Attachment Disorders: Theory, Research, and Treatment Considerations

Abstract

Over the last decade, there have been considerable advances in the scientific understanding of the origins and developmental course of attachment disorders conceived of both in the narrow diagnostic psychiatric sense, with respect to reactive attachment disorder (DSM 1980, 1994, 1999) and in the more general sense with respect to diverse forms of attachment-related disorders across the lifespan. This chapter is organized into three sections. The first section concerns familiar ground to many, i.e., infant–parent patterns of attachment, which serves as a background to the spectrum of attachment patterns including secure, insecure, disorganized, and nonattached. The second section elaborates on a model for understanding attachment disorders by way of summarizing recent research on a typical problem in childhood, i.e., the emergence, maintenance, and/or prevention of impulse-control difficulties that have to do with aggression. Attachment insecurities play a role in all range of childhood and adult psychological disorders as many have demonstrated via clinical work (e.g., Brisch, 2012), longitudinal developmental research (e.g., Grossmann, Grossmann, & Watters, 2005), and meta-analytic reports (e.g., Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsly, & Roisman, 2010). Direct effects of early attachment upon long-term mental health are difficult to establish, often involving a mediating or moderating role for attachment rather than a direct causal role per se. This has become evident from studies of the onset and course of children’s externalizing disorders, and so the second section of this chapter devotes itself to summarizing this recent work that may help refine our thinking about the influence of attachment upon mental health outcomes in general and reactive attachment disorder in particular. Finally, the third section focuses in some detail on the phenomenon of reactive attachment disorder, a diagnosis first identified in 1980, yet the syndrome of RAD fits with observations of institutionalized infants from previous decades (e.g., Provence & Lipton, 1962; Spitz, 1945) and would serve as a fitting account for many of the children adopted out of institutions since the 1980s. The development of these adoptees has been studied longitudinally, detailed in three recent monographs from the Society for Research in Child Development (McCall, van IJzendoorn, Juffer, Groark & Groza 2011; Rutter et al., 2010; The St. Petersburgh-USA Orphanage Research Team, 2008).