The current consensus on Reactive Attachment Disorder
July 11, 2013 7:00 AM Subscribe
What is the current consensus on Reactive Attachment Disorder in adults?
The online information I have found on it doesn't seem particularly reliable or credible, but the described symptoms do seem straightforward and logical. It would seem that any child with the disorder, or the characteristics commonly associated with the disorder and a history of childhood abuse/abandonment/instability, would continue to struggle with it as adults especially in the form of relationships, but there seems to be controversy about being diagnosed as an adult, and the diagnosis in children seems to be perceived as oppressive or abusive in itself from what I have read.
Is it ultimately considered a form of quackery? What are the main controversies? When did RAD come on the scene as an 'official' thing, and is there any rigorous research on adults who fit the diagnosis?
The online information I have found on it doesn't seem particularly reliable or credible, but the described symptoms do seem straightforward and logical. It would seem that any child with the disorder, or the characteristics commonly associated with the disorder and a history of childhood abuse/abandonment/instability, would continue to struggle with it as adults especially in the form of relationships, but there seems to be controversy about being diagnosed as an adult, and the diagnosis in children seems to be perceived as oppressive or abusive in itself from what I have read.
Is it ultimately considered a form of quackery? What are the main controversies? When did RAD come on the scene as an 'official' thing, and is there any rigorous research on adults who fit the diagnosis?
Response by poster: One further question: It seems that not every individual would end up as an empathy-less psychopath/sociopath, and that some would just end up with severe relationship problems (chasing away intimacy that is actually deeply desired, isolating from people even when that is not the desired result, and things like that.) There would seem to be a range. Or is RAD always considered in its most extreme form?
posted by thegreatfleecircus at 7:13 AM on July 11, 2013
posted by thegreatfleecircus at 7:13 AM on July 11, 2013
As a former child ward of the state, I can tell you that kids in the system are moved around at least once a year until either parental reunification takes place or the kid get adopted.
This type of diagnosis is made to allow children to be pacified with anti-psychotics. The children are upset because they don't know who takes care of them, or who will take care of them. To me, Reactive Attachment Disorder is an example of institutional failure from the child protection regency, and a fantastic example of why I'm glad that the National Institute of Mental Health dropped support for the Diagnostic and Statistical Manual of Mental Disorders earlier this year.
I am not a psychologist or psychiatrist; just a person that once lived with a five year old diagnosed with a personality disorder.
posted by oceanjesse at 7:24 AM on July 11, 2013 [9 favorites]
This type of diagnosis is made to allow children to be pacified with anti-psychotics. The children are upset because they don't know who takes care of them, or who will take care of them. To me, Reactive Attachment Disorder is an example of institutional failure from the child protection regency, and a fantastic example of why I'm glad that the National Institute of Mental Health dropped support for the Diagnostic and Statistical Manual of Mental Disorders earlier this year.
I am not a psychologist or psychiatrist; just a person that once lived with a five year old diagnosed with a personality disorder.
posted by oceanjesse at 7:24 AM on July 11, 2013 [9 favorites]
RAD is the extreme form.
Other people just have garden variety attachment disorders or personality disorders. I'm not at home right now so I can't look it up but we learned about a specific disorder that isn't as bad as RAD but results in superficial relationships since the person will drop friends as soon as it becomes "difficult." Finally you might be asking about a disorganized attachment style which is a mix of avoidant and anxious and commonly associated with abusive home environments but does not mean the individual is a psychopath.
posted by St. Peepsburg at 7:58 AM on July 11, 2013 [2 favorites]
Other people just have garden variety attachment disorders or personality disorders. I'm not at home right now so I can't look it up but we learned about a specific disorder that isn't as bad as RAD but results in superficial relationships since the person will drop friends as soon as it becomes "difficult." Finally you might be asking about a disorganized attachment style which is a mix of avoidant and anxious and commonly associated with abusive home environments but does not mean the individual is a psychopath.
posted by St. Peepsburg at 7:58 AM on July 11, 2013 [2 favorites]
In our family, we had a tentative RAD diagnosis that has been replaced with a confirmed Axis 2 mood disorder with borderline traits, previously known as Borderline. There was a lot of reluctance to diagnose a personality disorder before the age of 18, we were told because children change so much. We pushed for legal reasons relating to access to medical care.
Our experience personally and with friends who have kids diagnosed with RAD is that it depends on your psychiatrist entirely. We have had doctors who resisted any labels, and doctors who preferred labels, especially if they'd treated someone with RAD before. It seemed less permanent a diagnosis than a personality disorder, which psychiatrists don't want to give to children.
I know families with kids diagnosed with RAD who have gone on to an adult diagnosis of Axis 2 and others diagnosed with autism spectrum later on, and kids who outgrew it with therapy. Adoption and fostering in the child's background make an RAD diagnosis come through faster, but any severe neglect early on could cause it. I think it exists, but is more of a description of an adaptation to trauma like PTSD than a condition.
posted by viggorlijah at 8:08 AM on July 11, 2013
Our experience personally and with friends who have kids diagnosed with RAD is that it depends on your psychiatrist entirely. We have had doctors who resisted any labels, and doctors who preferred labels, especially if they'd treated someone with RAD before. It seemed less permanent a diagnosis than a personality disorder, which psychiatrists don't want to give to children.
I know families with kids diagnosed with RAD who have gone on to an adult diagnosis of Axis 2 and others diagnosed with autism spectrum later on, and kids who outgrew it with therapy. Adoption and fostering in the child's background make an RAD diagnosis come through faster, but any severe neglect early on could cause it. I think it exists, but is more of a description of an adaptation to trauma like PTSD than a condition.
posted by viggorlijah at 8:08 AM on July 11, 2013
Certainly it can be misdiagnosed or misused but to see what RAD "really" looks like, you can check out "Child of Rage", an excellent documentary about a young girl who was diagnosed with RAD and successfully rehabilitated using controversial techniques called "attachment therapy" which include the "holding" aspect. Basically they try to "break" the kid back down into a more helpless state and then "build" them up again to see themselves as lovable and good people, and to identify with their own goodness instead of projecting their self-hatred onto others. (This projection of self-hatred and bad feelings is why they then try to harm their caregivers, in a misguided attempt to relieve their own pain.) But this therapy is HIGHLY controversial as some kids died in foster care as a result of this "holding" therapy. (From the same woman who rehabilitated the little girl from the documentary.)
posted by St. Peepsburg at 9:21 AM on July 11, 2013 [4 favorites]
posted by St. Peepsburg at 9:21 AM on July 11, 2013 [4 favorites]
I recall a colleague mentioning this in passing as it is something she says the children she works with have been diagnosed with. When I asked her how it was different than traditional personality/attachment disorders she couldn't explain. I didn't think to follow up with a literature review, but my first thought was "is this some new Dr.Phil bullshit disorder?"
A brief research on the local EBSCO server returned quite a bit of peer-reviewed research on the subject in fairly reputable journals since the early 2000s, primarily regarding children and adolescents that have been neglected/abused/abandoned and etc. I was not able to locate a review of the literature on RAD more recent than this (again, brief search), but the article below may be a good starting point for your questions.
"Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment Implications." Hardy, Lyons T. Journal of Child & Adolescent Psychiatric Nursing. Feb2007, Vol. 20 Issue 1, p27-39. 13p
I was not able to find much on RAD in adults, but the article suggests that such studies do exist, and has a few citations if you are curious.
posted by Young Kullervo at 10:54 AM on July 11, 2013 [1 favorite]
A brief research on the local EBSCO server returned quite a bit of peer-reviewed research on the subject in fairly reputable journals since the early 2000s, primarily regarding children and adolescents that have been neglected/abused/abandoned and etc. I was not able to locate a review of the literature on RAD more recent than this (again, brief search), but the article below may be a good starting point for your questions.
"Attachment Theory and Reactive Attachment Disorder: Theoretical Perspectives and Treatment Implications." Hardy, Lyons T. Journal of Child & Adolescent Psychiatric Nursing. Feb2007, Vol. 20 Issue 1, p27-39. 13p
I was not able to find much on RAD in adults, but the article suggests that such studies do exist, and has a few citations if you are curious.
posted by Young Kullervo at 10:54 AM on July 11, 2013 [1 favorite]
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posted by St. Peepsburg at 7:06 AM on July 11, 2013 [1 favorite]