Attachment Disorders

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“Attachment disorder” is a general term used to describe children who have social, emotional, or behavioral problems that stem from poor or insufficient attachment to caregivers. There are really only 2 officially recognized attachment disorders: Reactive Attachment Disorder (RAD), and an almost identical diagnosis of Deprivation/Maltreatment Disorder of Infancy, which is very similar but intended as a diagnosis for children 3 or under. More loosely, however, child development specialists will refer to any child who has a history of attachment injuries or insecurities that coincide with mental health issues as having an attachment disorder.

What is attachment?

Attachment is simply a term that refers to the quality and dependability of love and care a child receives from their caretakers. Or as Donna Potter and her colleagues write, it’s “the system within which the child seeks out the parent in times of distress or when pleased with achievements, as well as the parental sensitivity to, acceptance of, and timely response to the child’s needs.” (Potter et al., 2009, p. 11) The more love, affection, and stability a child receives from caregivers, the stronger their attachment will be.

For research purposes, scientists classify children’s attachment patterns into 4 subtypes:

Secure attachment: Children have a strong bond with caretakers and rely on those people for emotional support. They are moderately upset when separated and seek affection upon that person’s return.

Insecure/avoidant: The child seems more insecure in their attachment and more distressed when a caregiver leaves, and may not reconnect as easily afterwards. However, they readily seek comfort from that person when in distress, and this insecurity could be a product of a child’s unique temperament as opposed to anything a caregiver has or hasn’t done.

Ambivalent attachment: A child shows distress in a caregiver’s absence but seems angry or distant when that person returns. They often act in an inhibited way, declining to actively explore their environment.

Disorganized attachment: This is the attachment style that commonly arises out of deficient caregiving. The parent figures are inconsistent or undependable, and so the child cannot rely on them for the comfort and stability they need. This results in interactions that are awkward or miss-attuned. Disorganized attachments seem to be the category of attachment most linked to future psychopathology. (AACAP, 2005; Main, 1996) This type of attachment style is rare in the general population (around 15%), but common in children who have suffered from abuse, neglect, or other forms of maltreatment. (Carlson et al., 1989; Vorria et al., 2003; Zeanah et al., 2005)

The importance of attachment

Attachment is the central hub in child development: Every single aspect of a child’s welfare you could name flows through attachment. It impacts a child’s socialization, their moods and emotions, their mental health and their behavior. When children’s attachments are secure, it provides a stable base for them to branch out, explore the world and grow as a person. When that love and security isn’t there, a child lacks this stable foundation from which to work from, and their self-identity is so fragile that it’s difficult to weather life’s storms or to take the risks that are necessary for growth.

Attachment also sets up a template in the child’s mind about “what others are,” which affects every interaction they have with the world. Are others generally trusting, kind, caring, and dependable? Or are they typically cold, callous, harsh, distant, and undependable? Can love be counted on or might it be snatched away at any moment? Whatever template a child learns, it will impact every interaction they have with the world going forward.

Given the profound importance of attachment, it’s no surprise that there’s a strong link between mental health disorders and attachment injuries. (Fonagy et al., 1996; Agrawaal et al., 2004; Brennan & Shaver, 1998) I can also tell you from personal experience: Nearly every behaviorally disturbed child I’ve ever worked with had an attachment injury somewhere in their background.

What causes an attachment disorder?

Attachment injuries occur in one of three ways:

Abuse can chip away at a child’s sense of secure attachment. When abuse comes at the hands of a parent or primary caregiver, each act can slice away a few threads from the rope that keeps children securely attached to their caregivers. The first act of violence is typically the most profound, since having a parent act violently towards you instantly raises trust issues in a child’s mind. But it also depends on what occurs. Isolated, minor cases of physical abuse that arise from a parent losing their temper may barely move the needle (especially if the parent sufficiently expresses remorse right after), and non-violent sexual abuse may not move it at all unless it continues despite the child’s desires to stop. Verbal and emotional abuse is tricky to decipher; since it’s more subtle, it doesn’t so much attack attachment directly as it does twist a child’s psyche into a tangled neurotic mess, but it can lead to many of the same effects.

Neglect can prevent those secure types of attachments from ever forming to begin with, which is why neglect is typically worse from a developmental standpoint than abuse. Whether this neglect arises from parental substance abuse or simple lack of interest, neglected kids are typically more vulnerable to attachment disorders than kids who experience other types of abuse.

Breaks in attachment are especially devastating. One of the most ironic tragedies of our child welfare system is that placing kids into foster care – which CPS officials routinely do nonchalantly even when they are still only investigating abuse – is typically far more traumatic than any physical, verbal, or sexual abuse or neglect children might experience in the home. Kids who are placed in foster care even for short periods of time have gone mute, become catatonic, and have suffered severe separation fears or attachment anxieties even after being returned to their natural homes. Their stress levels shoot through the roof. It’s traumatic. It even raises child mortality rates (i.e., more kids die), which may seem far-fetched at first until you consider that baby animals of every type that have been separated from their parents also have extremely high rates of mortality, even when provided with the best care that humans can offer. Foster care and institutional placement is the worst kind of abuse there is, and the fact that our government resorts to it so callously and carelessly is inexcusable.

“Severely disordered attachment histories are the rule rather than the exception in most children who have been removed from their biological parents’ custody.”

– Lyons Hardy (2007, p. 38)

Children with attachment disorders

Not all children who experience these hardships will go on to develop an attachment disorder. Even among children who spent their first 4 years in an institution with 50 different caregivers per week, a full third of them managed to develop an attachment to a selected caregiver. (Potter et al., 2009) Children are resilient, and the majority of abused, neglected, or institutionalized children will not develop a full-blown attachment disorder. Yet nearly all kids from disadvantaged backgrounds are going to have some degree of hypersensitive attachment issues. So even if a child doesn’t fit the criteria for a full-blown disorder, this information will help you better understand their behavior and the hidden insecurities created by injuries to attachment.

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