An attachment disorder is a behavioral disorder that affects the ability to form and maintain relationships. Attachment disorders are common in children but can occur in adults.
These disorders typically develop in childhood. They can result when a child is unable to have a consistent emotional connection with a parent or primary caregiver.
There is no formal attachment disorder diagnosis for adults, but they can experience attachment issues. These can stem from untreated or undiagnosed attachment disorders in childhood.
This article describes what attachment disorders are, including the types and their symptoms. We also explore the treatment options and when to see a doctor.
Attachment theory deals with how people form emotional bonds. The way that a person learns to form and maintain relationships primarily stems from their initial interactions with a parent or primary caregiver during childhood.
However, attachment disorders are distinct, diagnosable conditions.
The professional diagnostic guidelines — the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5-R) — lists two types of attachment disorders: reactive attachment disorder (RAD) and disinhibited social engagement disorder.
While RAD often occurs as a result of early childhood mistreatment or neglect, DSED often occurs following neglect in the first two years of life.
This section explains the two types of attachment disorder. However, it is worth noting that the criteria for each focuses on the symptoms in children.
Reactive attachment disorder
RAD
- having low levels of interaction with other people
- showing little or no evidence of emotion during social interactions
- having difficulty calming down when stressed
- seeming unhappy, irritable, sad, or scared when engaging in everyday activities with their caregivers
If the child does not receive effective treatment, the symptoms of RAD may manifest or continue into adulthood. Possible symptoms of the disorder in adults include:
- difficulty reading emotions
- resistance to affection
- difficulty showing affection
- low levels of trust
- difficulty maintaining relationships
- a negative self-image
- anger issues
- impulsivity
- detachment
Disinhibited social engagement disorder
DSED may develop in response to social neglect and a lack of consistent attachment to a primary caregiver during the first 2 years of life.
Children in social care often demonstrate symptoms of DSED. These may include:
- hyperactivity
- minimal social boundaries
- extreme sociability
- readiness to approach and engage with strangers
If a child with DSED does not receive effective treatment, the issue can manifest or continue into adulthood. An adolescent or adult with DSED may display:
- hyperactivity
- an extreme trust of people that they do not know well
- a lack of awareness of social boundaries
- a tendency to ask intrusive questions to people that they have just met
- other behaviors that show a lack of inhibition
Having dissociative identity disorder (DID) involves having at least two distinct personality states. Medical experts previously referred to the condition as multiple personality disorder.
However, researchers do not yet fully understand the causes of dissociative conditions, and it is a controversial diagnosis. Some theories suggest that they may develop after sexual or emotional abuse in childhood.
DID affects 1–3% of the population, but the general symptoms of dissociation are more common.
A person with DID is unaware of their alter personalities, or “alters.” The “primary” personality only realizes that they have lost time — during which the alters were present. There is also a loss of sense of self in the moment for the primary personality.
Below are some signs and symptoms of the disorder. Others may notice or the person may experience:
- uncertainty about their true identity
- discontinuity in their sense of self
- related changes in behavior, consciousness, and memory
- a feeling of disconnectedness from themselves and the world around them
- memory loss relating to personal information or everyday events
- reduced ability to feel physical pain
An attachment disorder that develops in childhood may affect relationships in adulthood.
A person with an attachment disorder may have difficulty trusting others or feeling safe and secure in a relationship. As a result, they may have difficulty forming and maintaining friendships and romantic partnerships.
MR 11/13/23: I am not aware of research linking adult dissociation or substance misuse with those attachment disorders, unless the author has research they have found. Otherwise, I would not link those here.
Untreated childhood RAD or DSED can cause the following during adulthood:
- low self-esteem
- emotional impairment
- difficulty in social situations
- anxiety
- depression
- dissociation
substance misuse
Currently, the DSM-5 does not recognize attachment disorders in adults, so an adult is unlikely to receive this diagnosis.
The treatment for a childhood attachment disorder typically involves psychotherapy — which may also benefit an adult who is experiencing a manifestation of the disorder.
An adult may find therapy or couples counseling useful. Attachment therapy focuses on helping a person overcome the impact of negative early experiences with attachment. It can also help create new, healthier attachment bonds.
Couples counseling can help people see how an attachment disorder may be affecting their relationship. With this knowledge and with the therapist’s help, couples can develop tools and strategies to strengthen their bond.
The following are answers to frequently asked questions.
What does attachment disorder look like in adults?
Untreated attachment disorders in childhood can cause a person to have low self-esteem, difficulty in social situations, and trouble maintaining relationships. They may also experience mental health conditions like anxiety and depression.
What is the best therapy for attachment disorders in adults?
Psychotherapy helps a person identify and understand thoughts and behaviors that may be negatively affecting their relationships. Once a person has addressed these issues, they can develop tools and coping strategies that work.
For some people, therapy may help. Couples therapy can also be useful for people who are having difficulty in their relationships. Cognitive behavioral therapy (CBT) can help a person change their thought patterns, behaviors, and actions.
A child who has experienced any form of neglect or maltreatment likely needs psychological support, regardless of whether they have an attachment disorder.
Anyone who feels that their thoughts or behaviors are negatively impacting their relationships should consider consulting a doctor or psychotherapist.
Also, any adult who has ever experienced maltreatment may benefit from discussing it with a therapist. Unresolved issues from the past may negatively impact life, emotions, and relationships.
An adult is unlikely to receive a diagnosis of an attachment disorder because the clinical guidelines only recognize these issues in children.
Nonetheless, if a child with an attachment disorder does not receive effective treatment, the symptoms can manifest or continue into adulthood, causing difficulties with social interactions and relationships.