Last week I spoke about Avoidant Personality Disorder, a disorder characterized by the “he loves me, he loves me not syndrome.” The individual lives a life of perpetual distrust and yet has a desire to connect with another person. The disorder, treatment, and cause(s) are complicated. For youngsters, however, treatment often includes counseling and parent education. Sadly, most research remains unclear on the cause of Avoidant Personality Disorder, but some research points to the infant and child disorder Reactive Attachment Disorder (RAD) as being the beginning of many woes.
Reactive Attachment Disorder (RAD) is characterized by impoverished emotional and relational bonds or attachments to the most important people in one’s life during childhood, that is, parental figures or caregivers. Children most frequently diagnosed with RAD include children who have been in orphanages, institutions for mental health, or foster care agencies. The disorder includes an inability to develop appropriate emotional bonds with adults as a result of an early life experience of negative experiences or lack of human connection. For example, children in orphanages who are rarely held or spoken to often develop symptoms of RAD. Reactive attachment disorder is a reare condition, but when it does occur, treatment is often complicated. It is a lifelong challenge and process of teaching the individual to trust others and increase self-esteem.
RAD is also the result of not having basic needs for nurturing, affection, food, shelter, communication, etc. met during the early years. Most children who have been severely abused, neglected, or traumatized are often diagnosed with RAD. In many foster care cases, a child may find it difficult to develop appropriate bonds with the foster parent/family as a result of extreme neglect or abuse during the early years. This child may become a “problem” for a foster family and end up back in foster care for another family to take on the stress. A new foster family may find it even more difficult to develop healthy attachments with this child. In such situations, a child is re-routed through the foster care system multiple times. Not only will the frequent change in foster families further damage the child, but so too will the inability to develop healthy relationships with caregivers or foster families.
Some children with RAD develop into teenagers with PTSD (post-traumatic stress disorder), severe anxiety disorders, and even depression. There are two specific types of responses that children with RAD exhibit:
- Inhibited: a child with inhibited personality traits often refrains from developing emotional bonds with others and tends to shun relationships. Consider my discussion on Avoidant Personality Disorder from last week. A child may also exhibit signs of liking you and trusting you one moment, and disliking and not trusting you another moment.
- Dis-inhibited: a child with disinhibited personality traits often searches for love, approval, and affection from anyone, including strangers. This is the child who may ask to sit on a strangers lap, ask for a hug from a stranger, or might become too trusting too soon. Some youngsters, especially teens may desire a romantic relationship with a teacher, therapist, or other adult and fantasize about the possibility. Stricter boundaries with compassion are very much needed in such cases.
Children with RAD may develop controlling tendencies that lead to anger management difficulties, substance abuse, or delinquency. Unfortunately, many youths cling to gangs or marginalized groups of young people who engage in delinquent behaviors. Most find their “approval” in gangs or in relationships that are emotionally stormy or entirely “unavailable.”
There are various possible causes of RAD, but a few include:
- Living in institutions, residential centers, hospitals, foster care institutions, or orphanages for long periods of time
- Parental mental illness, anger management issues, or substance abuse
- Postpartum depression in new mothers
- Abuse: sexual, emotional, physical, psychological
- Neglect or extreme poverty
- Inexperienced parental care
- Frequent changes in caregivers, parents, or guardians
Both avoidant personality disorder and reactive attachment disorder have similar etiologies. Most research points to an unhealthy attachment or lack of healthy bonds with parental figures or guardians during the early years.
As always, feel free to share your comments and experiences.