Thursday, March 2, 2017
Reactive Detachment Disorder is Fake News
Are you worried that your adopted, foster, or even biological child could have Reactive Detachment Disorder? Well, don’t be. There is no such thing.
Of course, that simple fact has not stopped various people from using the term Reactive Detachment Disorder. My first encounter with the expression was in about 2003, when I saw this expression used on a quite respectable Internet medical information site. I emailed them about it and they quickly admitted their mistake, apologized, and made the correction. Nevertheless, Reactive Detachment Disorder has remained a notional diagnosis, from the earliest example I can find, a 2002 discussion of the Hansen child starvation case in Utah, to the present day. A 2007 book by P.A. Potter, “Jekyll and Hyde: Arrested development and personality disorders”, refers to Reactive Detachment Disorder in adult criminals. Current websites like www.freedomfrommedom.com and www.health247.com come up in response to a Google search for Reactive Detachment Disorder (although some of these sites actually talk about Reactive Attachment Disorder). Reactive Detachment Disorder is referenced as associated with crime at www.archive.courierpress.com (“Defendant’s mental health scrutinized on first day of trial”) and given as a reason for judicial leniency at www.valleyjournal.net/article/17093/Negligent-homicide-case-headed-to-youth-court.
In many of these cases, Reactive Detachment Disorder is said to be connected with antisocial behavior in adolescence or adulthood. This suggests that what the speakers/writers are really talking about is the equally notional “Attachment Disorder”, another faux diagnosis perpetrated by proponents of a belief system that attributes violent, aggressive behavior to past difficulties with emotional attachment. This is a view created by such luminaries as Foster Cline and Nancy Thomas. Recent information about the Institute for Attachment and Child Development in Colorado, to the effect that the Randolph Attachment Disorder Questionnaire (RADQ) is still used there, suggests that the IACD staff is committed to the same belief system, although they do not use the term Reactive Detachment Disorder.
What does it mean to say that there is no such thing as Reactive Detachment Disorder? This is not to deny that there is antisocial, disturbing behavior shown by both children and adults. It is, however, a denial, first, that this term is ever used among knowledgeable mental health professionals; second, that assumptions associated with the term (as in its connection with “Attachment Disorder”) are correct; and finally, that the term is among those listed in either of the two professionally-developed sets of mental health diagnoses, the International International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Disorders (DSM).
The term Reactive ATTACHMENT Disorder does appear in both ICD and DSM. It is not applicable to older children ,adults or adolescents. It does not involve aggressive behavior. Here are its symptoms:
A. A consistent pattern of inhibited, emotionally withdrawn behavior toward adult caregivers, manifested by both of the following:
• The child rarely or minimally seeks comfort when distressed.
• The child rarely or minimally responds to comfort when distressed.
B. A persistent social or emotional disturbance characterized by the following:
• Minimal social and emotional responsiveness to others
• Limited positive affect
Of course, this description of symptoms does not deny that some children show aggressive, disturbing, antisocial behavior, of the kind that the term Reactive Detachment Disorder seems to include. Such behavior is associated with the idea of callous-unemotional traits, with conduct disorder, and with oppositional defiant disorder—all legitimate diagnostic categories. I’ve discussed this before, at https://childmyths.blogspot.com/2016/11/conduct-problems-and-callous.html.
As I pointed out in that post, there is much confusion about Reactive Attachment Disorder, which is widely assumed by journalists and poorly-trained therapists to involve antisocial behavior and to be present in adolescents and adults as well as young children. The “RAD defense”, claiming that an attachment disorder caused a crime, has been around for a while—and disturbingly, this defense includes not only the idea that a person with RAD is likely to be a criminal, but the claim that a child with RAD may be so evil that an adult caregiver is forced to kill the child. Isn’t this enough confusion? Why bring the notional Reactive Detachment Disorder into the picture?
The use of the “detachment” term probably began as a simple mistake, but I would speculate that it would be a tempting thought for the Cline-Thomas mindset. A child is detached—how wrong! Children are supposed to be attached, and in the belief system in question that means that they are obedient, compliant, attentive and affectionate and grateful to parents. They are “respectful, responsible, and fun to be around”. They respond enthusiastically to parents’ offers of affection (“on the parents’ terms”) but they do not demand attention or affection on their own terms. In other words, they allow their parents to be detached, to be unresponsive and inattentive to the relationship except when in the mood; the ideal child in this mindset is always available and interested in emotional contact with the parent, is never angry or disappointed when ignored or rejected, and asks for nothing but what the parent wants to give. A child who doesn’t meet these standards must be mentally ill, or simply willful, and draconian methods are needed to make the child “attached” while still allowing the adults to be detached. However, the pathology here seems to be not so much in the child as in the parents or practitioners who promote these beliefs and practices.
In sum, there are a lot of really bad ideas implied by the term Reactive Detachment Disorder, and it does not provide any meaningful information for the use of parents, mental health practitioners, or the courts. It would be a step forward if journalists and others would stop using Reactive Detachment Disorder and seek a real—and appropriate—diagnostic category.