Lately there’s been lots of talk about Attachment Disorders. I, personally, have been contacted by multiple people, both in the field of psychology and laypersons, telling me that my discussions of RAD are inaccurate or outdated. Others have even said that these disorders dealing with attachment don’t even exist. Actually, I appreciate this feedback greatly, because if there is new research being done, then you better believe I want in on it! I have two children suffering from mental illness and would love nothing more than to find new solutions to this problem.
However, some are under the belief that the phrase “Attachment Disorder” is faulty because Attachment Disorder is not in the DSM-V. Now, you and I may differ in the way we word things, but if a person comes to me and says they have “depression”, I immediately understand some of the basic symptoms they’re referring to. I would gather more information by asking if they have MDD, Bipolar, the frequency and length of the symptoms, etc. But because there are so many diagnoses that deal with depression, I don’t immediately jump all over that person for telling me they have a diagnosis that doesn’t exist… I understand that they are using a general term to express their symptoms.
That being said, when someone speaks to me about Attachment Disorders, I understand that they are speaking of a general group of diagnoses having to do with attachment issues, not claiming that Attachment Disorders is in the DSM. A major difference from the DSM-IV to the DSM-V is the separation or Reactive Attachment Disorder: disinhibited type and Reactive Attachment Disorder: inhibited type. RAD is now strictly referred to in its previous inhibited form, meaning that a child “is diagnosed when a his/her social relations are inhibited and, as a result, he/she fails to engage in social interactions in a manner appropriate to his/her developmental age. The child may exercise avoidance, hyper-vigilance or resistance to social contact. The child may also avoid social reciprocity, fail to seek comfort when upset, become overly attached to one adult, and refuse to acknowledge a caregiver. Links have been shown between RAD and future behavioral and relationship problems.” (APA 2013)
On the flip side of attachment is Disinhibited Social Engagement Disorder (DSED). This is what was previously known as RAD: disinhibited type. This means that there “is the absence of normal fear or discretion when approaching strangers. The child is unusually comfortable talking to, touching, and leaving a location with an adult stranger. These behaviors are not the result of attention problems or other issues that might be associated with impulsive behavior.” (APA 2013)
And yet, in that same DSM that is quoted above, very few behaviors are listed. It goes on to talk about causes and criteria for the diagnoses, but there is very little listed by way of symptoms. So, does this mean that children who struggle with attachments have no behavioral issues?
Of course not. What that tells me is that the American Psychological Association doesn’t want to write the Encyclopedia Britannica as the DSM – they would rather the book be used to help doctors diagnose, not list every symptom that could be possible for every case ever. They are very wise.
Therefore, when looking at “Attachment Disorders” (I can feel the emails coming in as I write that!), we look at the causes of RAD and DSED and other trauma-related disorders. We recognize that neglect, abuse, institutionalization, and multiple changes in care givers create the issues of attachment. And for some of those children, they struggle to accept affection or are unable to be consoled (RAD) whereas others willingly talk to strangers, are clingy, and require ALL of the physical attention they can get (DSED). In both of these cases, children can fall on a spectrum ranging from mild to severe.
And what determines where a child falls on that spectrum? The behavioral symptoms associated with the causes of the disorder. That means that these children who have faced horrible atrocities or never had their needs met as wee little ones will display behaviors associated with the traumas that they experienced. We don’t need the DSM-5 to tell us that these children may steal, lie, manipulate, or become aggressive. Because we already know that children who have gone through these life experiences will respond to people and daily circumstances in a way that protects them from the world and gets their needs met, since they couldn’t always depend on the adults in their lives to do that for them (hence the lying, stealing, aggression, and manipulation).
Look, my goal is not to argue semantics. There is new research coming out constantly, new studies being done regarding children with early childhood trauma and how it effects their attachments to others. Some face mild symptoms whereas others face severe ones. But to say that the diagnoses don’t exist or that these symptoms are not listed in the DSM-5 and can’t possibly be attributed to children with attachment disorders – well, this undermines all the parents, doctors, therapists, and children who are daily living it.
These issues are not a quick fix. There is no pill or specific therapy that will treat each child and cure each symptom. And as a child ages, these symptoms may change, as will their treatment. But what we can say for a fact? Consistency, unconditional positive regard, and structure are the best tools to combat a terrible set of diagnoses. So, whatever you choose to call it, whatever label you prefer, remember that there are people out there working on ways to best heal their children – and your labels and criticisms are not required. Jump in and help, by all means – we need it! But please leave the judgments at the door.
Blessings to you and thank you for all the research, resources, and love you provide to a population of hurting children!