Signs and Causes of Attachment Issues

What Are Attachment Issues?

An attachment disorder is a condition that affects mood or behavior and makes it difficult for people to form and maintain relationships with others. These conditions usually begin in early childhood, but attachment issues may also persist into adulthood.

Most infants develop secure emotional attachments to their caregivers at an early age. They show healthy anxiety when their caregiver is absent, and they show relief when they’re reunited. Some infants develop attachment disorders because their caregivers do not meet their needs. These babies are unable to bond with their caregivers, and they struggle to develop any type of emotional attachment.

Secure vs. Insecure Attachments

There are two primary attachment styles that can result from early childhood experiences with parents and caregivers: secure and insecure attachments.

Secure Attachments

Repeated positive experiences with a caregiver help infants develop a secure attachment. When an adult responds to a baby’s cries with feeding, changing, or comfort, the baby learns they can trust the adult to keep them safe and care for their needs.

Children who are securely attached tend to form better relationships with others and solve problems more readily. They are willing to try new things and explore independently and have less extreme responses to stress.

Insecure Attachments

Infants who experience negative or unpredictable responses from a caregiver may develop an insecure attachment style. They may see adults as unreliable and they may not trust them easily. Children with insecure attachments may avoid people, exaggerate distress, and show anger, fear, and anxiety. They may refuse to engage with others.

Signs of Attachment Issues

Signs that a child may have an attachment disorder include:

• Bullying or hurting others
• Extreme clinginess
• Failure to smile
• Intense bursts of anger
• Lack of eye contact
• Lack of fear of strangers
• Lack of affection for caregivers
• Oppositional behaviors
• Poor impulse control
• Self-destructive behaviors
• Watching others play but refusing to join in
• Withdrawn or listless moods

Attachment disorders that emerge in childhood can continue to affect a person's relationships in adulthood. However, the exact attachment styles people experience in childhood do not always directly correlate to attachment patterns in adulthood.

Diagnosing Attachment Disorder

A pediatrician or psychologist will conduct an examination to diagnose an attachment disorder in children. This evaluation may include:

• Interviews with caregivers about the child's symptoms
• Direct observations of the child's interactions with caregivers
• A history of home and family life since birth
• An evaluation of parents and caregivers to assess parenting styles and practices

A doctor may also conduct a physical exam, run lab tests, and use other psychiatric assessments to rule out any medical or mental health conditions contributing to symptoms.

A doctor or psychiatrist will utilize the diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to determine if a child has an attachment disorder.

The DSM-5-TR does not recognize attachment disorders in adults. However, if you believe that attachment issues are affecting your ability to form healthy relationships or if you are experiencing other mental health symptoms, talk to your doctor or mental health professional. They can provide an accurate diagnosis and recommend treatment options that can help.

Causes of Attachment Issues

Attachment issues can arise for a number of reasons, but they are typically rooted in childhood experiences. Inconsistent or neglectful caregivers, for example, may play a part in attachment disorders in childhood as well as attachment issues in adulthood.

Some children develop attachment disorders while others living in the same environment don’t. But researchers agree there is a link between attachment disorders and significant neglect or deprivation, repeated changes in primary caretakers, or being reared in institutional settings. 

Some other possible risk factors for attachment disorders include:

• Abuse (physical, emotional, or sexual)
• Caregivers with poor parenting skills
• Parental anger issues
• Parental neglect
• Parents with psychiatric conditions
• Prenatal exposure to alcohol or drugs
  

Attachment disorders are fairly rare in the general population. Children in foster care or children who have been institutionalized are at the greatest risk. Populations most at risk include:

• Children who have had many different foster care providers
• Children who have spent time in an orphanage
• Children who have experienced multiple traumatic events
• Children who were taken away from a primary caretaker after forming a healthy bond
  

Related Conditions

Children with attachment disorders are likely to struggle academically, socially, emotionally, and behaviorally. They are at a higher risk of developing legal issues during adolescence as well. Children with attachment disorders tend to have lower IQs, and they are at a higher risk of having language problems.

They’re also more likely to have psychiatric disorders. A 2013 study that examined children with attachment disorders found that:

• 52% had attention-deficit hyperactivity disorder (ADHD)
• 29% had oppositional defiant disorder (ODD)
• 29% had conduct disorder
• 19% had post-traumatic stress disorder (PTSD)
• 14% had an autism spectrum disorder
• 14% had a specific phobia
• 1% had a tic disorder
  

Link to Personality Disorders in Adulthood

Children don’t grow out of attachment disorders on their own. Their symptoms may shift as they grow older, but if left untreated, they are likely to continue to have ongoing problems into adulthood, including difficulty regulating their emotions.

Attachment disorders may also be linked to psychopathic traits. A 2018 study found that children with attachment disorders were more likely to exhibit callous and unemotional traits. While there is evidence the two are linked, there’s no proof that attachment disorders cause an individual to develop antisocial personality disorder.

Types of Attachment Disorders

The Diagnostic and Statistical Manual of Mental Disorders recognizes two distinct attachment disorders: disinhibited social engagement disorder and reactive attachment disorder. These conditions are often recognized around a child’s first birthday. The earliest warning signs often include failure to thrive or disinterest in interacting.

Disinhibited Social Engagement Disorder

A classic sign of disinhibited social engagement disorder (DSED) is overfriendliness with strangers. A child may seek comfort from a stranger, sit on a stranger’s lap, and not exhibit any distress when a caregiver isn’t present.

Children with DSED also show little interest or desire to check in with trusted adults before leaving a safe place and entering a situation that is strange or even threatening. Kids with this condition show little preference for trusted adults over strangers and may seek out affection from people they do not know.

Reactive Attachment Disorder

Reactive attachment disorder is a disorder of infancy or early childhood that involves a failure to seek comfort from a caregiver. A child with reactive attachment may resist physical comfort from a caregiver, avoid eye contact, and be hypervigilant.

Most children with reactive attachment disorder display a variety of behaviors. Such behaviors can include irritability, withdrawal, lack of comfort-seeking, not interacting with other children, and avoiding physical touch.

Treatment for Attachment Issues

The most important aspect of helping a child develop a secure attachment involves a stable, healthy environment. A child who continues to move from foster home to foster home or one who resides in an orphanage isn’t likely to develop a healthy bond with a caregiver.

Even when a child with an attachment disorder is placed in a loving home with a consistent caregiver, the symptoms won’t immediately resolve. They tend to push their caregivers away, and their behavior problems often repel those around them. They usually require intensive ongoing treatment.

Treatment typically involves:

• Psychotherapy: Psychotherapy for attachment disorders focuses on identifying problem areas and reducing problematic behaviors. This can be done one-on-one with a therapist but it may also involve caregivers as well.
• Social skills training: Developing social skills can help children learn how to interact better with others in school and social settings. Kids may practice these skills with their therapist and caregivers to help gain confidence and experience.
• Family therapy: Family therapy may help kids, caregivers, and other family members learn new ways of interacting and responding.

Coping With an Attachment Disorder

If your child or a child in your care has been diagnosed with an attachment disorder, there are things you can do to help them cope. In addition to seeking appropriate professional treatment, caregivers can help by being patient and having realistic expectations.

You can help a child cope by:

• Establishing boundaries: It is essential to provide consistency and stability. Create boundaries to help a child's world feel more predictable and trustworthy. Explain what is expected, and then be consistent about providing consequences. This can help kids regain trust and improve self-control.
• Follow a schedule: You can help establish consistency by having a daily routine that kids can follow. This can help kids feel like their world is more consistent and trustworthy, even during transition periods.
• Talk about emotions: Help kids learn to identify their emotions. Instead of judging emotions as "bad," focus on simply labeling them and discussing what kids can do to manage and express those feelings. 

If you are an adult struggling with attachment issues, remind yourself that it takes time to develop new patterns and behaviors. Psychotherapy can help you explore some of these issues in greater depth.

If you notice signs that your child may have an attachment disorder, talk to your child's doctor about an evaluation, diagnosis, or referral to a child mental health specialist. The earlier the intervention, the more likely a child is to experience a good outcome.

Another step that you can take to help a child with an attachment problem includes taking a parenting class. Children with attachment issues require special attention. Learning how to respond appropriately can help your child form a healthier, more secure bond with caregivers.