Attachment Disorder Overview

Most infants develop secure emotional attachments to their caregivers at an early age. They show healthy anxiety when their caregiver is absent and they show relief when they’re reunited.

Some infants, however, develop attachment disorders because their caregivers aren’t able to meet their needs. They’re unable to bond with their caregivers and they struggle to develop any type of emotional attachment.

Attachment disorders are treatable but early intervention is important. Without treatment, children with attachment disorders may experience ongoing issues throughout the course of their lives.

Repeated positive experiences with a caregiver helps infants develop a secure attachment. When an adult responds to a baby’s cries by feeding, changing, or rocking her, the baby learns she can trust the adult to keep her safe and care for her needs.

Children who are securely attached tend to:

• Form better relationships with others
• Solve problems more readily
• Try new things and explore independently
• Have less extreme responses to stress

Infants who experience negative or unpredictable responses to a caregiver may develop an insecure attachment style. They may see adults as unreliable and they may not trust them easily.

Children with insecure attachments may:

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

The DSM-V recognizes two distinct attachment disorders: disinhibited social engagement disorder and reactive attachment disorder.

A classic sign of disinhibited social engagement disorder is overfriendliness with strangers. A child may seek comfort from a stranger, sit on a stranger’s lap, and not exhibit any distress when a caregiver isn’t present.

Reactive attachment disorder is a disorder of infancy or early childhood that involves a failure to seek comfort from a caregiver. A child with reactive attachment may resist physical comfort from a caregiver, avoid eye contact, and be hypervigilant. Most children with reactive attachment disorder display a variety of problematic behaviors.

Attachment disorders go beyond just not having a close relationship with caregivers. Children with attachment disorders are likely to struggle academically, socially, emotionally, and behaviorally. They are at a higher risk of developing legal issues during adolescence as well.

Children with attachment disorders tend to have lower IQs. They are also at a higher risk of having language problems.

They’re more likely to have psychiatric disorders as well. A 2013 study that examined children with attachment disorders found that:

• 52 percent had ADHD
• 29 percent had oppositional defiant disorder
• 29 percent had conduct disorder
• 19 percent had PTSD
• 14 percent had an autism spectrum disorder
• 14 percent had a specific phobia
• 1 percent had a tic disorder

Overall, 85 percent of the children had another psychiatric condition in addition to having an attachment disorder.

Attachment disorders may also be linked to psychopathic traits. A 2018 study found that children with attachment disorders were more likely to exhibit callous and unemotional traits. While there is evidence the two are linked, there’s no proof that attachment disorders cause an individual to become a psychopath.

No one knows exactly why some children develop attachment disorders while others living in the same environment don’t. But, researchers agree there is a link between attachment disorders and significant neglect or deprivation, repeated changes in primary caretakers, or being reared in institutional settings. 

Attachment disorders are fairly rare in the general populations. Children in foster care or children who have been institutionalized are the greatest risk.

Attachment disorders are often recognized around a child’s first birthday. The earliest warning signs often include failure to thrive or disinterest in interacting.

Populations most at risk include:

• Children who have had many different foster care providers
• Children who have spent time in an orphanage
• Children who have experienced multiple traumatic events
• Children who were taken away from a primary caretaker after forming a healthy bond

Children don’t grow out of attachment disorders on their own. Their symptoms may shift as they grow older, but if left untreated, they are likely to continue to have ongoing problems into adulthood, including difficulty regulating their emotions.

The most important aspect of helping a child develop a secure attachment involves a stable, healthy environment. A child who continues to bounce from foster home to foster home or one who resides in an orphanage isn’t likely to develop a healthy bond with a caregiver.

Even when a child with an attachment disorder is placed in a loving home with a consistent caregiver, the symptoms won’t immediately resolve. They tend to push their caregivers away and the behavior problems often repel those around them. They usually require intensive ongoing treatment.

Mental health treatment that involves the caregivers can help children learn to develop more secure attachments. Comorbid conditions should also be treated.

If you are concerned about your child’s attachment, talk to your pediatrician. Your pediatrician can conduct an initial evaluation and rule out any medical issues.

You and your child may be referred for a psychological evaluation. Mental health professionals have a variety of tools they can use to assess a child’s attachment and determine if an attachment disorder may be present.