CHAPTER 17
Attachment Disorders
Children’s pattern of attachment to their parents and other caregivers
is of great developmental importance, with the quality of these selec-
tive attachments being predictive of their subsequent development. As
discussed in Chapter 32, about a third of children display an insecure
attachment pattern, and they tend to fare worse than securely attached
children in many aspects of their psychological and social development.
An insecure attachment pattern is best seen as a risk factor for psychosocial
maladjustment rather than as a disorder in itself; many insecurely attached
children are well adapted to their environment and do not develop any
psychiatric problems. In contrast, there are a few children who, following
severe deprivation (usually in institutions), do not display anything close
to selective security-seeking behaviour with any attachment figure. These
children’s behaviour is pervasive across all their relationships, and is
associated with marked distress or social impairment; they are deemed to
have an attachmentdisorder. This is in contrast to children with insecure
attachmentpatterns, who may function well, without distress, and may get
on perfectly satisfactorily in a range of relationships.
Varieties of attachment disorder
Both ICD-10 and DSM-IV recognise two varieties of attachment disorder:
1 Disinhibited. This relatively well-defined clinical picture is called ‘dis-
inhibited attachment disorder’ by ICD-10 and ‘reactive attachment
disorder, disinhibited type’ by DSM-IV. The child does seek comfort
when distressed, but lacks the normal degree of selectivity in the people
from whom comfort is sought. Social interactions with unfamiliar peo-
ple are poorly modulated with generally clinging behaviour in infancy
or attention-seeking and indiscriminately friendly behaviour in early
or middle childhood. There is accumulating research evidence for the
validity of disinhibited attachment disorders, which are typically linked
to repeated changes in caregiver in the early years of life, including
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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