Healthy Minds

Emotional Growth

Attachment Disorder

Attachment Disorders are psychiatric illnesses that can develop in young children who have problems in emotional attachments to others. Parents, caregivers, or physicians may notice that a child has problems with emotional attachment as early as their first birthday.

Most children with attachment disorders have had severe problems or difficulties in their early relationships. They may have been physically or emotionally abused or neglected.

Some have experienced inadequate care in their own home or other out-of-home placement ( for example: residential programs, foster care or orphanage). Others have had multiple traumatic losses or changes in their primary caregiver.

The physical, emotional and social problems associated with attachment disorders may persist as the child grows older.

Disinhibited Social Engagement Disorder (DSED)

  • Having extreme negative experiences with adults in their early years
  • Not fearful when meeting someone for the first time.
  • Overly friendly, walk up to strangers to talk, hug or even kiss them.
  • Allow strangers to pick them up, feed them.
  • Willingness to go home with an unfamiliar adult with little or no hesitation.
  • The criteria does not met for Autism Spectrum Disorder

The diagnosis of DSED is made before a child turns 5 years of age.

Reactive Attachment Disorder (RAD)

  • Having extreme negative experiences with adults in their early years
  • Rarely or minimal seeks or responds to comfort when being distressed
  • Appear unhappy, irritable, scared while having normal activities with their caretaker.
  • Have little to no emotions when interacting with others.
  • The disturbance is evident before 5 years of age

The diagnosis of RAD is made if symptoms become chronic. Children who have Disorganized Attachment may develop RAD.

The 4 main child/adult attachment styles have been identified as:

Secure Attachment

As Children

  • Are able to separate from parents
  • Seek comfort from parents when frightened
  • Greet return pf parents with positive emotions
  • Prefers parents to strangers

As Adults

  • Have trusting, lasting relationship
  • Tend to have high self-esteem
  • Are comfortable sharing feelings with friends and partners
  • Seek out social support

Avoidant Attachment

As Children

  • May avoid parents
  • Does not seek much contact or comfort from parents
  • Shows little or no reference for parents over strangers
  • Might develop Disinhibited Social Engagement Disorder

As Adults

  • May have problems with intimacy
  • Invest little emotions in social and romantic relationship
  • Unwilling or unable to share thoughts and feelings with others

Ambivalent Attachment

As Children

  • May be wary of strangers
  • Become greatly distress when parents leave
  • Do not appear to be comforted when parents return

As Adults

  • Reluctant to become close to others
  • Worry that their partner does not love them
  • Become very distraught when their relationship ends

Disorganized Attachment

At age 1

  • Shows a mixture of avoidant and resistant behaviors
  • May seem dazed, confused or apprehensive

At age 6

  • May take on a parental role
  • May act as a caregiver toward the parent
  • May develop Reactive Attachment Disorder when growing up.


Reactive Attachment Disorder and Disinhibited Social Engagement Disorder are serious clinical conditions. Children who exhibit signs of RAD or DSED need a comprehensive psychiatric assessment and individualized treatment plan.

Treatment must involve both the child and the family. A close and ongoing collaboration between the child’s family and the treatment team will increase the likelihood of a successful outcome.


Attachment work has its roots in providing the nurturing responses that the client missed in early childhood and requires a very skilled therapist who is familiar with Attachment work. Attachment difficulties will get better, however it takes a long time.

The family will need to re-create an emotionally safe environment for the child; be consistent and see the behaviors from an Attachment perspective (for example: an argumentative/ defiant behavior is a reflection of their independence; running away is trying to escape from others and their own feelings; self-harm is to release their pain, mitigate their numbness, consolidate their feelings).