A kiss, a hug, a caress… All of these have something in common: in most cases they are carried out with love , and most of us are awakened by feelings of warmth and affection. Let’s imagine for a moment that we have never received any in childhood. Or that we have, but without any affection or emotion having been manifested in it. Let’s also imagine that we have always felt secondary, unimportant to those close to us. How would we feel? How would we relate to others?

It would not be unusual for this to cause severe limitations, which would mark and hinder our development as people and our social relations. This is what happens to those with reactive attachment disorder . Let’s see what it consists of.

Reactive attachment disorder: main symptoms

Reactive attachment disorder is one of the disorders related to trauma and stress factors . It is also a new disorder included in the latest version of the reference manual of clinical psychology and psychiatry, the DSM 5.

Reactive attachment disorder is characterised by the presence in children over nine months of a pattern of behaviour in which there is a high level of emotional and affective inhibition towards their carers , not seeking and even avoiding contact and comfort in them even when some stimulus or situation occurs that frightens them or causes them pain or restlessness. In general, the subject feels unimportant and unvalued, and does not possess a strong emotional bond with them.

This pattern of inhibition is maintained not only with their caregivers but also at the social level, expressing difficulties in reacting emotionally to the social environment and manifesting with some frequency irritability, sadness or fear of the caregivers even in situations that do not pose a threat to them. It is frequent that they express few positive feelings or emotions in social interaction .

The symptoms described above can be seen before the age of five, and it is important to note that a diagnosis can only be made if the diagnostic criteria for autism are not met. In this sense, it is easy to see some similarity between some aspects of the symptomatology of both disorders , but there are great differences. One of them is the cause, which in the case of reactive attachment disorder has been identified and in fact forms part of its diagnostic criteria.


The causes of reactive attachment disorder, which is a de facto requirement for a diagnosis, are mainly found in insufficient care during the first years of life. The subject has not received enough affection or his emotional needs and care, affection and protection and/or the basic physiological needs have not been met.

It is more common in families where parents have poor parenting skills, or where they tend not to express feelings. It is common in families that are unstructured and do not provide for the child’s basic needs.

It is also possible that domestic violence, whether or not it is physical or directed at the child in question, or sexual abuse, has occurred. However, this does not mean that it cannot take place in families without great difficulties at a socio-economic level, the defining factor being the fact that they have not satisfied or have not been able to satisfy sufficiently the needs for affection, or have been excessively ambivalent in the expression of affectivity towards the subject in question.

Children may also have this disorder who have gone through various changes of primary caregivers (due to custody issues), or those who have been educated in institutions and settings such as orphanages or shelters where their emotional needs have not been sufficiently addressed or time spent. It should be taken into account that the experience of these circumstances does not have to cause a disorder .


The treatment of reactive attachment disorder is complex and requires a multidisciplinary approach in which professionals from psychology, medicine, social work, education and the field can come together.

The subject needs to be able to establish a strong bond with a reference caregiver who provides emotional support . For this reason, subjects with this type of disorder will often benefit from the use of family therapy, not only to treat the subject but also to ensure that appropriate educational guidelines are established in cases where there are deficits in parental skills.

It is essential to work on the emotional component with the child. In this sense, it will be very useful the use of therapies dedicated to strengthen the self-esteem of the subject , as well as training in social skills. Cognitive restructuring will allow for a change in the dysfunctional cognitions that the subject may have with respect to social bonding.

It should also be borne in mind that some cases occur in a context of severe neglect of the child’s needs, with circumstances that even endanger the subject’s life. such as the existence of drug dependency on the part of the parents. In this aspect it may be necessary for a judge to withdraw custody or guardianship either temporarily or permanently.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.