Reactive attachment disorder
The broad theoretical framework for current versions of RAD is attachment theory, based on work conducted from the 1940s to the 1980s by John Bowlby, Mary Ainsworth and René Spitz. Attachment theory is a framework that employs psychological, ethological and evolutionary concepts to explain social behaviors typical of young children. Attachment theory focuses on the tendency of infants or children to "seek proximity" to a "particular attachment figure" (familiar caregiver), in situations of alarm or distress, behavior which appears to have survival value. This is known as a discriminatory or selective attachment. Subsequently, the child begins to use the caregiver as a base of security from which to explore the environment, returning periodically to the familiar person. Attachment is not the same as love and/or affection although they are often associated. Attachment and attachment behaviors tend to develop between the ages of six months and three years. Infants become attached to adults who are sensitive and responsive in social interactions with the infant, and who remain as consistent caregivers for some time. Caregiver responses lead to the development of patterns of attachment, that in turn lead to internal working models which will guide the individual's feelings, thoughts, and expectations in later relationships. For a diagnosis of reactive attachment disorder, the child's history and atypical social behavior must suggest the absence of formation of a discriminatory or selective attachment.
Attachment and Health
Attachment theory predicts that people high in attachment avoidance and people high in attachment anxiety would display different utilization of health care resources based on their prototypical behavioural responses when stressed. The theory predicts that people high in attachment avoidance, when faced with an illness, are likely to minimize their symptoms, and wait longer to see a health care provider, since they view their own distress as a sign of unacceptable vulnerability and also because their internal working model dictates that other people are not useful in helping them manage distress. For those high in attachment anxiety, they would have higher distress when faced with an illness, less perceived ability to manage it on their own, and thus visit health care services more frequently to try to attain security. For those with high anxiety and high avoidance, or fearful attachment, they would be predicted to present less frequently than those with secure attachment, but show up in a crisis when they do, which may interfere with optimal care. Research findings have generally been supportive of these predictions. One of the earliest studies in the field found correlations between preoccupied attachment and increased symptom reporting and an inverse relationship between avoidant attachment and visits to health professionals. High attachment anxiety has been associated with increased symptom reporting and visits to healthcare providers, and high attachment avoidance associated with less visits and decreased treatment compliance