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.

The Importance of Attachment

Repeated positive experiences with a caregiver help infants develop a secure attachment. When an adult responds to a baby’s cries by feeding, changing, or comfort, the baby learns they can trust the adult to keep them safe and care for their needs.

Secure Attachments

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

Insecure Attachments

Infants who experience negative or unpredictable responses from 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

Symptoms

Signs that a child may have an attachment disorder include:

• Bullying or hurting others
• Extreme clinginess
• Failure to smile
• Intense bursts of anger
• Lack of eye contact
• Lack of fear of strangers
• Not affectionate toward caregivers
• Oppositional behaviors
• Poor impulse control
• Self-destructive behaviors
• Watching others play but refusing to join in
• Withdrawn or listless moods

The specific diagnosis depends on the pattern of symptoms that a child exhibits.

Types of Attachment Disorders

The DSM-5 recognizes two distinct attachment disorders: disinhibited social engagement disorder and reactive attachment disorder.

Disinhibited Social Engagement Disorder

A classic sign of disinhibited social engagement disorder (DSED) 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.

Children with DSED also show little interest or desire to check in with trusted adults before leaving a safe place and entering a situation that is strange or even threatening. Kids with this condition show little preference for trusted adults over strangers and may seek out affection from people they do not know.

Reactive Attachment Disorder

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. Such behaviors can include irritability, withdrawal, lack of comfort-seeking, not interacting with other children, and avoiding physical touch.

Related Conditions

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, and they are at a higher risk of having language problems. They’re also more likely to have psychiatric disorders. A 2013 study that examined children with attachment disorders found that:

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

Link to Personality Disorders in Adulthood

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.

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 develop antisocial personality disorder.

Causes

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. 

Some other possible risk factors for attachment disorders include:

• Abuse (physical, emotional, or sexual)
• Caregivers with poor parenting skills
• Frequent changes in care providers
• Institutional care
• Parental anger issues
• Parental neglect
• Parents with psychiatric conditions
• Prenatal exposure to alcohol or drugs

Attachment disorders are fairly rare in the general population. But children in foster care or children who have been institutionalized are the greatest risk. These conditions 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

Treatment

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.

Treatment typically involves:

• Psychotherapy: Psychotherapy for attachment disorders focuses on identifying problem areas and reducing problematic behaviors. This can be done one-on-one with a therapist but it may also involve caregivers as well.
• Social skills training: Developing social skills can help children learn how to interact better with other kids in school and social settings. Kids may practice these skills with their therapist and caregivers to help gain confidence and experience.
• Family therapy: Family therapy may help kids, caregivers, and other family members learn new ways of interacting and responding. 

Getting Help

If you notice signs that your child may have an attachment disorder, talk to your child's doctor about an evaluation, diagnosis, or referral to a child mental health specialist. The earlier the intervention, the more likely a child is to experience a good outcome.

Another step that you can take to help a child with an attachment problem includes taking a parenting class. Children with attachment issues require special attention so learning how to respond appropriately can help your child form a healthier, more secure bond with caregivers.

A Word From Verywell

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 then 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 and what the best treatment options are for the child.