Why INSIDE is OUT - Part 1

Have you ever had a question provide direction to your life?

You stumble upon a question, thought or idea, or make an observation or inquiry that leads to a discovery. It’s a discovery directed by questions or curiosity. You follow threads of thoughts and piece together something much larger. Licensed counselor Timothy Sanford did just that and that's how INSIDE: How Reactive Attachment Disorder Thinks and Feels came to be. Tim invites mental health professionals, family members, friends, and those dealing with attachment issues to dive deep into the world of Tom, a man living with RAD, coping with the disorder and his journey toward hope. There IS hope.

Tim tells how INSIDE came about:

As therapists, we don’t always get to pick our specialties.  Sometimes they pick us.  Such was the case for me with Reactive Attachment Disorder.  I have more than 27 years’ experience working with teens and adults and it’s normal for any number of issues to present, all as varied as the people sitting across from me.  Early on in my career there were two themes however, that I could not figure out where they were coming from: (1) a deep inability—an incapability really—to truly trust someone else and, (2) feeling in a low-grade state of survival constantly even when the external circumstances seemed to be acceptable.  These two themes were infused with intense reactions anytime anything—even a small thing—seemed to rock the client’s world.  It was the re-occurrence of these intense reactions that ultimately landed them in one of my blue La-Z-Boy recliners.

These two themes motivated me to gain an understanding of what I now realize is the disorder called Reactive Attachment Disorder.  The primary purpose for my research was to better understand the thinking patterns behind the many outward behaviors I was seeing in my office.  I have been working with this ever since.

What is it? Simply put, Reactive Attachment Disorder (also known as RAD because it’s shorter) is an infant’s inability to attach to its primary caregiver—generally the mother—during the first 12 months of the infant’s life.  What adds to the confusion surrounding attachment is the words “bonding” and “attachment” get used interchangeably.  In reality, they have very different meanings.  The easiest way to describe the difference between these two concepts is this way:

Bonding is what a normal, healthy (important adjectives here) adult will unconditionally (key word) do toward an infant.  Bonding is adult toward infant. Attachment is what a normal, healthy (important words again) infant will conditionally (key issue here) do if and when the infant assesses its environment to be safe enough and if the primary caregiver is consistent enough to be relied upon.  The subjective measurement is the word “enough.”  The actual amount of “enough” will vary from one infant to the next even when both are in the same home environment and same or similar circumstances are encountered.  Attachment is child toward adult. To make things foggier, the primary caregiver may in fact bond, but the infant may still not attach.

The most widely noted circumstances causing attachment disorders are abandonment, neglect and/or abuse (physical, sexual and/or emotional).  Other situations that have the potential for RAD to develop in an infant are:

             Pre-mature birth with complications

            Traumatic pregnancy and/or delivery

            Birth mother’s use of alcohol and/or drugs during pregnancy

            After birth complications or trauma for the infant

            Lack of enough nurturing from mother

            Lack of enough validation from father

            Any number of early childhood traumas

            Any combination of the above

Don’t jump to the conclusion that every adopted child or every pre-mature born infant has RAD. Obviously, that isn’t the case.  However, situations like the ones listed above would account for the times RAD exists when the child is a part of an intact family structure or was adopted at birth and taken home directly from the hospital to a good nurturing family.

But a person doesn’t simply “outgrow” attachment issues with time.  What happens is his/her behaviors change with age, which in turn, match a different set of collective behaviors and receives yet a different diagnostic name.   And many times these different disorders are accurate, mind you, just not complete.

The problem is that underlying the other disorder(s) may be RAD.  RAD may be (not always) the “starter domino” in the long domino train of destructive thinking patterns and behaviors that finally bubble to the surface in the adolescent or adult.  Dealing only with the end domino (dysfunctional thinking patterns or behaviors) will have a lesser chance of generating deep, permanent change.  Only when the where and why behind the behaviors are addressed can complete healing be possible.

Read this scholarly article for more information on attachment and bonding. To learn more about how to treat or live with Reactive Attachment Disorder, get INSIDE: How Reactive Attachment Disorder Thinks and Feels and watch for our next blog “Why INSIDE Is Out - Part 2” from LifEdvice: Learning to live life well!