What is Reactive Attachment Disorder?

“My psychiatrist says my primary diagnosis is bipolar disorder type II. He also tells me that the secondary diagnosis is reactive attachment disorder. Can you tell me what this means?”

You are probably aware of what a diagnosis of bipolar disorder type II is.  Basically you have periods of hypomania with an elevated mood, and behaviors such as irritability, lack of concentration and risky behavior. This is usually followed by a lengthy period of depression with low energy and a relatively lethargic attitude.  When more serious this would be a moderate clinical depression.

Reactive attachment disorder refers to a condition beginning in the first few months of life. It is characterized by a primary caretaker who is unable to meet the emotional needs of the infant. The caretaker may be avoidant and pay little or no attention to their child, they may be overprotective and anxious.  In some situations their behavior  may border on abusive or dismissive.  In these cases of inadequate bonding, children grow up without the proper tools to be well functioning adolescents and adults.

Initial treatment for reactive attachment disorder includes a rather lengthy diagnostic interview, possibly including brief tests to determine the specific type of attachment disorder and its severity.

Based on this diagnosis, treatment usually includes a careful examination of parenting style and subsequent impact on the child. Most professionals agree that mindful dialectical behavior therapy, or some similar orientation, is the most appropriate treatment for this disorder.

The therapy process will include an intensive examination of early childhood experiences, including thoughts feelings and actions.  Most often these recollections are fraught with negativity. In addition a look at anticipated future events is dominated by negative expectations.

The third focus is on the here and now. In other words – one cannot change the past, and the negative anticipations of future usually become self defeating.  Regular practice in and emphasis on mindfulness will help in this process.  One begins to develop a healthier perspective on the past, accepting that what others have done in their caretaking role was the best they could do.  In the process of gaining this new perspective acceptance and forgiveness are key elements.  With newfound acceptance, forgiveness and compassion one is better able to focus on the here and now and develop activities, and behaviors that will assist in shaping a more  acceptable, and fulfilling future.

One particularly promising treatment modality is the NAIKAN process.  Information on this process can be found on the TODO INSTITUTE website.  Another reference is the book Naikan, by Gregg Krech.  It will assist in your learning  more about this process.  I anticipate that these references will further assist you in answering your questions.  By all means be an educated consumer. Ask any potential therapists the extent to which they are familiar with these methods and able to apply them the treatment of the diagnoses of bipolar disorder type II coupled with  reactive attachment disorder.

~Dr. Manuel S. Silverman, PhD