By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.
What is Reactive Attachment Disorder (RAD) F94.1?
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Reactive Attachment Disorder begins early in life.
Reactive Attachment Disorder (RAD) is one of those disorders which was moved in the DSM-5.
It used to be included in the chapter on Disorders First Diagnosed in Infancy, Childhood, and Adolescence.
RAD now appears in the chapter on Trauma- and Stressor-Related Disorders.
Reactive Attachment Disorder is the result of deficiencies in early life care.
Reactive Attachment Disorder is an internalizing disorder. A related disorder called Disinhibited Social Engagement Disorder involves externalizing behaviors. Both conditions are thought to be caused by poor caregiving early in life. RAD involves a consistent pattern of shutting down, withdrawing, and inhibiting emotions. This disorder starts before age five and is rarely given after that age.
While this is a diagnosis primarily applied to very young children, in working with adults we often see conditions that probably began as Reactive Attachment Disorder. A common statement is that they “just don’t get close to others.” This condition involves an inability to regulate emotion and unexplained anger, both issues we frequently see in adults who came from dysfunctional homes.
With children, we usually know that the symptoms are caused by neglect and poor parenting. With adults, similar symptoms show up as depression, chronic sadness, anxiety disorders, or even personality disorders. Our understanding of reactive attachment disorder is pretty much an all or nothing condition. I can’t help wonder about the effects which varying degrees of neglect or failure to meet the child’s emotional needs might be causing.
Reactive Attachment Disorder involves a consistent behavioral pattern.
Most of the Trauma- and Stressor-Related Disorders are related to anxiety and obsessive-compulsive disorders and are fear-based. Reactive Attachment Disorder is about shutting down and internalizing. In Reactive Attachment Disorder, there is chronic sadness, depression, and loss of pleasure. There may also be accompanying anger, aggression, and dissociation. This involves a lot of withdrawal and inhibited emotion.
Reactive Attachment Disorder involves social and emotional problems.
Children with RAD are unresponsive to others. They’re rarely happy or positive. RAD involves frequent irritation, sadness and sometimes being afraid. Children with this disorder often react to adult caregivers in a negative way for no apparent reason. These patterns of poor relationships with adults continue even when caregivers change.
In adults, we see similar patterns with those people who get diagnosed with Persistent Depressive Disorder. They often say they do not ever remember being happy. What we often don’t know is if this person really had deficient care as a child or if they had a temperament which makes them difficult to parent. Sick, or irritable temperamental children are harder to parent and more likely to be abused or neglected.
Extremely deficient care results in Reactive Attachment Disorder.
Characteristics of this less-than-adequate care include emotional needs not being met, frequent changes in caregivers, and being raised in impersonal institutionalize settings. Mostly this deficient care results in poor relationships with caregivers and other adults, but it may also affect peer relationships.
Sometimes other things look like Reactive Attachment Disorder.
Sometimes children with Autism or developmental delays exhibit symptoms that can look like Reactive Attachment Disorder. In young children, it is important to be sure the problems were caused by poor caregiving. In adults, we see behaviors that we suspect began as Reactive Attachment Disorder, but without a prior diagnosis, we can’t be sure. RAD may affect many other developmental areas.
As with the other things we are calling a mental illness this RAD needs to interfere with the ability to work, or in children, go to school, relationships, or other enjoyable activities or cause personal distress. Otherwise, there may be issues, but the diagnoses will not be given. If the only time this happens is when someone is under the influence of drugs or medicines or because of some other physical or medical problem these problems would need to be more than the situation otherwise warrants. These other issues may need treating first, then if there are still symptoms, the diagnosis will be given.
Treatment for Reactive Attachment Disorder.
For children, getting into a situation with a caring, responsible, caregiver, can make all the difference. For adults with problems now, which may or may not be the result of early childhood experiences, there are several therapies which may be helpful.
It is imperative that children who have Reactive Attachment Disorder get treatment early to prevent lifelong difficulties. Adults who struggle with emotional difficulties may find that they still have early childhood issues that need to be addressed before their adult problems will resolve.
FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching, and related disciplines in a plain language way. Many are based on the new DSM-5; some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.
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