Reactive Attachment Disorder

Reactive attachment disorder is a clinical diagnosis describing a pattern in young children of markedly disturbed and developmentally inappropriate social relatedness toward caregivers, characterized by inhibited, emotionally withdrawn behavior in which the child rarely seeks or responds to comfort even when genuinely distressed, along with limited positive emotional expression and unexplained irritability, sadness, or fearfulness even during ordinary, non-threatening interactions with caregivers. The disorder is rooted directly in the attachment theory developed by the psychiatrist John Bowlby and the empirical attachment research of Mary Ainsworth, and it was formally introduced as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980, with its diagnostic criteria refined in later editions. A defining requirement for the diagnosis is a documented history of grossly insufficient early caregiving, such as severe and persistent neglect, repeated changes in primary caregiver that prevent the formation of a stable attachment, or prolonged rearing in an institutional setting such as an orphanage with a very high ratio of children to caregivers, reflecting the disorder's presumed origin in extreme early disruption of the normal attachment relationship rather than in any inherent trait of the child. The fifth edition of the diagnostic manual, published in 2013, split what earlier editions had treated as a single disorder into two clinically distinct conditions, retaining the inhibited, withdrawn presentation as reactive attachment disorder while separating the disorder's previously combined disinhibited, overly familiar presentation into its own newly named diagnosis.