13.5.5: Attachment Disorders

Learning Objectives

1. Describe the developmental consequences of severe deprivation and neglect in infancy.
2. Differentiate between Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).
3. Identify effective strategies for preventing and treating attachment disorders.
4. Discuss the concept of resiliency and the factors that contribute to adaptive outcomes in the face of early adversity.

Social Deprivation

Severe deprivation of parental attachment can lead to serious problems. According to studies of children who have not been given warm, nurturing care, they may show developmental delays, failure to thrive, and attachment disorders (Bowlby, 1982). Non-organic failure to thrive is the diagnosis for an infant who does not grow, develop, or gain weight on schedule. In addition, postpartum depression can cause even a well-intentioned mother to neglect her infant.

Figure \(\PageIndex{1}\): This is a residential nursery in 1888. Image is in the public domain.

Attachment Disorders

Attachment disorders occur when a child fails to form healthy emotional bonds with their caregivers, often as a result of neglect, abuse, or inconsistent caregiving during early childhood. These disorders can have profound effects on a child's emotional, social, and cognitive development. Insecure attachment patterns, if not addressed early, can evolve into more severe attachment disorders, including Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED). These conditions can affect a child's ability to form healthy relationships and regulate emotions throughout their life.

Reactive Attachment Disorder

RAD, or Reactive Attachment Disorder, is typically diagnosed in children who have experienced consistent neglect or emotional maltreatment in infancy or early childhood. Children with RAD may exhibit withdrawn, emotionally distant behavior, and may struggle with forming bonds with caregivers or peers. They may also display difficulty expressing emotions and show little or no response to comfort, even when upset (Zeanah et al., 2004). The disorder is often linked to institutional care or severe disruptions in primary caregiving.

The concept of RAD and the understanding of attachment disruptions were significantly informed by research conducted on children living in Romanian orphanages during the late 20th century. The fall of the Communist regime in Romania in the early 1990s led to the exposure of deeply troubling conditions in state-run orphanages, where children were subjected to severe neglect and emotional deprivation. These children were often raised in environments where caregivers were absent or unable to provide consistent, responsive, and loving care. Instead of receiving the emotional support and attention needed to form secure attachments, the children lived in overcrowded institutions with minimal human contact or individualized care.

In these institutions, children frequently faced physical neglect, malnutrition, and emotional isolation. The caregivers often lacked the training or resources to meet the children's emotional and psychological needs, which further exacerbated the attachment disruptions. As a result, children in these environments exhibited signs of RAD, including emotional withdrawal, difficulty forming relationships, and a lack of trust in others (Rutter et al., 2007).

Video	Video Description and Text Link
	Watch the video Growing Up in a Romanian Orphange to see and hear more about the conditions, as well as the experiences from Izidor Ruckel. Text link: https://www.youtube.com/watch?v=VCeWr8OFuEs

One of the most significant studies to emerge from this context was the Bucharest Early Intervention Project (BEIP), which began in the early 2000s and followed children who had been raised in Romanian orphanages. This longitudinal study highlighted the profound effects of early neglect on the development of secure attachment in children. Researchers found that children who were placed in foster care at an early age demonstrated significant improvements in attachment security compared to those who remained in institutional care. However, children who were institutionalized for longer periods of time before being placed in foster care often exhibited persistent attachment difficulties, underscoring the importance of early, consistent caregiving in the formation of secure bonds (Nelson et al., 2007).

Disinhibited Social Engagement Disorder

Disinhibited Social Engagement Disorder, DSED, is another attachment-related disorder, characterized by a child’s overly familiar behavior with strangers, such as seeking attention or physical contact with unfamiliar adults. This condition is often seen in children who have been exposed to inadequate caregiving, such as frequent changes in caregivers or neglect in institutional settings (Zeanah et al., 2004). Unlike RAD, children with DSED do not display the same withdrawal but may engage indiscriminately with strangers, which can lead to dangerous or inappropriate interactions.

Prevention and Treatment of Attachment Disorders

Preventing attachment disorders begins with ensuring that children are provided with a stable, loving, and responsive caregiving environment. Consistency in caregiving is crucial, as children thrive in environments where their emotional and physical needs are reliably met. Early intervention programs, including those focusing on strengthening the caregiver-child bond, can help prevent attachment disruptions, particularly in children at risk due to factors such as abuse or neglect. Education for caregivers on the importance of sensitive and responsive care is an effective preventative measure. Interventions such as parent training and support groups can provide valuable resources for caregivers, promoting a deeper understanding of attachment and its critical role in child development (Schmidt, 2013).

Treating attachment disorders often requires a multi-faceted approach involving both the child and the caregiver. Therapy, such as trauma-focused cognitive-behavioral therapy (TF-CBT), can be effective in helping children with RAD or DSED process past trauma and learn healthy coping mechanisms. Additionally, therapies aimed at improving attachment, such as attachment-based therapy or Dyadic Developmental Psychotherapy (DDP), work with both the child and caregiver to repair the bond and develop healthy, secure attachment patterns.

Figure \(\PageIndex{2}\). Family therapy. Image by Kaboompics.com licensed by Pexels.

Interventions may also include fostering a safe and stable environment that allows the child to learn to trust and form secure attachments. This often involves working with caregivers to understand the child's needs, reinforcing positive behaviors, and providing consistency in caregiving. Family therapy may also be beneficial, particularly when attachment disorders are linked to family dynamics. For children in institutional settings, moving to a stable and nurturing foster care arrangement can be a significant step toward healing (Dozier et al., 2014).

Resiliency

Being able to overcome challenges and successfully adapt is a sign of resilience. Even young children can exhibit remarkable resilience in the face of harsh circumstances. Resiliency can be attributed to certain personality factors, such as an easy-going temperament. Some children are warm, friendly, and responsive, whereas others tend to be more irritable, less manageable, and difficult to console. These differences play a role in attachment (Gillath et al., 2008; Seifer et al., 1996). It seems safe to say that attachment, like most other developmental processes, is affected by an interplay of genetic and socialization influences.

Receiving support from others also leads to resiliency. A positive and strong support group can help a parent and child build a strong foundation by offering assistance and positive attitudes toward the newborn and the parent. In a direct test of this idea, Dutch researcher van den Boom (1994) randomly assigned some mothers of babies to a training session in which they learned to better respond to their children’s needs. The research found that these mothers’ babies were more likely to exhibit a secure attachment style compared to the babies of mothers in a control group who did not receive training. ²²

Figure \(\PageIndex{3}\): This infant massage class for new mothers could provide training and support for mothers. Image is in the public domain.

References, Contributors and Attributions

22. Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.

Bowlby, J. (1982). Attachment and loss: Volume 1. Attachment (2nd ed.). Basic Books.

Gillath, O., Shaver, P. R., Baek, J. M., & Chun, D. (2008). How does attachment security shape social networks? Personality and Social Psychology Bulletin, 34(4), 422–433. https://doi.org/10.1177/0146167207311699

Seifer, R., Sameroff, A. J., Dickstein, S., Gitner, G., Miller, I., Rasmussen, S., & Hayden, L. C. (1996). Parental psychopathology, multiple contextual risks, and one-year outcomes in children. Journal of Clinical Child Psychology, 25(4), 423–435. https://doi.org/10.1207/s15374424jccp2504_7

van den Boom, D. C. (1994). The influence of maternal temperament and sensitive responsiveness on the development of the infant’s attachment. Developmental Psychology, 30(1), 57–69. https://doi.org/10.1037/0012-1649.30.1.57