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Reactive attachment disorder


Disease: Reactive attachment disorder Reactive attachment disorder
Category: Psychiatric diseases

Disease Definition:

The rare but serious condition in which young children and infants don't establish healthy bonds with parents or caregivers is called reactive attachment disorder.


Abused, neglected, or moved multiple times from one caregiver to another are typical characteristics of a child with reactive attachment disorder. The child never establishes loving and caring attachments with others because his/her basic needs for affection, nurturing and comfort aren't met.
In this way, the child's growing brain might be permanently altered and his/her ability to establish future relationships damaged.


With treatment, children can develop more healthy and stable relationships with caregivers and others, despite the fact that reactive attachment disorder is a lifelong condition. Psychological counseling and parent or caregiver education are included in proven and safe treatments for reactive attachment disorder.

Work Group:

Symptoms, Causes


Before the age of 5 is when reactive attachment disorder usually begins. The signs and symptoms of this disorder might start when the child is still an infant.


In babies, signs and symptoms may include:


  • Failure to reach out when picked up
  • No interest in playing with toys
  • Calm when left alone
  • Lack of the normal tendency to follow others in the room with the eyes
  • Sad, listless and withdrawn appearance
  • No interest in playing peekaboo or other interactive games
  • Engaging in self-soothing behavior, such as self-stroking or rocking
  • Failure to smile


In toddlers, older children and adolescents, signs and symptoms may include:


  • Failing to ask for support or assistance
  • Watching others closely but not engaging in social interaction
  • Acting aggressively toward peers
  • Alcohol or drug abuse in adolescents
  • Masking feelings of anger or distress
  • Withdrawing from others
  • Avoiding or dismissing comforting comments or gestures
  • Obvious and consistent awkwardness or discomfort


Children with reactive attachment disorder may develop either inhibited or disinhibited behavior patterns as they grow older. Many children exhibit both types of behavior while some children have signs and symptoms of just one type.

Inhibited behavior:

When a baby never gets the opportunity to develop an attachment to any caregiver, he/she may have inhibited behavior in which relationships and attachments to nearly everyone is shunned.

Disinhibited behavior:

When a baby has multiple caregivers or frequent changes in caregivers, he/she may have disinhibited behavior in which he/she seeks attention from nearly everyone including strangers. In the case of having this type of reactive attachment disorder, children may have inappropriately childish behavior, appear anxious or frequently ask for help doing tasks.


Beyond early childhood, there's little research on signs and symptoms of reactive attachment disorder. Research has found that it may lead to aggressive, delinquent or controlling behaviors, trouble relating to peers and other problems. The changes that happen throughout early childhood are permanent and the disorder is a lifelong challenge, however, treatment can help children and adults cope with reactive attachment disorder.


Parents should visit a doctor if they think that their child may have reactive attachment disorder. Visiting the family doctor as a start would be a good idea. A doctor who specializes in the diagnosis and treatment of mental illness (psychiatrist) should be seen for a complete evaluation if the child is likely to have reactive attachment disorder or another mental health problem.


Getting an evaluation should be considered if the child or baby:


  • Usually likes to play alone
  • Avoids parents
  • Seems uninterested in parents
  • Doesn't seek out physical contact
  • Prefers not to be held
  • Will readily go to strangers 


Young children and infants need a caring, stable environment to feel safe and develop trust. Their basic physical and emotional needs must be fulfilled consistently. The need for a diaper or a meal must be met with a shared emotional exchange that may include smiling, caressing and eye contact when the baby cries.


The child starts to expect rejection or hostility when his/her needs are ignored or met with physically or emotionally abusive responses, in which case the child becomes distrustful and learns to stay away from social contact. Development in the brain may be affected by emotional interactions between babies and caregivers, leading to attachment problems and affecting personality and relationships all through life.


It's not clear why some babies and children develop reactive attachment disorder and others don't. Even children who have lived in orphanages, had multiple caregivers or been neglected, can develop strong bonds and healthy relationships, additionally most children are naturally resilient.


There are no accurate statistics on how many babies and children have reactive attachment disorder, but this rare condition can affect boys and girls.


The chance of developing reactive attachment disorder increases due to several factors that include:


  • Frequent changes in foster care or caregivers
  • Inexperienced parents
  • Institutional care
  • Emotional, physical, or sexual abuse
  • Prolonged hospitalization
  • Postpartum depression in the baby's mother
  • Living in an orphanage
  • Forced removal from a neglectful or abusive home
  • Parents who have drug or alcohol abuse, a mental illness or anger management problems
  • Significant family trauma, such as divorce or death
  • Extreme poverty



With a possibility of continuing into adulthood, complications of reactive attachment disorder may include:


  • Depression
  • Relationship problems
  • Anxiety
  • Inappropriate sexual behavior
  • Unemployment or frequent job changes
  • Delayed learning or physical growth
  • Delinquent or antisocial behavior
  • Eating problems, which can lead to malnutrition in severe cases
  • Poor self-esteem
  • Drug and alcohol addiction
  • Temper or anger problems
  • Academic problems


A combination of education about the disorder, medications and psychological counseling is often involved in the treatment of reactive attachment disorder. A team of mental and medical health providers with expertise in attachment disorders may be involved as well. Usually, both the child or baby and the caregivers or parents are included in the treatment.


The aims of the treatment are to help ensure that the child or baby has a stable and safe living situation and that he/she develops positive interactions with caregivers and parents. Improving peer relationships and boosting self-esteem can also be achieved by treatment.


For reactive attachment disorder, there's no standard treatment, but treatment usually includes:


  • Family therapy
  • Special education services
  • Parenting skills classes
  • Education of parents and caregivers about the condition
  • Inpatient or residential treatment for children with more-serious problems or who put themselves or others at risk of harm
  • Medications for other conditions that may be present, such as depression, anxiety or hyperactivity
  • Individual psychological counseling


It might be useful to use other treatments for reactive attachment disorder, such as:


  • Comforting, close physical contact
  • Development of attachment between the child and the child's therapist


For caregivers and parents, managing reactive attachment disorder is a long term challenge, which could be quite demanding. Seeking psychological counseling or taking other steps to learn how to cope with the stress of having a child with reactive attachment disorder might be considered by the parents.


Unproven and dangerous treatment techniques for reactive attachment disorder have been criticized. Controversial practices may be physically and psychologically damaging and they have led to accidental deaths.


Some of the unproven treatments for reactive attachment disorder include:


  • Forcing a child to eat or drink
  • Tickling, pulling limbs or yelling, triggering anger that finally leads to submission
  • Withholding food or water
  • Tightly wrapping, binding or holding children


People should stay away from mental health providers who promote these methods. As evidence, some doctors offer research to support their techniques, however, none of these has been published in reputable mental or medical health journals.


Parents should talk to their child's psychiatrist before considering any kind of unconventional treatment to make sure it's legitimate and not harmful.


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