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Reactive attachment disorder—a theoretical model beyond attachment

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Abstract

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic—complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.

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Acknowledgements

We are grateful to Christine Puckering, Joyce Minnis, Chris Gillberg, Danya Glaser, Amanda Burston and Valerie Murray for comments on earlier drafts.

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Authors and Affiliations

  1. University of Glasgow Section of Psychological Medicine, Caledonia House, Yorkhill Hospital, Glasgow, SCO, G3 8SJ, UK

    Helen Minnis, Julie Arthur & Alexis McLaughlin

  2. Dept. of Childhood and Primary Studies, University of Strathclyde, National Centre for Autism Studies, Glasgow, SCO, UK

    Helen Marwick

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  1. Helen Minnis
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  2. Helen Marwick
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  4. Alexis McLaughlin
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Correspondence to Helen Minnis.

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Minnis, H., Marwick, H., Arthur, J. et al. Reactive attachment disorder—a theoretical model beyond attachment. Eur Child Adolesc Psychiatry 15, 336–342 (2006). https://doi.org/10.1007/s00787-006-0539-2

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