An attachment disorder is a mood or 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.
Psychologists initially studied and categorized different types of attachment that can develop during childhood. Researchers later developed the Adult Attachment Interview to distinguish the types in adults. The questions assess the type of early relationship that an adult had with their primary caregiver.
Types of attachment in adults are similar to those observed in children. They include:
- Secure: An adult with secure attachments likely had a positive emotional bond with their primary caregiver. They are comfortable in their relationships and have low relationship anxiety.
- Avoidant or dismissing: Adults with these attachments are uncomfortable with closeness and value independence in their relationships. As a child, their caregiver may not have been attuned to their needs.
- Anxious or preoccupied: Adults with these attachments crave intimacy and do not feel secure in their relationships. A child may develop this attachment style if their caregiver has intermittent or unpredictable availability.
- Disorganized: Adults with this attachment style may have intense or chaotic patterns of relationships, marked by seeking closeness then pushing people away, for example. It may develop in response to childhood trauma or abuse.
The professional diagnostic guidelines — the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) — lists two types of attachment disorders.
However, it is worth noting that the criteria for each focuses on the symptoms in children.
Reactive attachment disorder
Reactive attachment disorder (RAD)
The American Academy of Child and Adolescent Psychiatry note that children with RAD may:
- have low levels of interaction with other people
- show little or no evidence of emotion during social interactions
- have difficulty calming down when stressed
- seem 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
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 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.
Some
Still, researchers do not yet fully understand the causes of dissociative conditions. 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.
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, and more research into this area is necessary.
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.
Untreated childhood RAD or DSED can cause the following during adulthood:
- low self-esteem
- emotional impairment
- difficulty in social situations
- anxiety
- depression
- dissociation
- problems with
substance use
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 attachment therapy or couples counseling useful. Attachment therapy focuses on helping a person overcome the impact of negative early experiences with attachment.
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.
An attachment disorder can have a detrimental effect on a person’s personal relationships and overall quality of life. However, treatment can help.
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.
Ideally, treatment should begin in childhood. 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 be influencing thoughts and behaviors in the present.
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.
Anyone who has experienced childhood trauma or neglect should consider seeing a doctor or psychotherapist, especially if they feel that the issue is affecting their relationships.