University of New York in Prague
Reactive Attachment Disorder and Attachment Therapy
There has been growing attention on attachment theory and its impacts on later behavioral outcomes. Several research have found an association between attachment insecurity and personality disorders due to inconsistent and unstable sense of self; and association between insecure attachment and physical illness due to susceptibility to stress. Although it has various implications on sense of integrated personality and psychological well-being, the only pathology that is officially related to attachment is Reactive Attachment Disorder (RAD) of infancy or early childhood which is counted as very rare disorder in Diagnostic Statistical Manuel. There has been a wide range of debates on RAD with regard to its difficulties in diagnosing, validity of its subtypes, its susceptibility of being confused with other disorders, its relation with attachment theory and its treatment methods. In my opinion, RAD has not given much attention and has not been studied much due to these complications. In this paper, my attempt is to discuss these issues about RAD and its treatment models by providing with some empirical findings. Reactive Attachment Disorder can historically be traced on the studies with institutionalized children who were deprived from secure attachment and who had multiple caregivers. In very young institutionalized children who experienced social deprivation, Tizard and Rees (1975) identified two types of disorders. The first one was socially indiscriminate/ disinhibited type, in which children displayed nonselective preferences of using adults as seeking comfort and tendency to go with the strangers who offered them comfort. In the second type, children were relatively socially withdrawn/ inhibited, who showed limited social responsiveness, little positive affect and failure to seek comfort when needed. Later, these behavioral patterns with the requirement of signs result from pathogenic care were described as reactive attachment disorder. (Zeanah& Gleason, 2010)
Attachment Theory suggests that infants are evolutionarily primed to form close, enduring, dependent bond on a primary caregiver. The fulfillment of their physiological needs require close physical contact (Carlson, Sampson& Sroufe, 2003). In Diagnostic Statistical Manuel, the only pathology that is officially related to attachment is Reactive Attachment Disorder (RAD) of infancy or early childhood. The diagnostic criteria for RAD include: disturbed and developmentally inappropriate social relatedness prior to age five, pathogenic care such as persistent disregard of the child's basic emotional and physical needs and repeated changes of primary caregiver that prevents development of stable attachment, and these disturbances are not better accounted for pervasive developmental disorders or developmental delay (DSM-IV-TR, 2007). Two types of RAD behaviors have been classified: Inhibited type refers to emotionally withdrawn children who show limited social responsiveness, ambivalent or contradictory responses, little positive affect and a failure to seek comfort when they feel distressed. These behavior patterns are believed to be related with experiences with caregivers who do not provide emotional support and comfort when needed. Secondly, disinhibited type refers to children who have diffuse attachment and who show accessive and inappropriate familiarity with strangers. These behaviors are resulting from experiences with caregivers who are not very responsive but can provide some affection. (Haugaard and Hazan, 2004)
Some studies demonstrated that children with RAD might display inhibited behavioral patterns, disinhibited behavioral patterns and both inhibited and disinhibited behavioral patterns (Smyke, Dumitrescu & Zeanah,...