Attachment disorder
| Classification according to ICD-10 | |
|---|---|
| F94.1 | Reactive attachment disorder of childhood |
| F94.2 | Attachment disorder of childhood with disinhibition |
| ICD-10 online (WHO version 2019) | |
According to the ICD-10 classification, attachment disorders belong to a group of impaired social functions . A distinction is made between two forms, the restrained and the uninhibited form.
Symptoms and ailments
Reactive attachment disorder of childhood, also "inhibited form" (ICD-10 F94.1)
-
Disorders of social functions :
- Abnormal relationship pattern with caregivers with a mixture of approach and avoidance as well as resistance to encouragement,
- Limited interaction with peers,
- Impairment of social play,
- Aggression directed against oneself and others
-
Emotional abnormalities :
- Fearfulness,
- Over-caution,
- To be unhappy,
- Lack of emotional responsiveness,
- Loss / lack of emotional responses,
- Apathy,
- " Frozen watchfulness" ("frozen watchfulness")
By definition, the disturbances in social and emotional reactions should be noticeable in different situations.
Attachment disorder of childhood with disinhibition, also "uninhibited form" (ICD-10 F94.2)
-
Disorders of social functions (here the first four are identical to those of type F94.1):
- Abnormal relationship pattern with caregivers with a mixture of approach and avoidance as well as resistance to encouragement,
- Limited interaction with peers,
- Impairment of social play,
- Aggression directed against oneself and others
- In addition to type F94.1, the following symptoms can occur with type F94.2:
- Non-selective attachment behavior with indiscriminate friendliness and lack of distance ,
- Uniform patterns of interaction with strangers,
- Inadequate reactions to relationship offers from caregivers
Emotional abnormalities are not in the foreground; however, these may also occur.
causes
There are many causes that can cause attachment disorders in children. Some triggering factors can be:
- Premature birth
- In- utero trauma, such as B. Alcohol embryopathy or drug abuse by the mother
- Extreme abuse or neglect in the first three years of life
- Emotionally indifferent caregiver z. B. postnatal depression of the mother
- Separation from mother, father or foster parents
- Changing carers
- Sexual abuse
- Frequent hospital stays, painful medical interventions, or chronic pain
- Autism or early childhood autism , Asperger's Syndrome
The disinhibited attachment disorder often develops in the fifth year of life from neglect and emotional neglect. An explanatory model is the attachment theory of John Bowlby . Bowlby believes that an interpersonal bond is an important step in human development .
distribution
The reactive attachment disorder (ICD 10-F94.1) occurs particularly in younger children. The disinhibited attachment disorder (ICD 10-F94.2) usually develops from the first-mentioned disorder in the fifth year of life.
The neglect is the most common child abuse is the most serious long-term effects.
Differential diagnosis
For the diagnosis of attachment disorder, certain other disorders must be excluded, for example psychosocial problems as a result of sexual or physical abuse in childhood and physical problems as a result of abuse .
It is also important to differentiate between autism in early childhood , Asperger's syndrome , cognitive disability , schizoid personality disorder , adjustment disorder and certain forms of schizophrenia . In both forms of attachment disorder, language ability is intact, unlike in early childhood autism. Since the ability to speak is also given in Asperger's syndrome, the distinction must be made by taking anamnesis of the previous history. Attachment disorders are socially acquired. Disorders in the autistic area are, according to many indications, genetic. In contrast to the cognitive disability, the intelligence is developed as usual and there are no delusions as in schizophrenia.
treatment
When treating reactive attachment disorders, psychotherapy options are usually ruled out. Above all, psychotherapy without the involvement of the adult caregiver is not helpful. In the case of small children, play therapy can be used as a supportive measure with the involvement of the adult caregiver. It is important to create a stable and supportive environment for the child. Due to the enormous challenges that a child with reactive attachment disorder can pose to the adult caregiver, it makes sense to provide the caregiver with expert advice and support. In addition, drug treatment can be helpful for particularly irregular or aggressive behavior.
study
A British study of Romanian adoptive children with different lengths of deprivation time came to the following results: Among Romanian children with long deprivation time before adoption , the incidence of severe attachment disorders at the age of six was 30%.
See also
- Adjustment disorder
- outsider
- Ability to bind
- Attachment theory
- Reference person
- Hospitalism
- Jaktation
- Parentification
- Social isolation
- neglect
Individual evidence
- ↑ on this term see Festschrift for Günther Beitzke on his 70th birthday on April 26, 1979. p. 223
- ↑ Norbert Kühne : Early Development and Upbringing - The Critical Period. In: Teaching Materials Pedagogy - Psychology. No. 694. Stark Verlag, Hallbergmoos 2012.
- ↑ Patrick Day: Reactive Attachment Disorder. (PDF, 2 pages, 38 kB, archived) Retrieved on September 3, 2013 (English).
- ↑ Helmut Johnson (2006) material on attachment theory and systemic work in education and care (with a description of Bowlby's work from page 13). (PDF, 20 pages, 72 kB, archived).
- ↑ Kathrin Keller-Schuhmacher (2010) Attachment - from theory to practice: what is important? Presentation at the AWO conference on November 8, 2010 in Freiburg i.Br., (PDF, 10 pages, 111 kB, archived).
- ↑ German Ärzteblatt , 13/2010
- ↑ Jochen Gehrmann: Parents' information on attachment disorders. September 2010, accessed September 3, 2013 .
