According to the American Academy of Child and Adolescent Psychiatry (AACAP), reactive attachment disorder (RAD) is a complex psychiatric illness that can affect children. It might start in infancy or early childhood when the physical and emotional needs of the child are neglected by the parents or caregivers. It is the bond that is shared between a mother and her child that makes the child aware of love. Soon, the child begins to connect with the father, grandparents, siblings, friends, and others. However, when a child cannot feel the bond with his/her parents or primary caregiver, it could cause an attachment disorder. Under such circumstances, the child might not turn to the caregiver for the love, protection, or comfort. RAD is more likely to be observed in children below the age of 5 years. It is believed that it might persist into adolescence or adulthood, if it goes undiagnosed. RAD has been listed in the Diagnostic and Statistical Manual of Mental disorders (DSM). According to the DSM-V, the criteria for RAD is: ➞ A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers ➞ A persistent social and emotional disturbance ➞ A pattern of extremes of insufficient care ➞ The care described in the third criterion is presumed to be responsible for the disturbed behavior described in the first criterion ➞ The criteria for autism spectrum disorder are not met ➞ The disturbance is evident before age 5 years ➞ The child has a developmental age of at least 9 months RAD is an acute psychiatric illness in which an individual experiences difficulty in forming loving, lasting, and intimate relationships. Individuals affected by this disorder believe that they are capable of looking after themselves and providing for their own needs. Individuals with RAD might fail to show empathy and genuine affection, because that makes them extremely uncomfortable. However, RAD includes both inhibited and dis-inhibited behavioral subtypes, wherein the dis-inhibited subtype behavior, makes the individual demand attention and affection from familiar people as well as complete strangers. In case of inhibited subtype, the affected individual cringes away from any form of human contact. These individuals lack the ability to trust others wholeheartedly. Therefore, they might not allow anyone to control them or make them feel vulnerable to hurt. This disorder is believed to develop in an infant or child, when the primary caregiver, is not physically or emotionally present to provide the necessary love, security, nurturing, and safe environment to the child. Abuse of the child during his/her first 5 years, at the hands of the caregiver is usually the underlying cause. It could affect a child who: ➞ Lives in an orphanage or institution ➞ Has to frequently change foster homes or caregivers ➞ Has parents who are inexperienced ➞ Has stayed away from his parents/caregivers for a long period due to hospitalization ➞ Has a mother with postpartum depression ➞ Is a part of a very large family, due to which parents are unable to spend time with him/her According to Magid & McKelvey (1988), if a child cannot develop a bond of love with the mother, the child will find it extremely difficult to develop meaningful relationships with any person throughout his/her life. An individual who is affected by RAD is more likely to remain detached. RAD is an illness of extremes. Sometimes, the affected individual may show hostility towards others, which in turn might affect his/her ability to form strong, intimate relationships. At times, the affected individuals may live superficial lives, never being able to express their true emotions and secluding themselves from the company of others. The symptoms of RAD are divided into two categories: avoidant attachment (inhibited) and ambivalent (dis-inhibited) attachment. Symptoms of Avoidant Reactive Attachment Disorder ➞ Avoiding intimacy ➞ Showing compulsive self-reliance ➞ Difficulty in getting along with co-workers; preference for working alone rather than begin a team player ➞ Fear of closeness in relationships ➞ Lack of empathy ➞ Tendency to be overly critical of others ➞ Passive withdrawal ➞ Considering relationships as a threat to his/her sense of control; considering relationships not being worth the effort ➞ Being overly sensitive to blame ➞ Tendency to become intensely self-critical ➞ Tendency to not believe in idealizing a romantic relationship ➞ Finding others untrustworthy or undependable ➞ Thinking of himself/herself as an unlovable person ➞ Avoiding personal relationships by citing work reasons ➞ Being passive-aggressive Symptoms of Ambivalent Reactive Attachment Disorder ➞ Showing compulsive care-giving nature ➞ Desiring excessive intimate contact and declarations of affection from his/her partner ➞ Tendency to either feel over-involved and under-appreciated in his/her work or relationships ➞ Tendency to idealize others ➞ Jealousy ➞ Experiencing mood swings and extreme emotions ➞ Finding it hard to maintain a long-term relationship ➞ Tendency to be emotionally overindulgent in a relationship ➞ Feeling that others are very difficult to understand ➞ Possessiveness ➞ Tendency to be exceedingly dependent on his/her relationships ➞ Feeling a sense of security only when in a relationship ➞ Being sensitive to any form of rejection ➞ Depression ➞ Suicidal tendencies ➞ Finding his/her partner unpredictable ➞ Feeling unlovable or undesired by others Individuals affected by RAD require professional guidance and therapy to help them cope with their problems. Give them all your support while they are undergoing therapy. Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.