What we know about “attachment disorders” in childhood

Current nosology describes reactive attachment disorder as represented by two distinct disorders: reactive attachment disorder, characterized by markedly inhibited and emotionally withdrawn behavior toward adult caregivers, minimally seeking comfort or minimally responding to comfort in time of distress, and disinhibited social engagement disorder, which is represented by an indiscriminate social behavior, sanctioned from culture and which crosses social boundaries, in the presence of unfamiliar adults. Both disorders, despite their different phenotypes, are caused by a pathogenic caregiving environment, repeated changes of attachment figures, social neglect and deprivation in the first years of life. The article examines recent diagnostic criteria reported in the literature comparing diagnostic classifications and attempting to understand the etiology of the disorder. Unresolved questions exist in current nosology, which means that the quality of the evidence supporting the diagnostic criteria needs to be improved. This review concludes that, despite the currently available diagnostic classifications, future longitudinal studies should be conducted to assess the evolution of reactive attachment disorder over the time and to discriminate its features from other psychopathologies.