Abstract
The etiology, differential diagnosis, and treatment of Reactive Attachment Disorder (RAD) are discussed utilizing a psychodynamically-informed biopsychosocial approach. Early trauma in childhood attachment experiences alters the structures, neuro-chemicals, and connectivity of the brain. The neurobiological effects of childhood neglect equal and even surpass the impact of abuse and related trauma. This paper discusses structures in the brain involved in early emotional and attachment experiences and how they are affected by pathogenic caregiving, the absence of caregivers, or the disruption of the early caregiving environment. All three types of neglect affect the ability of the Hypothalamic-Pituitary-Adrenal (HPA) axis to regulate the body and brain’s response to stress in a significant and enduring way.
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References
Ainsworth, M. D. S. (1967). Infancy in Uganda. Baltimore: Johns Hopkins University Press.
Ainsworth, M. D. S. (1973). The development of infant–mother attachment. In B. M. Caldwell, & H. N. Ricciuti (Eds.), Review of child development research (Vol. 3, pp. 1–94). Chicago: University of Chicago Press.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
Amini, F., Lewis, T., Lannon, R., et al. (1996). Affect, attachment, memory: Contributions toward psychobiological integration. Psychiatry, 59, 213–239.
Beebe, B., & Lachmann, F. (2002). Infant research and adult treatment. London: Analytic Press.
Begley, S. (2006, February 24). Parents can counteract ‘environments’ created by children’s genes. The Wall Street Journal, p. B1.
Berzoff, J., Flanagan, L. M., & Hertz, P. (2002). Inside out and outside in: Psychodynamic clinical theory and practice in contemporary multicultural contexts. Northvale, New Jersey: Jason Aronson.
Bowlby, J. (1960). Grief and mourning in infancy and early childhood. Psychoanalytic Study of the Child, 15, 9–52.
Bowlby, J. (1969). Attachment and loss, volume one: Attachment. New York: Basic Books.
Dusheck, J. (2002). The interpretation of genes. Natural History, 111(8), 52–58.
Edelman, G. (2004). Wider than the sky: The phenomenal gift of consciousness. New Haven: Yale University Press.
Fairbairn, W. R. D. (1954). An object relations theory of personality. New York: Basic Books.
Fonagy, P. (2001). Attachment theory and psychoanalysis. New York: Other Press.
Freud, S. (1923/1966). The ego and the id. In J. Strachey (Ed. & Trans.) The Standard Edition of the Complete Psychological Works of Sigmund Freud. (pp. 12–66). London: Hogarth Press.
Gabbard, G. O. (2005). Mind, brain, and personality disorders. American Journal of Psychiatry, 162(4), 648–655.
Greenough, W. T., Withers, G. S., & Wallace, C. S. (1990). Morphological changes in the nervous system arising from behavioral experience: What is the evidence they are involved in learning and memory? In L. R. Squire, E. Lindenlaub (Eds.), The Biology of Memory(pp. 159–185). Stuttgart: Schttauder.
Gruber, C. (1987). Repairing ego deficits in children with developmental disorders. Child and Adolescent Social Work, 4(1), 50–63.
Heller, S., Larrieu, J., D’Imperio, R., & Boris, N. (1999). Research on resilience to child maltreatment: Empirical considerations. Child Abuse and Neglect, 23, 321–338.
Insel, T. R. (1997). A neurobiological basis of social attachment. American Journal of Psychiatry, 154(6), 726–735.
Kernberg, O. (1976). Object relations theory and clinical psychoanalysis. New York: Aronson.
Klein, M. (1932). The psycho-analysis of children. London: Hogarth Press.
Kradin, R. (2004). The placebo response complex. Journal of Analytical Psychology, 49, 617–634.
La Barre, F. (2001). On moving and being moved: Nonverbal behavior in clinical practice. Hillsdale: The Analytic Press.
Lieberman, A. F., Padrón, E., Van Horn, P., & Harris, W. W. (2005). Angels in the nursery: The intergenerational transmission of benevolent parental influences. Infant Mental Health Journal, 26(6), 504–520.
Liggan, D. Y., & Kay, J. (1999). Some neurobiological aspects of psychotherapy: A review. Journal of Psychotherapy Practice, 8(2), 103–114.
Luthar, S. S., Cicchetti, D. S., & Becker, B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543–562.
Mahler, M., Pine, F., & Bergman, A. (1975). The psychological birth of the human infant. New York: Basic Books.
Main, M., & Hesse, E. (1990). Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? In M. T. Greenberg, D. Cicchetti, & E. M. Cummings (Eds.), Attachment in the preschool years: Theory, research, and intervention. Chicago: University of Chicago Press.
Masten, A. S. (2001). Ordinary magic: Resilience processes in development. American Psychologist, 56, 227–238.
Mathew, S. J., Coplan, J. D., & Gorman, J. M. (2001). Neurobiological mechanisms of social anxiety disorder. American Journal of Psychiatry, 158(10), 1558–1567.
McEwen, B. S. (1999). Stress and hippocampal plasticity. Annual Review Neuroscience, 22, 105–122.
Osofsky, J. D., & Thomson, M. D. (2000). Adaptive and maladaptive parenting: Perspectives on risk and protective factors. In J. Shonkoff, & S. Meisels (Eds.), Handbook of early childhood intervention. Cambridge: Cambridge University Press.
Petitto, J. M., Quade, D., & Evans, D. L. (1992). Relationship of object loss during development to hypothalamic-pituitary-adrenal axis function during major affective illness later in life. Psychiatry Research, 44, 227–236.
Perry, B. D., Pollard, R. A., Blakley, T. L., Baker, W. L., Vigilante, D. (1995). Childhood trauma, the neurobiology of adaptation, and “user-dependent” development of the brain: How “states” become “traits”. Infant Mental Health Journal, 16(4), 271–291.
Ridley, M. (1999). Genome: The biography of a species in 23 chapters. New York: Prennial—An Imprint of Harper Collins Publishers.
Schore, A. (1999). Affect regulation and the origin of the self. Mahwah: Lawrence Erlbaum.
Schore, A. (2003). Affect regulation and disorders of the self. New York: Norton.
Spitz, R. A., & Wolf, K. M. (1946). Anaclitic depression: An inquiry into the genesis of psychiatric conditions in early childhood, II. Psychoanalytic Study of the Child, 2, 313–342.
Sroufe, J. W. (2003). The infant and adult attachment categories. In M. Cortina, M. Marrone (Eds.), Attachment theory and the psychoanalytic process. London: Whurr Publishers, Ltd.
Starkman, M. N., Giordani, B., Gerbski, S. S., Berent, S., Schork, M. A., & Schteingart D. E. (1999). Decrease in cortisol reverses human hippocampal atrophy following treatment of Cushing’s disease. Biological Psychiatry, 46, 1595–1602.
Stern, D. (1985). The interpersonal world of the infant: A view from psychoanalysis and developmental psychology. New York: Basic Books.
Stern, D. (2004). The present moment in psychotherapy and everyday life. New York: W.W. Norton and Company.
Stolorow, R. D., & Atwood, G. E. (1992). Context of being: The intersubjective foundation of psychological life. Hillsdale: The Analytic Press.
Teicher, M. H. (2002). Scars that won’t heal: The neurobiology of child abuse. Scientific American, 286(3), 68–75.
Tennant, C. (1988). Parental loss in childhood. Archives of General Psychiatry, 45, 1045–1050.
Trevarthen, C. (1990). Brain circuits and functions of the mind. Cambridge: Cambridge University Press.
Trevarthen, C. (1998). The concept and foundations of infant intersubjectivity. In S. Braton, et al. (Eds.), Intersubjective communication and emotion in early ontogeny: Studies in emotion and social interaction. Cambridge: Cambridge University Press.
Tyson, P. T. (2002). The challenges of psychoanalytic developmental theory. Journal of the American Psychoanalytic Association, 50(1), 19–52.
Van der Kolk, B. (2003). Posttraumatic stress disorder and the nature of trauma. In M. F. Solomon, & D. J. Siegel (Eds.), Healing trauma: Attachment, mind, body, and brain (pp. 168–195). New York: W.W. Norton and Company.
Wamboldt, M. Z., & Reiss, D. (2006). Explorations of parenting environments in the evolution of psychiatric problems in children. American Journal of Psychiatry, 163(6), 951–953.
Winnicott, D. W. (1959). The fate of the transitional object. In Psychoanalytic Explorations. Cambridge: Harvard University Press.
Winnicott, D. W. (1965). The maturational processes and the facilitating environment. London: Hogarth Press.
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Corbin, J.R. Reactive Attachment Disorder: A Biopsychosocial Disturbance of Attachment. Child Adolesc Soc Work J 24, 539–552 (2007). https://doi.org/10.1007/s10560-007-0105-x
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DOI: https://doi.org/10.1007/s10560-007-0105-x
Keywords
- Reactive Attachment Disorder
- Neurobiology
- Neglect
- Memory
- Play therapy