What are the 4 types of attachment disorders? The more we understand about children who have experienced a break in attachment in the early years of life, therapists have learned that attachment issues are more complex than is currently defined.
Attachment disorder is currently diagnosed as Reactive Attachment Disorder (RAD) or Disinhibited Social Engagement Disorder (DSED). Yet for those of us living with children who struggle to maintain healthy relationships, these criteria are often not accurate or do not go far enough in distinguishing the patterns of behavior.
4 Categories of Attachment Disorder in Children and Teens
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Lawrence B. Smith of Attachment Disorder Maryland, along with the work of Elizabeth Randolph, Ph.D., has proposed that Attachment Disorder is a spectrum or continuum. (See also Psychalive.org, Psychologytoday.com, Mayo click on Attachment Disorder, and Psychcentral.com for discussion of these types of attachment issues, including affects into adulthood.)
The following 4 categories are proposed diagnoses or clusters of attachment disorder:
- Anxious Attachment Disorder
- Avoidant Attachment Disorder
- Ambivalent Attachment Disorder
- Neurologically Disorganized Attachment Disorder
According to Lawrence Smith, children with attachment disorder can attach but they cannot maintain it across time because they lack self and object constancy, or have a false sense of self.
Children with milder forms may be described as having attachment issues or attachment insecurities (the most mild form would be a child with separate anxiety), with the most severe being a child with attachment disorder.
What If My Child Needs Residential Treatment?
When a child’s behavior becomes dangerous to himself or others, treatment outside of the home is considered as a last (but sometimes necessary) resort. This can include in-home hospitalization, residential treatment centers, wilderness programs, and other options.
For Parents of Children with Attachment Issues
The information presented on this website is informative only and not for treatment or diagnosis. Consult with a qualified professional.
As a fellow parent who is raising children who have experienced trauma, allow me to offer you a word of caution before you read the following information.
Information is power but it is never a replacement for what you know best — your child. Information like this is helpful in understanding our children’s perspective, but it can also become a negative projection.
Never allow these descriptions to supersede the good you know is in your child.
Your child needs you to believe the best in him, even when no diagnosis says it is true. You as the parent must believe in and see the good.
Be his champion.
Listed below is a summary. Please go to Attachment Disorder Maryland for a full description of each of these disorders.
Anxious Attachment Disorder
Description: Children with this style of attachment feel extreme anxiety connected to abandonment. Parents may have left the child or ignored the child in favor of a sibling. They have a terrifying inner emptiness. These children appear at first to relate emotionally to others. Attention from others helps to confirm their existence. When attention is gone, they feel they are fading away. They seek physical closeness as a treatment for the terror, rather than an actual desire to be close to other people in a meaningful way.
- impression management
- whining and complaining
- baby talk
- ADHD type hyperactivity
- manage adults into liking them vs actually having close relationships
- lie often and highly proficient at it (will lie about lying)
- rarely express thoughts as truly their own
- devote hyper vigilant skills to determining what others want from them (“What do you want me to say?”)
- typically deceive adults outside the home
- behaviors vary dramatically depending on who they are with
- sometimes do well in school by getting teachers to like them
- intrusive, conversationally and in personal space
- may buy friendships with treats and money
- requires vigilant and highly skilled therapy to get past the facade
Recommended Parenting Strategies for Parents or Caregivers of a Child with Anxious Attachment Disorder
Here are some helpful strategies if you parent a child with anxious style of attachment.
- Seek therapy from a therapist qualified to treat attachment disorder.
- Teach child the appropriate way to request conversation with you instead of constantly interrupting.
- Do not allow non-stop talking or asking questions. See this post for help with kids who ask too many questions.
- Research Sensory Processing Disorder and incorporate methods as helpful.
- Engage child in activities that calm the body, such as swimming, yoga, and martial arts, which also helps calm the mind.
- Set realistic but high expectations. Do not give in to behaviors or allow a child to not complete life requirements due to anxiety.
Recommended Therapy for Children with Anxious Attachment Disorder
Here is a guide to seeking proper treatment for children with anxious attachment, both young children, school age and teens.
- Seek help from a qualified attachment therapist. Many therapist understand anxiety in children, but few are qualified to see the underlying attachment reasons, which is critical to successful therapy.
- Therapy must go past the surface level anxiety and work on the core attachment issues.
- The child must be gently led to more challenging activities to overcome anxiety.
- Too much empathy and support, too soon, can halt therapeutic progress.
Avoidant Attachment Disorder
Description: Children with Avoidant Attachment Disorder feel predominant sadness related to emptiness and loneliness. They see their sadness as unending and go to great lengths to avoid expressing it, to the point that they often do not think they are sad. Avoidant children feel anxious and rarely relax so that the sadness does not creep up on them. They remain hyper vigilant and avoid physical and emotional closeness that might trigger the sadness. These children perceive adults efforts to be close as malicious.
- tasks are done slowly
- promises are broken
- speech is sprinkled with unintelligible muttering
- stiffen when touched and do not like physical contact (like hugging a board)
- pull away when touched or say it itches or hurts
- touching may result in physical aggression
- may complain of continual headaches, stomachaches, etc.
- overreact to minor cuts, bruises
- push away friendships or friends are years younger
- openly hostile when pushed into relationships
- therapy requires accessing the deep sadness and may require physical touch with parents to find it
Recommended Parenting Strategies for Parenting a Child with Anxious Attachment Disorder
Here are recommended parenting strategies for parenting a child or teen with anxious attachment disorder.
- Seek therapy from an attachment therapist.
- Do not respond to speech that is unintelligible.
- Allow natural consequences to broken promises, even if very painful.
- Find ways to promote physical touch on your terms. This can be through sports, sitting together on the couch watching TV, rubbing lotion on hands or back.
- “Call out” passive aggressive behaviors.
- Remember that defiance and over-confidence is to try to hide a deep sadness and depression.
Recommended Therapy for Children and Teens with Avoidant Attachment Disorder
In order for therapy to be successful, the following must occur.
- Treatment must be provided by a therapist who understands attachment disorder.
- Therapy must seek to get to the root sadness, not just deal with the external behavior.
- Therapy that only focuses on the passive-aggressive behaviors, will not be successful to providing healing.
- As therapy progresses, children may become depressed or even suicidal as deep sadness is accessed.
Ambivalent Attachment Disorder
Description: For children with Ambivalent attachment disorder, the primary emotion is rage. These children are openly angry — verbally, behaviorally. This sub type is most interested in fire, gore, and death and least developed in terms of conscience.
- direct aggression
- not passive aggressive — overtly oppositional and demanding
- destroy own and other’s property
- carry potential to hurt animals and other children
- understand impact of their behavior but are indifferent
- verbally threatening. Carry through depends on their assessment of their own danger level
- derive excitement from risk-taking behavior and do not understand danger involved
- often misdiagnosed as Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD)
- operate on a scarcity model – “what is wanted should be taken”
- other people are to be exploited and their feelings are irrelevant
- Incapable of truly giving or receiving affection
- do not withdraw from touch, but it is meaningless
- friendships are short-lived
- untreated, have sociopathic or psychopathic potential
- academic underachievers
Recommended Parenting Strategies for Parenting a Child with Ambivalent Attachment Disorder
Here are parenting techniques for parenting a child with or youth with Ambivalent Attachment.
- Safety is critical. Each family should have a safety plan in place.
- The child should be supervised with line of sight supervision around children and animals at all times.
- Seek therapy from a qualified therapist who understands attachment.
- Keep an ongoing record of treatments and behaviors, as this may be required later to seek funding for in-patient or residential treatment. Click here for more help on in-patient treatment for children with mental health issues and click here for help on getting residential treatment for a child.
- Children with this disorder may need to live outside of a family setting due to safety concerns.
Recommended Therapy for Children and Teens with Ambivalent Attachment Disorder
- Therapy must be provided by a therapist who understands attachment issues.
- First focus is on safety concerns and safety planning.
- Therapist may provide assistance in seeking a higher level of care, such as residential treatment.
Neuorologically Disorganized Attachment Disorder
Description: The primary emotion of children with Neurologically Disorganized attachment is anxiety that is chaotic. This leads to highly disordered thinking that is illogical and at times hard to follow. Speech can be erratic with odd arrangements of words and sentences, although the child does not recognize the unusual patterns.
With this diagnosis, there is some neurological impairment present. Attachment difficulties are viewed as secondary to the neurological factor rather than the primary, making it different from the first 3 disorders. Children with this diagnosis are susceptible to disregulation on multiple levels.
Some of the common reasons for a Neurologically Disorganized Attachment Disorder:
- Fetal alcohol exposure
- Fetal drug exposure
- significant prematurity
- grossly negligent/abusive pre- or post- natal care
- untreated postnatal injuries or illnesses
- genetic inheritance
- auditory hallucinations (hearing voices)
- unpredictable behavior
- learning difficulties
- unusual speech patterns
- behavior doesn’t relate to situation at hand
- bizarre behaviors
- problem behaviors shift in form
- child feels remorse afterwards
- excessively friendly with strangers
- oblivious to boundaries
- therapy focuses on minimizing the time between melt-downs to allow the child’s nervous system to settle and regulate
Recommended Parenting Strategies for Parenting a Child with Neuorologically Disorganized Attachment Disorder
Here are helpful parenting techniques for parenting a child or teen with Neuorologically Disorganized attachment.
- Seek help from a therapist qualified to treat attachment disorders.
- Teach physical boundaries and enforce them consistently.
- Support friendships and supervise child to help the child successfully interact with others.
- Maintain a consistent routine.
- Maintain a structured home environment.
- Research Sensory Processing Disorder and implement regulation techniques.
- Treat other medical conditions.
Recommended Therapy for Children and Teens with Neuorologically Disorganized Attachment Disorder
When looking for therapy for a child or youth with Neuorological disorganization, consider the following.
- Therapist must understand attachment issues.
- Focus on calming rages in order to help the mind and body regulate.
- Consider anti-psychotic medication.
What Are the Two Types of Reactive Attachment Disorder?
There are two main types of reactive attachment disorder: inhibited and disinhibited. Not much research has been done on the signs and symptoms of this disorder beyond early childhood, however as children grow older they may develop either inhibited or disinhibited behavior patterns.
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FAQ about Attachment Disorder
Here are answers to commonly asked questions about Attachment Disorder in teens and children.
What are the different types of Attachment Disorder?
Currently the official 2 types of attachment disorder that can be diagnosed are Inhibited Attachment Disorder and Disinhibited Attachment Disorder. However, many experts and parents identify with other additional categories, such as anxious attachment, avoidant attachment, ambivalent attachment, and neurologically impaired attachment disorders.
Does Attachment Order Get Better or Go Away on Its Own?
No. Attachment disorders of all types require proper treatment from a skilled attachment therapist.
Can Attachment Disorder Be Cured?
Attachment disorders are serious diagnosis with life-long consequences. Children and adults can make tremendous strides with proper treatment. Many children with attachment disorders do become successful adults. But looked at critically, the reality is that many children with attachment issues grow up to suffer life-long mental health and behavioral challenges.
At What Age Does Attachment Disorder Occur?
Attachment Disorder begins during the first 3 years a life when a child has a trauma or is neglected. Some symptoms and behaviors may not present until the child is older. Children and adults who have a healthy attachment in early life do not later develop attachment disorder.
Can Attachment Disorder Occur with Other Disorders?
Yes. Children with RAD (Reactive Attachment Disorder) or Attachment issues can also develop other mental health issues, be developmentally or intellectually challenged, or have Autism.
Can Adults Have Attachment Disorder?
Yes, adults who did not receive proper treatment as children, and had trauma or neglect (attachment trauma) during their first 3 years of life, may have attachment disorder. Seek treatment from a therapist qualified in attachment issues.
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