Reactive attachment disorder

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Reactive attachment disorder of infancy and early childhood

This term denotes a syndrome starring before the age of 5 years and associated with grossly abnormal care-giving. There are two subtypes: inhibited and disinhibited. Children in the first subgroup may show a combination of behavioral inhibition, vigilance, and fearfulness, which is sometimes called frozen watchfulness. These children are miserable, difficult to console, and sometimes aggressive. Some fail to thrive. Such behavior is seen among children who have been abused. Children with the disinhibited subtype of the disorder relate indiscriminately to people, irrespective of their closeness, and are excessively familiar with strangers. Such behavior has been described most clearly in children raised in institutions. In DSM-IV, the diagnosis is made when the disturbance of relationships appears to be a direct result of abnormal care-giving. ICD-10 does not use this criterion but requires that the behavior is present in several situations.

Cause of Reactive attachment disorder

It seems that these syndromes are characteristic of the type of care-giving (abusive or institutional) rather than of the child. Insecure attachment in infancy is often followed by conflicts with care-givers and impulsive behavior later in childhood. Nevertheless, considerable improvement can occur if the child experiences a secure attachment to a care-giver, for example, as a result of fostering or adoption. (These observations have not been made specifically in relation to attachment disorder as defined in ICD-10 and DSM-IV.)

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