Attachment disorder

From birth, we develop a close bond with our main caregivers (usually our parents). This attachment helps us to learn and develop in a trusting environment, even at such a young age, we know our parents will be there for us.

For some children, however, this bond is not formed. There are a multitude of reasons for this, but typically there is a situation where the caregiver is unable to provide the care and attention required to form a close attachment.

The child may have been abused, neglected or separated from their parents for other reasons. Whatever the cause, the effect of not forming this bond can lead to attachment difficulties and at its worst, a condition called reactive attachment disorder.

In this section, we’ll look at attachment difficulties in more detail, including treatment and attachment disorder in adults.

What are attachment difficulties?

Usually babies develop close bonds to their caregivers by the age of nine months. They have learnt to rely on their parents to provide food, shelter and protection. This gives children the confidence to try new things, learn and cope with new situations.

Babies at this age (between six and nine months) tend to go through a ‘clingy’ stage and don’t like being separated from their parents. This is because of the close bond they’ve formed and because they associate their parents with safety.

These strong and ‘secure’ attachments are not always made, however. In these cases, the security and safety element associated with parents is lost. This can make it difficult for the child to deal with new experiences and form relationships.

Not forming this bond can lead to a set of behavioural and emotional difficulties which can affect development and lead to mental health problems later in life.

Attachment difficulties work on a spectrum. For some the effects are minimal, for others, the effects are emotionally traumatic. There are treatments available however and ways to overcome such issues, even in adulthood.

Who might develop attachment difficulties?

Attachment disorder typically develops by the age of five. Those at high risk of developing difficulties include:

  • children who have suffered abuse
  • children who have been neglected
  • children in the care system
  • children who have been separated from caregivers

These are examples and generally, any situation where caregiver and child are unable to form a bond can lead to attachment difficulties.

Attachment disorder counselling

If attachment issues are left untreated, they can develop into attachment disorder and cause further behavioural problems. For this reason, the earlier attachment concerns are addressed, the better. Having said this, help can be sought at any stage and treatment is available for adults with attachment disorder.

For children, play therapy and/or family therapy is often used. Depending on the situation, psychotherapy looks to strengthen the bond between the child and caregiver while helping the child develop ways to cope with symptoms of attachment difficulties.

For adults who never addressed their attachment difficulties, psychotherapy can be incredibly beneficial. It offers space to explore losses, gain a sense of closure and learn how to create bonds as an adult (if this is a problem). This can all help adults with attachment difficulties build better relationships with friends, partners and their own children.

Attachment disorder symptoms

Like many mental health concerns, attachment problems fall on a spectrum. Some are mild cases that can be more easily addressed, while others may become an attachment disorder.

Recognising the signs and symptoms of insecure attachment can help you take action quicker. Although it’s never too late to seek help, the earlier difficulties are addressed, the less likely it is to develop into attachment disorder.

Below we look at some of the signs your child may have an attachment problem:

Problems expressing anger - Children with attachment disorder may struggle to control and express their anger. They may express it through tantrums and acting out, or use passive-aggressive behaviour. They can also hide anger under socially acceptable behaviours, like hugging too tightly.

Poor eye contact - Difficulty holding eye contact can signify a number of things with children. If seen along with other associated symptoms it could be a sign that the child is struggling with attachment.

A need for control - Often those with attachment difficulties feel a strong desire to be in control. They may go to great lengths to feel in control of situations and can become disobedient and argumentative.

Problems with self-monitoring - Self-monitoring is when we observe our own behaviour (either consciously or subconsciously) and recognise if behaviours need to change. For those with attachment disorder, this can become difficult.

Difficulty showing affection - When the attachment bond to parents is insecure (or not there at all) children often show little to no affection towards their parents.

Seeks affection from strangers - As a child with attachment disorder is/was unable to get ‘enough’ affection from their parents, they may seek it elsewhere. They may, therefore, act inappropriately affectionate towards strangers.

An underdeveloped conscience - Those with attachment disorder can act as if they don’t have a conscience, failing to show remorse or regret after behaving badly.

Two children playing in a field

If the child is very young, you may want to keep an eye out for the following behaviours:

  • Not turning towards their parent/caregiver when scared or upset.
  • Is uncomfortable being comforted or touched.
  • Shows little to no affection towards their parents/caregivers.
  • Doesn’t respond or smile when interacting with adults.
  • Doesn’t get upset in situations where you would expect a child to be upset.
  • Seems withdrawn and avoids interacting with adults and other children.
  • Appears anxious and fearful.
  • Shows aggressive behaviour towards others.

If you suspect attachment difficulties, seeking a diagnosis from a professional should be your next step. Mental health concerns like this are diagnosed based on the signs and symptoms presented.

If attachment disorder symptoms are present, your doctor will likely perform a physical examination. This is to rule out physical illness. If no physical cause can be found, a mental health professional will be required to assess and diagnose. Psychiatrists and psychologists specially trained to help young people can use interview and assessment tools to evaluate the child.

Parenting a child with an attachment disorder is a challenging experience. Of course, providing safety for the child and the rest of the family will be a priority. Families will need ongoing support and education to help overcome challenges with attachment.  

Reactive attachment disorder

Reactive attachment disorder is considered one of the more severe attachment problems. It tends to occur when the child has been abused or neglected.

It is unclear how many children are affected. However, one study carried out by The British Journal of Psychiatry showed 1.4% of children in a deprived area of the UK, aged six to eight were affected.

It is considered a rare condition and not every child who has experienced neglect will develop it. There are various theories on why it occurs, but further research is required to develop a better understanding of the condition.

Within this disorder, there are two subtypes - inhibited and disinhibited. Children with inhibited reactive attachment disorder are very withdrawn and seem emotionally detached. Those with disinhibited symptoms are more likely to seek affection from others, with no preference for their parents.

The signs and symptoms of reactive attachment disorder are similar to general attachment problems:

  • aversion to being touched
  • needing to feel in control
  • difficulty expressing anger
  • an underdeveloped conscience
  • difficulty showing affection

It is possible to prevent reactive attachment disorder if signs are addressed early. If you suspect your child has the condition, be sure to visit a professional for a formal diagnosis.

Before visiting your doctor, it can be useful to do some preparation. Noting down a list of the following can help:

  • Behavioural problems and/or emotional issues you’ve seen.
  • Personal history, e.g. major life changes/stress your family has gone through.
  • Medical history, any medication, vitamins or supplements your child is taking.
  • Any questions you have for the doctor.

Your doctor will ask a number of questions and, after ruling out physical illness, will refer you to a child psychologist/psychiatrist. They will then carry out an assessment. As other conditions can cause similar symptoms (such as depressive disorders and autism), these will be ruled out before a diagnosis is made.

When children with reactive attachment disorder grow older, they tend to fall into having either inhibited or disinhibited symptoms.

Inhibited symptoms

Those with inhibited symptoms will be emotionally detached. They are unlikely to respond emotionally to what’s happening around them, despite them being hyper-aware of what is happening. They will be very withdrawn and have an aversion to being comforted or touched. They may push people away, ignoring them or even acting aggressively. As they get older, they may become physically aggressive to those trying to get close.

Disinhibited symptoms

A child showing disinhibited symptoms will not have a preference for their parents over others (including strangers). They will seek attention from almost anyone and can act inappropriately affectionate with people they don’t know. They may be very dependent and come across younger than their true age. Their behaviours can make them appear chronically anxious.

Although reactive attachment disorder is a serious condition, it’s important to remember that help is available at any stage. Psychotherapy, education and support from professionals for your family are key.

Attachment disorder in adults

Attachment disorder is typically thought to be specific to children and young people. There is, however, a growing understanding that unresolved attachment issues can cause significant problems in adulthood.

When attachment issues aren’t addressed during childhood, adults can be left with resulting struggles. Forming relationships and bonds with others is often the biggest issue. Adults with attachment disorder may become co-dependent or, alternatively, exert a level of hostility that prevents others from getting close. Others may struggle to tune into their emotions. Many will rely on the coping mechanisms they built during childhood, which can leave them isolated as adults.

The good news is that it’s never too late to seek support and treatment is available for adults with attachment problems, too.

Man standing alone on the beach

Common behaviours in adults with reactive attachment disorder

Below we look at some of the behaviours you may see in an adult with attachment problems:

  • difficulty trusting others
  • a need to control their environment
  • anger issues, often lashing out at others
  • impulsive
  • negative thinking, potentially provoking others to feel the same
  • difficulty connecting to others
  • resistance to accepting guidance or advice
  • addictions may become a coping mechanism
  • isolating themselves and withdrawing from social activities

Types of attachment disorder in adults

Depending on the individual and the early experiences they’ve had, adults with attachment problems tend to fall into one of the following categories:

Avoidant

Those in the avoidant category are likely to distrust people and feel a sense of anger. They can lack empathy and shy away from intimacy. They often feel like they can only rely on themselves.

Anxious/ambivalent

Someone in this category may become compulsive in their caregiving. They tend to overinvest their emotions in relationships and may struggle to maintain long-term relationships. A strong desire for contact is common and they may perceive relationships as unbalanced.

Treatment options for adults

Adults with attachment disorder may shy away from seeking help. This can be because they find it difficult to trust others, and therefore worry about talking about themselves to a professional.

If you’re an adult and think you have attachment problems, you may feel more comfortable getting support from a friend or family member when seeking help initially. No matter how long ago you think your attachment problems came about, know that a professional can support you and help you overcome them.

A counsellor may use different techniques to help with this. Working to release mental and emotional blocks is important, as well as rebuilding emotions. Touch therapy and/or role play may be used as part of your treatment, but this will depend on your experiences and the counsellor’s way of working.

Medication isn’t a key part of treatment, however, for those with associated mental health conditions such as depression, medication may be advised.

Supporting an adult with attachment disorder

If you think someone you care about may have attachment problems, try to encourage them to seek help. Often those with attachment disorder don’t realise they have a ‘condition’ and may think they simply are the way they are.

Supporting them and gentle encouragement to start treatment can help them take that vital first step. Having a support network outside of talking therapy improves the chances of success, allowing adults to learn how to form long-lasting and loving relationships.

Associated mental health conditions

If attachment problems aren’t addressed and treated, they can affect a child’s emotional development. This can leave children at greater risk of developing certain mental health conditions as they grow up.

This won’t happen in every case, but attachment disorder becomes a risk factor. It is therefore always advised to seek help as early as possible.

Below we look at some mental health conditions and emotional problems that can occur as a result of attachment disorder:

Depression

Having a sense of abandonment and isolation at a young age can be linked to the development of depression later in life. The child may grow up to feel anxious about being alone and uncomfortable in social settings. This continues the sense of isolation and can turn into anxiety and/or depression.

Read more about depression in children.

Aggressive/disruptive behaviour

Children with attachment disorder often learn that they can only depend on themselves. This makes them untrusting of others. As the child grows up this can translate into a lack of trust in authority figures like teachers.

Read more about childhood behavioural problems.

Learning difficulties

As children, one of the key ways we learn is through the loving attachment we form with our caregivers. Having this attachment makes us feel safe when we learn new things. Without this bond, it can make learning more difficult.

Read more about learning difficulties and learning disabilities.

Inability to form meaningful relationships

Forming relationships at a young age with our parents is one of the key ways we learn about relationships and how to form bonds. If this relationship isn’t there, for whatever reason, it can be confusing for the child growing up. They may struggle to form relationships, both platonic and romantic.

Read more about relationship issues.

Low self-esteem

Children who don’t form attachments to their parents can feel abandoned, regardless of whether or not actual abandonment took place. This can lead to feelings of worthlessness and low self-esteem. Such feelings can have a big impact on a child’s mental well-being.

Read more about low self-esteem.

Substance abuse

Children who don’t form attachments (and especially those who have been neglected) can fall into the habit of self-soothing. As they grow up, this habit may continue through the use of alcohol or drugs. If the child’s parents have substance addictions too, this may increase the risk of developing an addiction.  

Read more about addictions.

Social difficulties

Those with attachment difficulties may find it difficult to socialise. They may find it hard to understand other people and be wary of them. This can lead to social anxiety.

Read more about anxiety.

Treating attachment difficulties early is the best way to lower the risk of these problems developing in later life. Help is available at every stage though - if you believe you or your child have developed further mental health problems, remember it is never too late to seek help.

Everyone has mental health and we all have our different struggles. Speaking to a professional and treating your family’s mental health as seriously as you would your physical health is important. 

Treatment options for attachment disorder

In terms of treating attachment disorder, there are usually two aims. The first is to ensure that the child in question, and the rest of the family, are safe. This is key if abuse or neglect is the cause of attachment disorder. The second aim is to encourage the child to form a healthy and loving bond with an appropriate caregiver and help to manage residual concerns.

Each case will be different and will, therefore, require different approaches, but often psychological therapy and parental education are involved. While children with attachment disorder may find it more difficult to form attachments, it is entirely possible with the right support.

Once the family’s safety has been assured (if this has been necessary) the following options may be recommended.

Family therapy

Depending on the circumstances, it is typical for therapies to include both the child and parents. Family therapy looks to help the child form a bond with their parents and teach parents how they can aid the child’s recovery. Positive interaction through games and activities is encouraged.

Play therapy

Play therapy is a helpful way to make learning fun and hold attention. Through play therapy children can also learn important social skills they may lack. This approach is especially useful if children struggle to express themselves or are withdrawn.

One-to-one counselling

In some cases, individual counselling with the child may be recommended. The therapist may want to see the child’s behaviour when they are separated from their parents to monitor more accurately. Parents may be able to observe, out of sight.

Parenting skills classes

Educating parents or caregivers about attachment disorder is key. As well as education about the disorder itself, further parenting skills may be learnt to ensure the child progresses well.

Cognitive behavioural therapy (CBT)

For slightly older children, CBT may be recommended. This is a type of talking therapy that can help people come to terms with what’s happened to them in the past and develop healthy coping mechanisms.

Medication

Medication is not usually prescribed for attachment disorder itself, however, if the child is suffering related symptoms (such as anxiety, depression or sleeping difficulties), medication may be offered. Discussing all medical options with your doctor is advised.

Family together speaking with a professional

How to help your child during treatment

As a parent, it can be very difficult emotionally taking care of a child with attachment disorder. Rebuilding this bond (or building it from scratch if you are adoptive parents) can take time and requires patience.

Getting guidance from professionals is recommended, but keeping the following in mind while your child is receiving treatment can help.

Celebrate the successes - Try to be realistic with your expectations and know the process will take time. Focusing on moving forward and celebrating every success, no matter how small, will keep up the momentum and inspire positivity.

Keep calm when setbacks happen - There may be bumps in the road during the process, but remaining calm during this helps to create a safe and secure atmosphere. You will be reassuring your child that it’s OK for things not to go perfectly and that you can overcome setbacks.

Look after yourself - You won’t be fit to look after others if you don’t first look after yourself. Try to keep stress levels low and factor in plenty of self-care - get enough sleep, eat well and exercise. Being a pillar of strength and calm sets an example.

Create a support network - Support from professionals is key, but also look for support from friends, family members and even through support groups. It can help to talk to other parents who have similar experiences.

Set boundaries - For children with attachment disorder, having consistent and loving boundaries can help to make the world less scary. Setting limits also help to instil a sense of control.

Be there after conflict - When conflict happens, remain calm and be readily available to reconnect after. This reinforces your love and consistency, showing them that you will be there for them no matter what.

Make amends - Being willing to make amends and owning up to mistakes you may have made during conflict can help to strengthen trust and your attachment bond.

Keep a routine - Consistency and familiarity are key for those with attachment disorder, offering a sense of security and comfort. If changes in routine do occur, explain why these have happened and look to keep other elements consistent.

Help your child feel loved - Spending time with your child helps them feel safe and secure. Ensure you are dedicating a good amount of time playing, talking and listening to your child. Consistency is key.


What should I be looking for in a counsellor?

Whilst there are currently no official rules or regulations in place that stipulate what level of training a counsellor needs when dealing with attachment disorder, it is recommended that you check to see if your therapist is experienced in this area.

While some aspects of counselling remain the same regardless of age, there are certain issues and developmental intricacies that often require an alternative approach when it comes to counselling children.

A Diploma level qualification (or equivalent) in child/youth counselling or a related topic will provide assurance and peace of mind that your counsellor has developed the necessary skills.

Another way to assure they have undergone this type of specialist training is to check if they belong to a relevant professional organisation representing child/youth counsellors or those dealing with attachment disorder.

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