Reactive Attachment Disorder

- Introduction

The International Classification of Diseases 11th edition (ICD-11) classifies reactive attachment disorder and disinhibited social engagement disorder as two of the disorders specifically associated with stress, with onset in childhood. However, The Diagnostic and Statistical Manual 5th Edition (DSM-5) classifies reactive attachment disorder (RAD) as a trauma- and stress-related condition of early childhood caused by social neglect or maltreatment. ^{12, 13}

Children with reactive attachment disorder show a consistent pattern of inhibited, emotionally withdrawn behavior towards adult caregivers. The child rarely or minimally seeks comfort when distressed, and rarely or minimally responds to comfort when distressed. There is minimal social and emotional responsiveness to others, episodes of unexplained irritability, sadness, or fearfulness that are evident even during non-threatening interaction with adult caregivers. ⁴

The child has typically experienced a pattern of extremes of insufficient care, such as social neglect or deprivation with persistent lack of basic emotional needs for comfort, stimulation, and affection met by caregiving adults. There may be a history of repeated changes of primary caregivers that limit opportunities to form stable attachments or rearing in unusual settings that severely limit opportunities to form selective attachments.⁴