Disturbances in attachment: inhibited and disinhibited symptoms in foster children

Background: Previous DSM-versions recognized an inhibited and a disinhibited subtype of the Reactive Attachment Disorder (RAD). The current DSM-5 distinguishes two different disorders, instead of two subtypes of RAD. This study examined whether a split-up of the subtypes is valid. Method: In 126 foster children, attachment disorder symptoms were assessed with the Disturbances of Attachment Interview. Forms of pathogenic care were identified based on dossier analyses. Associations between symptoms of attachment disorder with internalizing and externalizing problems (Child Behavior Checklist and Teacher Report Form) were examined. Results: Omnibus tests showed no significant association between type of symptoms and type of pathogenic care. Exploratory analyses did reveal an univariate association between disinhibited symptoms and history of physical abuse. Disinhibited symptoms were associated with more internalizing and externalizing problems (d's <0.50). Conclusion: The distinction of inhibited and disinhibited subtypes of RAD seems valid regarding their emotional and behavioral correlations. Whereas inhibited symptoms lack a correlation, disinhibited symptoms seem to have an externalizing and internalizing correlation