Attachment Disorders

Also known as 'anxious attachment'

Positive child-caregiver relationships are vital to a baby’s development and understanding of the world. Babies and young children rely on caregivers for their wellbeing and learn early social skills by experiencing how the caregiver responds to them and others. Attachment disorders (also called anxious attachment) can develop in some young children who have had problems in forming emotional attachments to others.

Research suggests most children with attachment disorders have had severe difficulties in early relationships. Psychological, social or physical problems associated with attachment disorders may persist into adolescence and adulthood.

Children at increased risk

Certain childhood experiences increase the likelihood of developing an attachment disorder, including:

- Inadequate care in an institutional setting or other out-of-home placement (such as residential programs, foster care or orphanage)
- Multiple traumatic losses, including early separation from a parent or changes in primary caregivers
- Troubled childhood, including physical, emotional or sexual abuse or instances of neglect or mistreatment
- Caregivers who ridiculed or became annoyed with a child in distress

Two possible types of attachment disorders

Reactive attachment disorder (RAD): Young children having negative experiences with adults might be unable to calm down when stressed and upset or seek comfort from their caregivers. Children are diagnosed with RAD if symptoms become chronic. This includes seeming to have little to no emotions when interacting with caretakers and appearing unhappy, irritable, sad or scared with others.

Disinhibited social engagement disorder (DSED): In contrast, children with DSED are overly friendly with strangers and do not appear fearful when meeting them for the first time. Younger children may allow strangers to pick them up, feed them or give them toys; older children may walk up to them to talk or even hug them. They may go off with someone they do not know without checking with their parents or caregivers.

Symptoms

Baby attachment problems: Parents, caregivers or physicians may notice as early as a child’s first birthday some of these symptoms:

- Colic and/or feeding difficulties
- Failure to gain weight
- Detached and unresponsive behavior
- Difficulty being comforted
- Preoccupied and/or defiant behavior
- Inhibition or hesitancy in social interactions
- Being too close with strangers

Children attachment problems:

- Crying that is not easily consoled
- Clinging to caregivers or becoming overly upset when they leave
- Exploring less than children of similar age
- Appearing overly anxious, sad, fearful
- Either not interacting or over interacting with strangers
- Not controlling negative emotions or behaving aggressively
- Having poor peer interactions

Adolescent and adult attachment problems:

- Being highly emotional, impulsive, unpredictable, moody—with feelings of low self-worth
- Difficulty trusting others
- Being overly dependent in relationships and requiring frequent reassurances of the caring of others
- Craving closeness and intimacy, while being overly sensitive to a partner’s actions and moods or overly worried of being abandoned

Increased risk for anxiety and mood disorders

Young adults who develop anxious attachment may be at increased risk for other anxiety disorders. A 2015 study on adolescents and young adults found a history of emotional neglect (antipathy) during childhood was associated with anxiety disorders later in life, including:

- Social phobia
- Generalized anxiety disorder
- Panic attacks
- Depression is another condition that may arise.

Early Intervention & Diagnosis

Children showing signs or symptoms of reactive attachment disorder (RAD) or disinhibited social engagement disorder (DSED) need a comprehensive assessment and individualized treatment plan, generally involving both child and family. Without early intervention, these serious clinical conditions can negatively affect a child’s social and emotional development. However, close and ongoing collaboration between the child’s family and the treatment team increases the likelihood of a successful outcome.

CFI's Attachment-Based Therapy

The goal of attachment-based therapy is to form a trusting relationship with parental figures or with the clinician as a bridge to forming strong bonds in other relationships.

A CFI therapist with expertise in preventing or treating attachment disorders can design a treatment plan based on the child’s developmental age, the severity and complexity of the disorder and the existence of other mental health conditions or issues.

Attachment-based therapy also works with other treatments and services, including individual or group therapy:

- Cognitive behavioral therapy (CBT)
- Dialectical behavioral therapy (DBT)
- Social anxiety and social skills group therapy: Learning skills to manage stress or deal with persistent symptoms
- Mindfulness, with meditation
- Psychiatry
- Medication management

Educational Advocacy & School Coordination

Many children with attachment disorders experience difficulty at school. The therapist-led treatment team can plan and implement school and community interventions, along with in-session therapy.

Treatment At Home

For young children: Parents, caregivers and other family members can reinforce what is learned in the therapy session at home.

With parental support, children and adolescents can increase the likelihood of forming positive relationships outside the home.
Parents and families can build understanding and support for children with anyone who interacts with their child.

For adolescents and young adults: Older children and young adults can work to feel more secure in themselves and their relationships. While requiring conscious effort and self-awareness, there are steps to take:

Practice being aware of interactions in relationships
Connect with emotions when experiencing anxiety or insecurity in a relationship—and reactions to such emotions
Use CBT, DBT or mindfulness exercises, such as meditation, to help regulate and respond in different ways to these emotions

For family or friends of those with attachment disorders: partners, siblings and friends can help:

Provide ongoing assurance of caring about them
Be consistent in giving them attention
Follow through on promises and commitments
Encourage self-awareness and self-reflection to help them overcome anxious or depressed behaviors and feel more secure

References

Child & Adolescent Psychiatry

Healthline

PsychNet

Simply Psychology