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Reactive Attachment Disorder

Question:

I was recently diagnosed with RAD (Reactive Attachment Disorder) among other things. I am 19 years old, and I don’t feel that I am phony or manipulative- I also have a VERY strong conscience, I just don’t trust people and have some of the other symptoms. How is it diagnosed (the pdoc didn’t really ask anything about my parents or childhood- his reason for diagnosing me was something like, I was distant and seemed to not want close relationships, and in all probablity he felt this stemmed from early chaos (never ASKED… I did have lots of early chaos, but considering I didn’t tell him very much, I am a little perplexed- can they really just diagnose you after asking yor favourite authors, tkaing in your physical appearence and.. that’s it?) He also said that due to my “dishevelled appearence” I might be at risk for psychosis (and because I talked about aliens a bit). The whole encounter struck me as odd, almost comical. So what if I mentioned aliens once (I drew them). They are a popular theme. Do you know how to appeal diagnoses’ or how to register comments with pdoc bosses? Thank you. Also, having RAD doesn’t mean a person is necessarily manipulative and lacking a conscience right? Because I am almost neurotic, I feel so much guilt…

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Answer:

Reactive Attachment Disorder is a disorder of childhood which by definition must start before five years of age. As a result of ‘grossly pathological care’ (resulting from parental abuse, neglect, etc.) a child may begin to behave in one of two different ways. In the ‘Inhibited’ form of RAD, the child becomes tense and anxious and is unable to bond properly with caregiving people (parental or otherwise). In the ‘Disinhibited’ form, the child shows indiscriminant attachment to most anyone around. In either case, the child shows signs of ‘disturbed and developmentally inappropriate social relatedness’. In order to diagnose RAD, your doctor must satisfy him/herself that you have disturbed social relationships characterized by an inability to bond normally with parent figures, that this condition started at or before age 5, and that it cannot be better accounted for by some other condition.

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p> Since RAD is a disorder of attachments it has implications for ones ability to form lasting relationships with loving figures. Being manipulative and/or not being consciencious could be ways that RAD might play out in adulthood – as these behaviors would interfere with one’s ability to form lasting loving relationships, but they are not givens of RAD. RAD would not necessarily have anything to do with being manipulative or phony or lacking in conscienciousness.

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p> Your doctor’s thoughts about the ‘possible psychosis’ problems that you might have are somewhat understandable to me. Doctors are trained to look for problems – that is what they do. Though ‘normal’ people do talk about aliens quite commonly, such talk is also sometimes associated with what are called ‘schizophreniform disorders’ including schizophrenia, and schizotypal personality disorder. There is also a frequent assumption that doctors make that you have the social wherewithall to know that you are being evaluated and to act in ‘socially appropriate’ ways during an evaluation. Usually, talking about aliens is not considered normal doctor-patient conversation.

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p> Not having been there during your examination, I can’t really know what decision process your doctor went through in order to arrive at the diagnoses you were given. However, if you are dissatisfied with how you have been diagnosed, by all means try to get a second opinion with a different doctor. There is no way really to get an ‘appeal’ but you usually don’t have to work with a doctor you don’t like either.

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