Attachment disorders in adults (5 key insights)

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In this blog we will explore what attachment disorders in adults are and what are the various types of adult attachment disorders. 

We will also explore possible causes that lead to attachment disorders during adulthood and how attachment can impact the quality of life of an individual as well as possible treatment options for people with attachment disorders. 

What is Adult Attachment Disorder?

Attachment disorders are psychological disorders that include a marked difficulty in forming emotional attachment with others. 

This form of psychological disorders is usually identified in cases that involve children that are between the ages of 9 months to  age of five. 

In this context, attachment disorder refers to psychological dysfunction caused by the child’s inability to form emotional attachment with their parents and caregivers. 

It is a recognised psychological condition that is recognised as Reactive Attachment Disorder by the American psychological Association in their Diagnostic and statistical many of mental disorders (5th Edition), 

However, in the case of adults, attachment disorders are not recognised which means that adult attachment disorders are not officially diagnosed in people who struggle with forming healthy emotional attachment in their relationships. 

However, there are many people who struggle with this condition as a result of poor or insecure attachment form during their childhood. 

Unfortunately, because it is not officially diagnosable, it is hard to define attachment disorders when it comes to adults as well as to streamline treatments related to these experiences and challenges. 

Even Though attachment disorders cannot be diagnosed in adults, the experiences and distress experienced by adults in their relationships due to poor or insecure attachment is a valid phenomenon that is marked by the following:

  • Poor emotional regulation
  • Lack of clear boundaries
  • Severe dependency
  • Codependency
  • Trust issues
  • Fear of abandonment and rejection
  • Inability to form close bonds
  • Negative behaviours such as substance use and violence

Let us take a look at the two types of attachment disorders that has been recognised by the DSM-5 and how they might manifest in adulthood

What are the types of Attachment disorder in adults?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists two childhood attachment disorders whose symptoms first emerge between when the child is around 9 months to 5 years of age. 

When such symptoms of the disorders arise and there are no proper and effective interventions, the consiqeues of the disorder and the dycnitinfuon it causes in the children can persist into adolescence and adulthood. 

The two attachment disorders are:

Reactive Attachment Disorder in Adults

Reactive attachment disorder (RAD) is a psychiatric disorder that has been identified and recognised by the DSM-5 where a child is unable to develop and maintain healthy attachments with caregivers.

The most obvious and telling symptoms of this disorder is the child’s inability to find comfort in other people as well as experience no positive emotions when socialising with caregivers and other individuals in their life. 

The DSM-5 recognizes the following symptoms as criteria for the diagnosis of RAD:

  • The child rarely seeks comfort from other people when they are distressed nor do they react to efforts made to comfort them.
  • They lack the ability to express positive emotions especially when interacting with others such as laughing, smiling.
  • They often react with irritability, fee, and discomfort when they are engaging with caregivers and might throw tantrums. 

They also seem to have a lack of emotional needs and their need for affection is also not met by their caregivers. 

When it comes to RAD, there is also a history of neglect and repeated changes or separation from their caregivers that hamper the development of attachment building. 

There could also be a history of childhood neglect, abuse, or witnessing abuse that could be one of the causes of the development of this disorder. 

While the research done on adult attachment disorder is still lacking, there has been a few that has considered the manifestation of RAD in adults. 

One such study published in 2016 explores the manifestations of Reactive Attachment disorder in young adult populations- the participants were between the ages of 15 to 25 who were at one point diagnosed with RAD in their childhood. 

The results of this study found that at least 22 percent of the sample population met the criteria for Borderline personality disorder which suggested that it is possible that RAD in adults manifest in the form of personality disorders rather than a specific attachment disorder. 

This study brings to light that many of the attachment disorder symptoms that is often observed in clinical setting such as:

  • Detachment
  • Inability to maintain significant relationships, romantic or platonic
  • Inability to show affection
  • Control issues
  • Anger problems
  • Impulsivity
  • Inability to grasp emotions

These symptoms further suggest that RAD in adults could be related to attachment problems that often develop in personality disorders such as Avoidant personality disorder, Borderline personality disorder, and Dependent personality disorder. 

Disinhibited Social Engagement Disorder in Adults

Disinhibited social engagement disorder (DSED) is a disorder  that is marked by a child’s inability to form meaningful relationships with other people.

The major criteria for the diagnosis of this disorder is that the children that have this disorder do not show normal fear associated with strangers and tend to be overly friendly with them.

They exhibit overly friendly behaviour with strangers even to the point that they can venture off away from their caregivers and even wonder off with the strangers.

There is also very little or no hesitation to interact with strangers with little or no checking abc with their primary caregiver.

In cases where children have this disorder there is usually a history of neglect and deprivation where their basic emotional needs are not met. 

There is also a lack of attention and comfort from the caregiver and there has been prepared change and separation from primary caregivers due to which attachment has not been formed. 

It is also possible that the child could have been raised whether there are many caregivers due to which selective attachment has not been formed leading them to not be able to form or understand how meaningful relationships are made. 

Similar to RAD, the adult manifestations of DSED lack clinical research and observation and literature in the Thai area is still lacking. 

However, there has been a study done on Romanian adoptees during their young adult years that explores the manifestation of DSED in adulthood. 

In this study 165 participants were engaged in assessments for DSE behavoirios, neurological development, and mental health. 

The findings of this study found there does seem to be some DSED behaviours in adults who experience childhood deprivation as well as  was marked cognitive impairment in the participants which the researchers hypnotised to be a result of deprivation which manifested in the form of other disorders such as Autism Spectrum disorder and Attention Deficit disorder

The findings also indicated that the participants did not seem to have any direct relationship in the form of depression or anxiety due to DSED but rahter the effect of the DSED was on their quality of life which was also indirectly linked to the neurodevelopmental issues faced due to deprivation. 

Researchers concluded that while there are some DSED behaviours observed in the population, the impact on their lives did not cause significant dysfunction that the disorder could be identified in adults; rather there was alternate or comorbide consciousness such as ADHD and ASD as a result of deprivation during childhood. 

How does Attachment impact an individual?

Attachment problems in adulthood are not diagnosable disorders but rather are oftentimes observed as symptoms in various mental disorders- especially personality disorders. 

People might struggle with one of the following attachment styles that are related to insecure attachment styles that develop as a result of inconsistent care and lack of healthy attachment formed during their formative years.

Ambivalent or anxious-preoccupied attachment style

People with an ambivalent attachment style tend to be overly dependent and needy with preoccupation with anxiety and uncertainty. 

This form of attachment style is marked by lack of self esteem and extreme craving for emotional intimacy while being anxious that people do not want them.

People with this form of attachment style often struggle to trust others and be intimate with them while also being very preoccupied with the idea and need for intimacy. 

They also struggle with healthy boundaries and any space is a threat to them for fear of being rejected or losing people and the relationship.

They also need constant reassurance and are often dependent on the relationship and acceptance of others to feel validated and worthy.

Avoidant-dismissive attachment style

Adults with an avoidant-dismissive insecure attachment style are often wary of emotional connection and closeness with others. 

They are often intolerant of intimacy and highly value independence as opposed to closeness with others. 

This form of attachment problem is marked by extreme independence and withdrawal when there is the threat of intimacy of closeness with others. 

They are often fearful of emotions and are often seen as distant and closed off. They often disregard others in the relationship and prefer casual relationships as opposed to deep ones. 

Disorganised/disoriented attachment style

Disorganised/disoriented attachment is often a result of childhood trauma, neglect, or abuse and is often observed in Borderline Personality disorder. 

People with this form of attachment studley with the belief that they do not deserve intimacy in their relationships. They often feel frightened by intimacy and at the same time crave it and are desperate for it. 

They often swing between emotional extremes of love and hate for a partner and also tend to be controlling and untrusting towards others and might even lead to violent and abusive behaviours. 

There is also the possibility of negative behaviour patterns, abuse of alcohol or drugs and complete rejection of responsibility while also craving for the security and safety of a meaningful relationship.

Conclusion

In this blog we have  explored what attachment disorders in adults are and what are the various types of adult attachment disorders. 

We have also explored possible causes that lead to attachment disorders during adulthood and how attachment can impact the quality of life of an individual as well as possible treatment options for people with attachment disorders. 

FAQ related to Attachment disorders in adults

What are the signs of attachment problems in adults?

Some of the possible signs of attachment problems include:

  • Poor emotional regulation
  • Lack of clear boundaries
  • Severe dependency
  • Codependency
  • Trust issues
  • Fear of abandonment and rejection
  • Inability to form close bonds
  • Negative behaviours such as substance use and violence

What are the 4 attachment styles of adults?

Adults are described as having four attachment styles: 

  • Secure attachment
  • Anxious-attachment/preoccupied
  • Dismissive/avoidant
  • Fearful-avoidant. 

What is an unhealthy attachment?

In an unhealthy attachment, there appears to be an inability to trust their partner and commit to the relationship. There will also be marked signs of over dependence, emotional dysregulation and negative behaviours such as substance abuse and violence including a lack of ability to respect and maintain boundaries. 

What is the most unhealthy attachment style?

The most unhealthy kind of attachment style is disorganised attachment that is observed in people who have experienced abuse during childhood from their caregivers. 

References

Attachment Disorders in Adults: Types, Symptoms, & Treatments. Choosing Therapy. 29th April 2021. Retrieved on13th Dec 2021. https://www.choosingtherapy.com/attachment-disorders-adults/

Kennedy M, Kreppner J, Knights N, et al. Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: examination of its clinical status and functional impact. Br J Psychiatry. 2017;211(5):289-295. doi:10.1192/bjp.bp.117.200618

Davies. N. Understanding Adult Attachment Disorders. Psychiatry Advisor. 3rd August, 2020. Retrieved on 13th Dec 2021. https://www.psychiatryadvisor.com/home/topics/general-psychiatry/understanding-adult-attachment-disorders/

Mirza, K., Mwimba, G., Pritchett, R., & Davidson, C. (2016). Association between reactive attachment disorder/disinhibited social engagement disorder and emerging personality disorder: A feasibility study. The Scientific World Journal, 2016.

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