to keep them safe. They, in fact, learned that adults were uncaring, mean, rejecting, violent, unreliable, unresponsive, or absent. Many children with reactive attachment disorder learn that they must take care of themselves and cannot depend on their caregiver to meet their basic needs. (Attachment Disorder Site, 2000) Reactive attachment disorder can be defined as a child’s inability to form a healthy functioning relationship with a primary care giver (Attachment Disorder Site, 2000). A child
with reactive attachment disorder typically is or has been neglected, abused or has been frequently moved from one caregiver to another never having the opportunity to establish a loving relationship with a caregiver (Mayo Clinic Staff, 2009). Attachment disorders are the result of negative experiences in the early years (Kemp, Smith 2010). Children with reactive attachment disorder are generally reacting to events that took place early in their lives (Attachment Disorder Site, 2000). Children with an attachment disorder lack trust and often feel unsafe and alone (Kemp, Smith 2010). Children suffering from reactive attachment disorders come from families that have disregard for the child’s basic emotional needs for comfort, stimulation and affection and persistent disregard for the child’s physical needs (Robertson, 2000) According to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) reactive attachment disorder begins before the age of five and the course varies dependent upon the individual child and caregiver and the severity of the neglect and the nature of intervention. Sherpis, Doggett, Hoda, Blanchard, Renfro-Michel, Holiness & Schlagheck, 2003, report that the criteria for reactive attachment disorder is often difficult to process due to problems with differential diagnosis as well as disagreement among professionals regarding the etiology of reactive attachment disorder. Boris, Zeanah, Larriew, Scheeringa, and Heller report (as cited in Sherpis, et al, 2003) that the DSM-IV-TR has been critiqued for its focusing on reactive attachment disorder as a “maltreatment syndrome” focusing on problematic parental care and social oddities rather than a focus on the attachment issue.
The DSM-IV-TR offers the following as the diagnostic criteria for reactive attachment disorder: Diagnostic criteria for 313.89 Reactive Attachment Disorder of Infancy or Early Childhood A. Markedly disturbed and developmentally inappropriate social relatedness in most contexts, beginning before age 5 years, as evidenced by either (1) or (2): (1) Persistent failure to initiate or respond in a developmentally appropriate fashion to most social interactions, as manifest by excessively inhibited, hyper vigilant, or...