Reactive Attachment Disorder (A Comprehensive Guide)

In this guide, reactive attachment disorder will be explained along with causes and treatment for reactive attachment disorder.

What is Attachment

Attachment is the bond one feels with another person.

Most children develop safe emotional attachments at an early age. If the caregiver is missing, they display anxiety which is normal and they relax when the parents care for them.

Nevertheless, certain children might develop attachment disorder because their parents could not satisfy their desires.

When this happens, the child is not able to bond with caregivers and may struggle to develop emotional attachments of any kind.

Attachment disorder is treatable, but it is necessary to act early.

Kids with attachment disorder will endure persistent difficulties throughout their life if their condition is left untreated.

Why Attachments are Important?

Attachments recreate the person’s self-image as well as guide them in handling the situations around them.

Repeated positive experiences with a caregiver help to develop a secure and healthy attachment for infants.

When a baby cries and an adult responds by feeding, changing, or rocking, the baby learns that she can trust the adult to keep her safe and care for her needs.

The babies who have secure attachments will:

  • Explore independently and try new things
  • Form relationships with others in a better and healthy way
  • When stressed, have less extreme responses
  • Be able to solve problems more quickly

Insecure attachment may develop if the infant experiences unpredictable or negative responses from a caregiver.

They will be less likely to trust the adults and see them as unreliable.

Insecure children will be likely to:

  • Refuse to engage with others
  • Show anxiety, anxiety, and fear
  • Avoid people
  • Exaggerate distress

Types of Attachment disorder

The diagnostic statistical manual of mental disorders fifth edition includes two attachment disorder: Reactive Attachment disorder (RAD) and Disinhibited Social Engagement Disorder (DSED).

Reactive Attachment Disorder (RAD)

Reactive Attachment Disorder is a rare condition, and starts at a young age, as early as from the age of infant.

The child will not establish a healthy attachment with caregivers.

In the Reactive Attachment Disorder, the child may be unable to get the basic needs of nurturance, care and love gets fulfilled, and these unmet needs lead to Reactive Attachment Disorder.

This condition can start in infancy and the research on symptoms and signs of reactive attachment disorder is very limited.

It is still unclear whether this disorder can occur in children that are older than five years.

Symptoms and signs are:

  • When distressed, they do not seek comfort and when comfort is given, they do not show any response
  • Restless and sad
  • Do not engage in social interactions but watch others
  • Do not engage in interactive games
  • Failure to smile
  • Like other infants, do not ask to be picked up
  • Unable to ask for assistance or support
  • Unexplained fear, withdrawal, gloominess or irritability

 Outlook of Reactive Attachment Disorder

Reactive attachment disorder usually if not treated will lead to the physical, emotional, behavioural, social and moral development.

Children with reactive attachment disorder will be prone to anxiety, depression, aggressiveness, learning difficulties, and low self-esteem.

When to see a doctor

Consider getting an examination of the child if he shows any of the above symptoms.

The symptoms might occur in children who have no reactive attachment disorder or who have another condition, such as autism spectrum disorder.

It is important to have the child assessed by a pediatric psychiatrist or psychologist who is able to determine if such behaviours indicate reactive attachment disorder or some other condition.

Causes of RAD

Children and infants need a secure, loving place to feel safe and build trust.

It is important to regularly fulfil their basic emotional and physical needs.

For example, when a baby cries because he wants to be fed or needs a diaper change, a healthy emotional response should be shared that may include eye contact, laughing, and caressing.

A child whose needs are neglected or met with a lack of caregivers ‘ emotional response does not form a stable relationship to caregivers or expect support or attention from them.

It is not clear why some children and babies develop reactive attachment disorder and others do not.

There are various theories about reactive attachment disorder and its causes, and there is a need for more research to develop a better understanding and improved options for diagnosis and treatment.

Risk factors

The risk factors of developing reactive attachment disorder in children suffering from emotional neglect may include:

  • Changing foster homes and/or caregivers
  • Living in an orphanage or children’s home
  • Because of hospitalization, prolonged separation from parents or caregivers
  • Parents with mental health problems like substance abuse or criminal behaviour

It is not necessary that the child will surely develop reactive attachment disorder even if he experiences severe emotional neglect.


Reactive attachment disorder can continue for several years without treatment and can have lifelong consequences.

Some research suggests that some children and adolescents with reactive attachment disorder may display insensitive, unemotional behaviours that may include behavioural problems and abuse to humans or animals.

More research is needed to decide whether problems are related to experiences of early childhood reactive attachment disorder in older children and adults.


While it is not known with certainty whether it is possible to prevent reactive attachment disorder or not but there are ways to reduce the risk of its development.

The following suggestions for parenting may be helpful:

  • Take parenting classes
  • Be actively engaged with the child in play activities
  • Learn to interpret when the baby needs nurturing or emotional support
  • Provide warm, nurturing interaction during bathing, changing diapers or feeding the child
  • Offer both nonverbal and verbal responses like touch, warm facial expressions

Safety for a Child with an Attachment Disorder

For children with attachment problems, safety is the main problem. They are distant and suspicious because they feel insecure in the world.

To protect themselves, they keep their guard up, but it also prevents them from accepting love and support.

So, before anything else, building up the sense of security of the child is essential.

This can be accomplished by setting clear expectations and behavioural rules, and by responding consistently so that the child knows what to expect when they act in a certain way and knows that you can be counted on regardless of what happens.

Following steps can be taken to make the child feel secure and responsible:

  • Owning up to mistakes and taking initiative to repair the damage
  • Setting limits and boundaries
  • Taking charge while remaining calm when the child is misbehaving or throwing a tantrum
  • Making and maintaining schedules and routines
  • Being immediately available after having a conflict with the child

Making the child with attachment disorder feel loved

It will be difficult for a child who has not bonded early in life to embrace love, especially physical expressions of love.

But with time, consistency and repetition one can help them learn to accept love and affection.

Confidence and security come from seeing acts of affection, listening to reassuring words and always being comforted.

Following are the ways they can be taught to accept love:

  • Respond in accordance with the emotional age of a child
  • Play, listen and talk to the child
  • Try to identify the things that make the child feel good
  • Assist the child in identifying his emotions
  • Let them know it is alright to express their needs

Supporting the health of a child with attachment issues

Sleeping, eating, and exercise habits for infants and children are always important, but they are even more important for children with attachment difficulties.

Healthy lifestyle practices can go a long way to lower the stress levels of a child and reduce his or her mood swings.

When kids with attachment problems are relaxed, well-rested, and feel good generally, handling the challenges of life will be much easier for them.

Anything like food, rest and exercise can make a difference between a good and a bad day for a child who has attachment difficulties.

These are the basics that help in ensuring that the brain of the child is ready to connect and healthy.

Professional treatment for Reactive Attachment Disorder

Reactive attachment disorder therapy usually involves combining therapy, parenting education, and counselling to ensure that the living environment of the child is safe has positive interactions and better relationships with caregivers.

Although medicine can be used to treat related conditions such as depression, anxiety, or hyperactivity, no quick fix is possible for such conditions.

Therapist of paediatrician may follow the treatment plan that has:

  • Individual psychological counselling
  • Play therapy
  • Family therapy
  • Parenting skills classes
  • Special education services 

Attachment Disorder is developed when the infants experience a lack of warmth and care from caregivers.

Two types of attachment disorder are included in DSM-5: Reactive Attachment Disorder and Disinhibited Social Engagement Disorder.

Treatment includes psychotherapy of the child as well as parents.

Frequently Asked Questions for Reactive Attachment Disorder

What are the symptoms of reactive attachment disorder?

The symptoms of reactive attachment disorder are that child will be aversive to touch, and physical affection.

As well as they will flinch, laugh or gets irritated when touched.

The touch will produce negative feelings rather than producing the positive feelings.

What are the two types of reactive attachment disorder?

There are two types of reactive attachment disorder: Inhibited and disinhibited reactive attachment disorder.

The research has not been done extensively on these topics.

However, as children grow older they develop the inhibited or disinhibited behaviour patterns. 

Can a child with RAD be cured?

RAD cannot be cured immediately, as there is no cure available.

As this is an acquired disorder so the brain development was altered in which no medication or medical treatment can help.

However, children with reactive attachment disorder can seek psychological help.

How does reactive attachment disorder develop?

The reactive attachment disorder develops as a result of child abuse, and the inability to make the bond with the primary caregivers.

What are the four attachment styles?

The four attachment styles are secure, avoidant, anxious, and disorganized attachment style.

Please use the comment section below if you have any questions.





Attachment, Trauma, and Healing: Understanding and Treating Attachment Disorder in Children and Families

Treating Attachment Disorders, Second Edition: From Theory to Therapy

A Short Introduction to Attachment and Attachment Disorder (JKP Short Introductions)

Building the Bonds of Attachment: Awakening Love in Deeply Traumatized Children

Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice (Child and Adolescent Mental Health)

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