Causes & Effects of Reactive Attachment Disorder

Learn how to recognize the signs and symptoms of reactive attachment disorder and get help for your child, teen, or young adult.

Understanding Reactive Attachment Disorder

Learn about reactive attachment disorder

Reactive attachment disorder (RAD) is a rare, but serious mental health condition that occurs when an infant or child is prevented from establishing a healthy attachment to parents or caregivers. More specifically, when a child’s basic needs for comfort and affection are not met, it prevents him or her from being able to develop loving, caring, and stable relationships. In many cases a child with reactive attachment disorder has been a victim of abuse, neglect, or abandonment.

In order to feel safe and develop trust, infants and young children need to be surrounded with a stable, caring environment. Additionally, their basic emotional and physical needs must be regularly met. A child who is ignored or is not met with any emotional response from a caregiver does not rely on care or comfort from a caregiver and will therefore not have any type of attachment to those caregivers.

Underdeveloped attachments can potentially damage a child’s development and lead to a number of different behavioral problems in the future. With adequate treatment, children who have developed reactive attachment disorder will be able to go on to develop more stable and health relationships with caregivers and other individuals.


Reactive attachment disorder statistics

Due to the rarity of reactive attachment disorder, along with the fact that it is scarcely seen in clinical settings, its true prevalence remains unknown. Psychiatrists have noted that, even within the population of children who have been the victims of severe abuse and neglect, less than 10% go on to develop RAD.

Causes and Risk Factors

Causes and risk factors for reactive attachment disorder

Since reactive attachment disorder is so rare, it is not understood why some children develop this disorder, while others do not. Therefore, specific causes and risk factors that lead to the development of this disorder is not conclusive. However, the following factors have been noted as likely to impact the development of reactive attachment disorder:

Genetic: While there is no specific genetic link tied to the onset of RAD, research has identified the role of genetics in the development of other attachment disorders, and so many professionals in the field have hypothesized that genetic influences impact the development of reactive attachment disorder as well.

Physical: The way in which infants and their mothers or other primary caregivers interact has an impact on how the brain develops. When emotional interaction is lacking or nonexistent, an alteration in brain development occurs which can, in turn, affect the molding of one’s personality. This affects how a child views and experiences interpersonal relationships, which can further determine whether or not the onset of RAD will occur.

Environmental: It is widely believed that the onset of reactive attachment disorder is ultimately the result of the environment in which the child grew up. As a child being denied a healthy, emotional, and affectionate relationship with a caregiver can greatly hamper successful mental health development.

Risk Factors:

  • Being socially neglected
  • Growing up in an institution or children’s home
  • Frequently changes foster home or caregivers
  • Having inexperienced parents
  • Being forcefully removed from an abusive or neglectful home
  • Having a mother who suffers from severe postpartum depression
  • Experiencing other kinds of traumatic losses or significant changes with a primary caregiver

Signs and Symptoms

Signs and symptoms of reactive attachment disorder

When a child has reactive attachment disorder there are a wide variety of signs and symptoms that are displayed depending upon specific circumstances that occurred during the early development stage. Examples of various symptoms that may present can include:

Behavioral symptoms:

  • Does not make eye contact
  • Refusing to interact with peers
  • No interest in playing interactive games
  • Does not seek comfort or shows no response when comfort is given
  • Failure to smile
  • Participating in self-soothing behaviors, such as stroking one’s arms or consistently rocking back and forth
  • Turning or leaning away from someone who is trying to show affection
  • Does not engage in social interaction

Physical symptoms:

  • Looking joyless
  • Inability to gain weight
  • Failure to smile
  • Sad and listless appearance

Cognitive symptoms:

  • Cognitive delays
  • Language delays
  • Other developmental delays
  • Delayed responsiveness to stimuli

Psychosocial symptoms:

  • Overwhelming feelings of sadness
  • Experiences difficulty or is incapable of being comforted
  • Constantly feels unsafe
  • Feeling “empty” inside
  • Feelings of worthlessness
  • Extremely low self-esteem
  • Inability to trust others
  • Lacks a sense of belonging
  • Feeling unwanted
  • Chronic anxiety


Effects of reactive attachment disorder

If left untreated, reactive attachment disorder has the ability to continue for several years, which increases the possibility for the development of lifelong consequences. Examples of these negative effects may include:

  • Inability to form interpersonal relationships with others
  • Having control issues
  • Underdeveloped conscience
  • Having a strong aversion to any kind of physical touch
  • Lacking the ability to have genuine feelings of empathy towards others
  • Delayed physical growth
  • Depression
  • Anxiety
  • Delinquent or antisocial behaviors

Co-Occurring Disorders

Reactive attachment disorder and co-occurring disorders

There are a number of conditions that have been known to co-occur with reactive attachment disorder. Some of the specific disorders that have been cited as occurring alongside reactive attachment disorder include:

  • Anxiety disorders
  • Depressive disorders
  • Autism spectrum disorders
  • Pervasive developmental disorder
  • Pica disorder
  • Rumination disorder
  • Communication disorders
  • Neurocognitive disorders

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