Reactive Attachment Disorder
Short Description or Definition
Children with reactive attachment disorder (RAD) or disinhibited social engagement disorder (DSED) exhibit abnormal social and attachment-related behaviors before the age of 5 years. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and the International Classification of Diseases, 10th revision (ICD-10), these are stress-related disorders, and the symptoms occur in consequence, i.e., following, or in reaction to, pathogenic caretaking of the child in the early years of life.
In the DSM-IV, the RAD diagnosis included two subtypes, characterized by different behavioral patterns. In the inhibited or withdrawn type, children avoid comfort, seem afraid to seek it, do not respond to it, and even resent comfort offered to them by caregivers. Failure to develop attachments to any caregivers is the essence of this disorder. In the disinhibited or indiscriminate type,...
References and Reading
- Ainsworth, M. D., Blehar, M., Waters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale: Lawrence Erlbaum Associates.Google Scholar
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR (4th ed.). Washington, DC: Author.Google Scholar
- Bowlby, J. (1988). A secure base. London: Routledge.Google Scholar
- Gleason, M. M., Fox, N. A., Drury, S., Smyke, A., Egger, H. L., Nelson, C. A., et al. (2011). Validity of evidence-derived criteria for reactive attachment disorder: Indiscriminately social/disinhibited and emotionally withdrawn/inhibited types. Journal of the American Academy of Child and Adolescent Psychiatry, 50(3), 216–231.CrossRefPubMedPubMedCentralGoogle Scholar
- Minde, K. (2003). Assessment and treatment of attachment disorders. Current Opinion in Psychiatry, 16(4), 377–381.Google Scholar
- World Health Organization. (1992). International statistical classification of diseases and related health problems. Geneva: Author. 10th revision.Google Scholar
- Zeanah, C. H., Chesher, T., Boris, N. W., Walter, H. J., Bukstein, O. G., Bellonci, C., … Hayek, M. (2016). Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder and disinhibited social engagement disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 990–1003.Google Scholar
- Zero to Three. (2005). Diagnostic Classification of mental health and developmental disorders of infancy and early childhood: (DC:0-3R). Washington, DC: Author. Revised edition.Google Scholar