Reactive Attachment Disorder vs Borderline PD in an Adult

Reader’s Question

As my therapist and I have discussed my husband’s behavior because of its effect on me, she has hazarded a guess that he is dealing with reactive attachment disorder. The things I’ve noticed about him seem to indicate he’s got borderline PD tendencies. (He himself agrees to this.) I did some searching to find information about reactive attachment disorder, but all the information seems focused on children, not adults. My question is this: What happens to a child with reactive attachment disorder when he grows up, especially if the problem goes unrecognized and untreated? Do you call it reactive attachment for an adult, or does it get a new name, such as borderline? How much do these conditions overlap? It seems to me that there is a fair deal of similarity, but the focus on children with RAD makes it hard to tell. Thanks.

Our Consulting Clinical Psychologist’s Reply

Reactive Attachment Disorder (RAD) is considered a disorder of childhood and many of the criteria for the disorder begin before the age of five years. I would consider a diagnosis of RAD in an adult to be inappropriate. However, many professionals believe, as you suspect, that RAD often serves as a starting-point or precursor for the development of a personality disorder in adulthood. In this theory, RAD-Inhibited Type (severe social impairment) is seen as the precursor for Schizoid Personality Disorder, while RAD-Uninhibited Type (inappropriate social attachments and behavior) may be a foundation for Histrionic Personality Disorder and Borderline Personality Disorder.

From a practical standpoint, I wouldn’t focus on RAD except as a possible starting-point for your husband’s difficulties. I’d concentrate on the current personality-disorder symptoms, especially if he has borderline traits. You’ll need a concentration on his current behavior and symptoms, not his childhood. When your house is flooding and you’re trying to survive, it’s ineffective to think about the dam that broke 100 miles upstream.

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