Criteria for the Diagnosis of Reactive Attachment Disorder (DSM-5)

By Leah S. Robbins, Ph.D.

This article is copyrighted and posted with permission of the author.

 

Reactive Attachment Disorder occurs when infants or children have not been able to form healthy bonds with at least one caregiver before age 5 and present after 9 months of age. The disorder is considered persistent when symptoms are present for more than 12 months. The disorder is specified as severe when a child exhibits all symptoms of the disorder at relatively high levels. The signs and symptoms listed in the DSM-5 are:

• A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
• The child rarely or minimally seeks comfort when distressed.
• The child rarely or minimally responds to comfort when distressed.
• A persistent social and emotional disturbance characterized by at least two of the following:
• Minimal social and emotional responsiveness to others.
• Limited positive affect.
• Episodes of unexplained irritability, sadness, or fearfulness that are evident even during nonthreatening interactions with adult caregivers.

According to the DSM-5 criteria, this develops as a direct result of parenting that either did not meet the child’s basic needs such as abusive or neglectful environments, or not having a stable caregiver to attach to:

• The child has experienced a pattern of extremes of insufficient care as evidenced by at least one of the following:
• Social neglect or deprivation in the form of persistent lack of having basic emotional needs for comfort, stimulation, and affection met by care giving adults.
• Repeated changes of primary caregivers that limit opportunities to form stable attachments (e.g., frequent changes in foster care).
• Rearing in unusual settings that severely limit opportunities to form selective attachments (e.g., institutions with high child-to-caregiver ratios).
• The criteria are not met for autism spectrum disorder.

Reactive Attachments will have a serious impact on the children’s future mental health and relationships throughout their lifetime if they don’t receive treatment.

References

Reactive attachment disorder of infancy or early childhood. In: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC, American Psychiatric Association, 2013.