Reactive Attachment Disorder and its Implications in Defining the "Good Mother"

Abstract

Reactive Attachment Disorder (RAD) made its first appearance in the Diagnostic and Statistical Manual of Mental Disorders’ nosology in 1980 (DSM-III: American Psychiatric Association). Its inclusion was a response to findings from a sparse, but compelling, literature that focused primarily on institutionalized children and the consequences that could result from severe maltreatment and extreme deprivation experienced during infancy. In its earliest iterations, the disorder became synonymous with “maternal deprivation,” a term introduced by Spitz (1945) in his work with “foundlings” and later popularized by Bowlby (1951, 1952, 1958) through his work with the World Health Organization. Recognized as a “disorder of mothering,” RAD in infancy was commonly linked to poor mothering skills or maternal psychopathology (Derivan, 1982; Evler, 1985; Tibbits-Kleber & Howell, 1985). In 1997 Volkmar recommended that “[a]lthough empirical data on the reactive attachment disorder diagnostic concept, strictly defined, are rather limited, ample evidence supports its continued inclusion in the DSM-IV.” (p. 261). The ubiquitous use of the term “attachment disorders” in the applied, clinical and particularly in the popular literatures blending concepts drawn from different disciplines and research paradigms has introduced both a level of confusion to the RAD construct as well as a more global focus on mothering practices. This paper reviews the historical development of the “disorder,” its contemporary definitions and associated problems, and discusses the ways in which RAD informs notions of contemporary motherhood.