Adult Attachment Disorder: Signs, Causes, and Treatment for Undiagnosed RAD
If we have a consistent and reliable emotional bond with our caregivers in childhood, we’re much more likely to easily form healthy and secure relationships in adulthood. Attachment theory looks at this process and what happens if our earliest bonds are difficult, lonely, chaotic, or traumatic.
Adult attachment issues in relationships can cause a great deal of distress, confusion, misunderstanding, heartbreak, anxiety, and conflict. Yet learning about attachment theory can be highly helpful to people who struggle in their close relationships, as it can highlight what’s going on and help with future difficulties.
Overcoming attachment issues in adulthood is entirely possible. Although, while there are a lot of self-help resources for attachment styles, some people will need professional support for attachment wounds and emotional healing.
This article can help you:
- Understand the basics of attachment theory and codependency
- Identify adult attachment disorder signs, the different types of attachment disorders, and what causes them
- Learn what treatment is available for supporting those with attachment issues
What Are Attachment Styles?
Attachment styles are categories for describing the different ways people feel and behave in close relationships. They were initially defined by Mary Ainsworth, who created the Strange Situation experiment in the 1970s, and expanded on through further research.1
This experiment looked at the relationship between children and their caregivers and found three “styles” of attachment in the children. These were secure, avoidant, and anxious. The disorganized attachment style was identified in the years after this initial experiment.
Though the field of attachment theory was initially geared towards children, it later gained attention in adult psychology as it was found that these patterns of behavior can continue. When looking at attachment theory and adult behavior, we can use the following summary to understand what’s going on in relationships based on the type of caregiving we received.2
| Attachment style | Pattern of relating | Caused by |
| Secure attachment | Healthy self-confidence, emotional availability, and a belief that needs will be met in close relationships | Caregivers being quick to respond to needs, handling them sensitively and consistently. |
| Anxious attachment (known as “anxious-preoccupied” in adults) | Feeling unworthy, fearing rejection, and depending too much on others for reassurance and validation | Caregivers alternating between responding to needs sensitively and rejectingly |
| Avoidant attachment (known as “avoidant-dismissive in adults) | Devaluing intimacy and acting overly self-reliant in attempts to avoid vulnerability | Caregivers acting distant or disengaged and rejecting emotional needs |
| Disorganized attachment (known as “fearful-avoidant” in adults) | Exhibit a mixture of anxious and avoidant tendencies based on circumstances | Caregivers being inconsistent, chaotic, and sometimes frightening |
It’s worth noting that most people have different attachment styles in different types of relationships. For example, someone could be securely attached to friends, anxiously attached to romantic partners, and avoidantly attached to their parents. So, if you experience a mixture of these patterns of relating, it could be that you have different styles with different types of relationships.
What is Codependency?
Unfortunately, if reparative situations aren’t experienced, people with insecure attachment styles are more likely to have dysfunctional and codependent relationships.3 Codependency describes a relationship dynamic in which there is an imbalance of caretaking or focus on one person’s needs. Additionally, codependent people are more likely to engage in behaviors that are either distancing (avoidant) or pursuing (anxious).3
Typically, the codependent party in a relationship is usually the one who assumes the role of “giver.” This might look like frequently putting other people’s needs before their own, and having low self-esteem, self-awareness, and self-acceptance. This way of relating comes from the dysfunctional relationships they had with caregivers in childhood, so there’s naturally a lot of overlap between codependency and attachment styles.3
Codependency can provide reassurance for both people in the relationship: the giver and the taker. It may feel right to those with attachment wounds because it resembles the unhealthy relationship dynamics that were modeled to them as children. However, it’s an imbalanced dynamic that can create frustration and a loss of sense of self.
You can read more about codependency to learn more, but we’ll now look more closely at attachment disorders.
Adult Attachment Disorders
Adult attachment disorders are caused by serious neglect and/or abuse in the first five years of life. They are characterized by difficulties forming relationships, resistance to engaging in emotional intimacy, and having trouble regulating emotions.5
Adults with attachment disorders may also have low self-esteem and struggle with their mental and physical health. There are two attachment disorders recognized by the DSM-5, but these are only formally diagnosed in children: reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED).
Reactive Attachment Disorder (RAD)
Reactive attachment disorder is classified by the DSM-5 as a trauma and stress-related condition caused by maltreatment and neglect.4 Such early experiences prevent a child from forming emotional bonds with caregivers. The following signs can be seen in children with RAD:
- Unpredictable behavior
- Difficulty being soothed and disciplined
- Reacting violently to being comforted
- Erratic mood fluctuations
- Strong desire to make decisions and control their environment
- Difficulty forming emotional attachments
- Reduced ability to experience positive emotions
- Struggles with developing academic skills
- Engagement in high-risk behaviors in adolescence
These signs of RAD may escalate in severity if children don’t receive sufficient mental stimulation and emotional support. Interventions are needed to help them form emotional bonds with one or more caregivers and develop a sense of safety in their environment. If not, these children may suffer behaviorally and mentally, and have difficulties developing their language and memory skills.4
Disinhibited Social Engagement Disorder (DSED)
Disinhibited social engagement disorder is also classified by the DSM-5 as a trauma and stress-induced childhood disorder. However, DSED has almost the opposite symptoms of RAD, with children typically being overly friendly to strangers and acquaintances.4 The following signs can be seen in children with DSED:
- Over-familiar verbal and physical behaviors
- Treating strangers similarly to primary caregivers
- Failing to check in with adults in unfamiliar settings
- Willingness to go off with strangers
Similarly to RAD, children with DSED must be supported in developing emotional bonds and a sense of safety.
As mentioned, the causes of adult attachment disorders like RAD and DSED typically revolve around traumatic experiences that include emotional neglect. This means they’ve been chronically deprived of basic emotional needs like stimulation, comfort, and affection, or had a constant flux of different caregivers.4
A common factor in cases of RAD and DSED is children spending time in institutional settings like foster care or overcrowded orphanages in the first five years of life. This is because they may have spent extended time alone or lacked a consistent caregiver.8
Attachment Disorders Beyond Childhood
Though the DSM-5 does not apply these RAD and DSED diagnoses to adults, if they’re not treated in childhood, many of the signs listed above may continue to be present in adulthood.
For instance, RAD in adults may manifest as difficulties with emotional intimacy, trust, control, maintaining relationships, showing and receiving love, impulsivity, and feelings of emptiness or lack of belonging.
Adults with DSED may be overly trusting, making them vulnerable to abuse and dysfunctional relationships.6 They might continue to be “disinhibited” socially, which may look like asking intrusive questions or not respecting typical social boundaries.
Attachment Issues and Complex PTSD
When people experience multiple significant traumas over a long period of time, they may develop complex post-traumatic stress disorder (known as cPTSD or complex PTSD). This can happen at any point in life, but attachment issues can cause it in childhood.
Attachment issues can be present in people with cPTSD if their traumatic experiences interfered with their development of a sense of self and emotional bonds with caregivers.7 For example, in some cases, children’s caregivers may be perpetrators of abuse. For these children, their source of love is also a source of fear, so they still attach to their parents despite the terror they feel.
This conflict of experiencing both love and fear in one relationship can form an attachment wound. As a result, adults with attachment issues may engage in relationships in which they are abused or act abusively to others. Learn more about attachment issues and cPTSD.
Adult Attachment Disorder vs BPD
BPD is a personality disorder affecting numerous parts of an individual’s life. It’s common for people to be confused about whether they have borderline personality disorder (BPD) or an attachment disorder. This is because people with these conditions tend to experience disruptions in their relationships and have difficulty regulating their emotions.9
Research found that around 90% of people with BPD are insecurely attached, while only a subgroup of insecurely attached people will have symptoms of BPD. Despite both conditions involving negative feelings about relationships, people with BPD are more likely than those with attachment disorders to let these feelings come out in their behavior.9
Alongside feelings of emptiness, rocky interpersonal relationships, and an unstable self-image (things that those with attachment disorders may share), people with BPD might also be prone to anger, impulsivity, and self-harm.10
Treating Adult Attachment Disorders
Since attachment disorders cannot be formally diagnosed in adults, you might feel like you’re living with an undiagnosed attachment disorder. Regardless of a diagnosis, you can absolutely get support for such issues.
The most recommended treatment for adult attachment issues is talking therapy. This could be psychodynamic, humanistic, cognitive-behavioral, among others. If your attachment disorder stems from adverse childhood experiences, it’s worth talking these through in therapy in order to gain a deep understanding of how it’s impacting you now. Additionally, if you have cPTSD, this can be worked through in trauma-informed therapy.
Some research suggests that psychotherapy works for adults with attachment issues because it can provide “reparenting,” whereby you form a secure emotional bond to your therapist.11
From this secure base, you can relearn what you missed out on in childhood, receive support you know you can rely on, and get used to expressing your needs and emotions. This therapeutic relationship can then be a vehicle to more functional and satisfying relationships in your everyday life.
Get Support Today for Adult Attachment Disorders
Insecure attachment styles can take a significant toll on daily life and relationships. If you’re in need of support, you might be looking for adult attachment disorder treatment. Here at Mission Connection, we understand that treating adult attachment disorders can require a varied approach, which is why we offer many types of therapy and medication management.
Attachment wounds don’t have to continue affecting your relationships and happiness. Together, we can help you heal and achieve the relationship goals you deserve. Contact us today to learn more about our treatment options.
References
- Cassidy, J., Jones, J. D., & Shaver, P. R. (2013). Contributions of attachment theory and research: A framework for future research, translation, and policy. Development and Psychopathology, 25(4pt2), 1415–1434. https://doi.org/10.1017/s0954579413000692
- Santoro, G., Costanzo, A., Franceschini, C., Lenzo, V., Musetti, A., & Schimmenti, A. (2024). Insecure Minds through the Looking Glass: The Mediating Role of Mentalization in the Relationships between Adult Attachment Styles and Problematic Social Media Use. International Journal of Environmental Research and Public Health, 21(3), 255. https://doi.org/10.3390/ijerph21030255
- Kolenova, A. S., Kukulyar, A. M., Denisova, E. G., & Ermakov, P. N. (2024). Self-Attitude and Reflection in Codependent Women: A Comparative Study. Psychology in Russia: State of the Art, 17(1), 116–132. https://doi.org/10.11621/pir.2024.0107
- Ellis, E. E., & Saadabadi, A. (2023, May 1). Reactive attachment disorder. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537155/
- Moran, K., Dyas, R., Kelly, C., Young, D., & Minnis, H. (2023). Reactive Attachment Disorder, Disinhibited Social Engagement Disorder, adverse childhood experiences, and mental health in an imprisoned young offender population. Psychiatry Research, 332, 115597. https://doi.org/10.1016/j.psychres.2023.115597
- Kennedy, M., Kreppner, J., Knights, N., Kumsta, R., Maughan, B., Golm, D., Hill, J., Rutter, M., Schlotz, W., & Sonuga-Barke, E. (2017). Adult disinhibited social engagement in adoptees exposed to extreme institutional deprivation: examination of its clinical status and functional impact. The British Journal of Psychiatry, 211(5), 289–295. https://doi.org/10.1192/bjp.bp.117.200618
- The National Child Traumatic Stress Network. (2018, May 25). Complex trauma. The National Child Traumatic Stress Network. https://www.nctsn.org/what-is-child-trauma/trauma-types/complex-trauma
- Seim, A. R., Jozefiak, T., Wichstrøm, L., & Kayed, N. S. (2019). Validity of reactive attachment disorder and disinhibited social engagement disorder in adolescence. European Child & Adolescent Psychiatry, 29. https://doi.org/10.1007/s00787-019-01456-9
- Kaurin, A., Beeney, J. E., Stepp, S. D., Scott, L. N., Woods, W. C., Pilkonis, P. A., & Wright, A. G. C. (2020). Attachment and Borderline Personality Disorder: Differential Effects on Situational Socio-Affective Processes. Affective Science, 1(3), 117–127. https://doi.org/10.1007/s42761-020-00017-7
- Smith, M., & South, S. (2020). Romantic attachment style and borderline personality pathology: A meta-analysis. Clinical Psychology Review, 75, 101781. https://doi.org/10.1016/j.cpr.2019.101781
- Andriopoulou, P. (2022). Healing attachment trauma in adult psychotherapy: The role of limited reparenting. European Journal of Psychotherapy & Counselling, 23(4), 1–15. https://doi.org/10.1080/13642537.2021.2000465
