Reactive Attachment Disorder and Disinhibited Social Engagement Disorder

The first two disorders within the category of trauma-related disorders pertain to attachment issues in childhood.

We previously discussed attachment in the context of separation anxiety disorder. Here, we will revisit the definition of attachment, focusing specifically on the child's perspective. Attachment is that "special" bond that a child forms during infancy with their caregiver, providing a sense of protection and satisfaction of primary (physical and psychological) needs.

Both Reactive Attachment Disorder and Disinhibited Social Engagement Disorder, as defined by the DSM-5, are characterized by insufficient care. Insufficient care refers to at least one of the following situations:

• A consistent lack of comfort from the caregiver
• Repeated changes of caregivers that prevent the formation of an attachment bond
• Growing up in environments where forming an attachment bond is difficult (such as an overcrowded institution).

The lack of these essential care conditions is presumed to cause the symptoms described below.

In Reactive Attachment Disorder, the child rarely seeks or responds to comfort when distressed. Additionally, the child exhibits at least two of the following behaviors:

• Minimal response to others socially and emotionally
• Reduced intensity of positive emotions (such as joy)
• Unexplained irritability with adult caregivers.

In Disinhibited Social Engagement Disorder, the child exhibits at least two of the following behaviors:

• Approaches and interacts easily with unfamiliar adults
• Behaves in an overly familiar manner (both verbally and physically)
• Shows little regard for whether their caregiver is nearby
• Willingness to leave with an unfamiliar adult without hesitation.

These behaviors are not impulsive but characteristic of the child's disinhibition.

Sources:

• American Psychiatric Association (2013) - Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
• Bernhill, J. W. (2014) - DSM-5 Clinical Cases.

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