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Reactive Attachment Disorder (RAD)

According to the DSM-V Reactive Attachment Disorder (RAD) is one of many disorders that can develop in response to traumatic or stress-inducing experiences. RAD typically develops in childhood and is characterized by an individual’s lack of attachment to their caregiver (DSM-V). An individual’s level of attachment begins developing at birth when an infant depends on his or her parental figure to provide a certain amount of care. The degree to which a child’s needs are met acts as the foundation for his or her level of security or insecurity as it relates to emotional attachment (Byng-Hall, 2002). Attachment is also what provides individuals with a sense of belonging to a family, culture, religion, etc. and in turn gives them a sense of self (Barth, 2002). It is also important to note that attachment is not the same as dependency. Young adults, while no longer dependent upon caregivers to meet their needs may still feel a sense of attachment to those caregivers (Prior and Glasser, 2006). It is widely believed that the development of an attachment disorder in childhood will continue to persist into adulthood becoming evident in an individual’s romantic relationships (Prior and Glasser, 2006).

Importance of a Therapist Understanding

In therapy, it is not uncommon for a therapist to ask clients to reflect upon their feelings and the feelings of others in relation to how they view the world and the people around them. Individuals with low levels of attachment will find this process more challenging because they may have very little connection to the world that surrounds them (Prior and Glasser, 2006). It has been discovered that an individual’s attachments or lack thereof in childhood can affect their social functioning in adulthood. Furthermore, an individual’s level of attachment can provide some explanation of how it is that they choose to deal with stressful situations such as the separation from or loss of a close acquaintance (Prior and Glasser, 2006).

Attachment theory can also help explain a individual’s willingness or ability to form a relationship with a therapist (Prior and Glasser, 2006). Having a strong client-therapist relationship is known to be an essential part of the therapeutic process. However, establishing this when an individual is in the habit of maintaining a certain level of detachment from others can be challenging. Although, by gaining an understanding of a client's family history and the attachments they feel toward their caregivers can help a therapist assess how deeply they should expect their client to connect with them. Some clients will form a quick attachment to their therapist, which could bring about its own associated dilemmas while other clients will be difficult to connect with.

Attachments are interlocked with a child’s development of their sense of self. It is what helps determine their identity as it relates to culture, socio-economic status, religious beliefs, etc. (Barth, 2002). Children develop life-long expectations of how they and others should behave based on the manner in which their parents, or other attachment figures, respond to their actions (Bowlby, 1969/1982, 1973; May, 2005). As a result, children approach new experiences with certain preconceptions, assumptions, and behavioral biases (May, 2005; Sroufe, Carlsonr, Levy, & Egeland, 1999).

Freud’s theory of development emphasized the impact early experiences, emotional relationships with caregivers, and infants’ construction of representations about significant figures in their lives can have on a child’s development (Miller, 2011). However, unlike Freud’s theory of development in which he determined that successful development involves the abandonment of previous attachments in the adoption of new ones, attachment theory holds the belief that individuals carry infant-caretaker attachments with them throughout life (Miller, 2011). This places attachment theory more in line with object relations theory, which was based on Bowlby’s study of infant’s attachments (Miller, 2011). Object relations theory views child development as an evolution of internal working models or a mental representation of how the child is connected to each significant adult in their life (Miller, 2011). These working models later lead to expectations for how other relationships should function (Miller, 2011).

If a child experiences healthy levels of attachment in childhood, he or she is more likely to develop a secure sense of self, setting the foundation for healthy relationships in adulthood. If, however the opposite is true, a child is more likely to develop into an insecure individual who forms ambivalent or disorganized attachments (Byng-Hall, 2002). Ambivalent attachments lead to individuals who exhibit behavior that is either immature or mature beyond their years (Byng-Hall, 2002). Disorganized attachments elicit controlling behaviors or individuals who are easily controlled by others (Byng-Hall, 2002). Having an understanding of an individual’s childhood experiences and the types of attachments they did or did not develop will offer insight into their current views of the world and how they approach new relationships.

An attachment disorder has been shown to be something a child carries with them into adulthood. Issues with attachment can be reflected in the romantic relationships an individual establishes in adulthood as well as in the relationship clients form with their therapist when entering into therapy (Prior and Glasser, 2006). In addition to attachment assessments, a therapist can use these relationships as a template for helping a client manage their attachment-related problems (Prior and Glasser, 2006). For example, if a therapist notices that a client has formed a fast attachment and is becoming too dependent upon their therapist, the therapist may want to consider suggesting or creating larger gaps between therapy sessions. Conversely, if a client struggles to connect with a therapist due to attachment issues, this can be used as grounds for reflection about a client’s relationships with others.

Once an attachment disorder has been established, steps need to be taken to appropriately help a client manage the associated symptoms. By providing a client with new experiences he or she may be able to form new mental representations of their relationships with others, allowing them to develop different levels of attachment (Byng-Hall, 2002). This, in turn, will hopefully diminish a client’s separation anxieties both in relation to therapy and other significant relationships in their life. Additionally, a family therapist can help a family reinforce boundaries in the hopes that associated attachment issues will decrease over time (Byng-Hall, 2002). Addressing trans-generational patterns can also offer insight into parenting and attachment patterns, potentially minimizing a parent’s distraction from their own caregiver duties (Byng-Hall, 2002). By doing this, a family therapist can provide clients with the opportunity to focus more of their energy on healthy parenting and relationship techniques. Hopefully this will diminish the chances of forming new issues related to their attachment disorder or yet another child developing issues related to their attachment to others.

While efforts can be made throughout the therapeutic process via interventions and directives, addressing all associated challenges of attachment disorder can be a challenge. Much of this is due to the fact that it is very much a disorder that is ingrained into the personality of an individual. A client’s feelings about their attachment to others have been reinforced for so many years that replacing or correcting those attachment ideas will indeed be a challenging process. However, by providing a client the opportunity to see how their childhood connections are making an impact on their present day life will be an insight that he or she will be able to carry with them from that point forward as they continue to grow and change.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Barth, D. (2002, Nov). Case studies: Separation anxieties. Psychotherapy Networker, 26.6. Retrieved from

Bowlby, J. (1969/1982). Attachment and loss, Vol. 1: Attachment, New York: Basic Books.

Bowlby, J. (1973). Attachment and loss, Vol. 2: Separation. New York: Basic Books.

Byng-Hall, J. (2002). Relieving parentified children's burdens in families with insecure attachment patterns. Family Process, 41(3), 375-88. Retrieved from

May, J. C. (2005). Family attachment narrative therapy: Healing the experience of early childhood maltreatment. Journal of Marital and Family Therapy, 31(3), 221-37. Retrieved from

Miller, P. H. (2011). Theories of developmental psychology. New York: Worth Publishers.

Prior, V. & Glaser, D. (2006). Understanding attachment and attachment disorders: Theory, evidence and practice. Jessica Kingsley Publishers: London and Philadelphia. Retrieved from

Sroufe, L. A., Carlson, E. A., Levy, A. K., & Egeland, B. (1999). Implications of attachment theory for developmental psychopathology. Developmental Psychology, 11, 1-13.

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