Type I: Nonattached Attachment Disorder

1.   Child fails to demonstrate a preference for a particular adult caregiver, even when hurt, frightened, sick, or in other situations that ordinarily stimulate the attachment behavioral system.

2.   Child fails to exhibit separation protest or exhibits indiscriminate separation protest (cries when almost anyone leaves).

3.   If the child is social with anyone, s/he is likely to be indiscriminately social.

4.   Child has a mental age of at least 8 months.

 Type II: Indiscriminate Attachment Disorder

1.   Child repeatedly leaves the safety provided by the presence of the attachment figure and wanders off without checking back (e.g. leaves the house and goes into the street or "slips away" in public).

2.   Child exhibits a pattern of entering situations that place him or her at risk for physical harm.

3.   Child may exhibit socially promiscuous behavior by demonstrating friendly overtures toward or by seeking comfort and nurturance from relatively or completely unfamiliar adults.

4.   Symptoms cannot be explained by Attention-Deficit Hyperactivity Disorder.

5.   There are two subtypes:

1. Socially Promiscuous

(i)         Indiscriminate friendliness and shallow social responsiveness.

(ii)        Child may seek comfort when distressed, albeit s/he does not express a preference and is often difficult to soothe.

2. Reckless/Accident -Prone/Risk-Taking

(i)         Child appears to exhibit a pattern of recklessness, accident proneness, and risk-taking behaviors that is more than can be explained by a failure to check back with an attachment figure.

(ii)       The child's reckless behavior may have a driven-quality to it.

 Type III: Inhibited Attachment Disorder

1.   Child exhibits an ongoing reluctance to approach, touch, or manipulate inanimate objects such as toys in unfamiliar surroundings, and especially in the presence of unfamiliar people.

2.   Child actively avoids or withdraws too readily from social interaction with people other than the attachment figure.

3.   Child exhibits a restricted range of affect in social situations, even in the presence of the attachment figure, with predominant mood ranging from sober scrutiny to hypervigilance.

4.   There are two subtypes:

1. Excessive Clinging

(i)        Child appears comfortable in attachment figure's immediate vacinity, but is easily frightened by unfamiliar settings, objects, or individuals. Still, proximity to the attachment figure is anxiety-laden.

(ii)        Separation from the attachment figure is vigorously resisted and leads to severe distress.

2. Compulsive Compliance

(i)        Child readily complies with directives from the attachment figure, with little or no hesitation or resistance.

(ii)       Child has limited positive affective interchanges with the attachment figure.

(iii)      Child appears frightened of attachment figure.

(iv)      Child may appear less inhibited, frightened, and uninvolved in absence of attachment figure.

Type IV: Aggressive Attachment Disorder

1.   Child has a clear preference for an attachment figure, but comfort seeking is often interrupted by the child's aggressive, angry outbursts directed toward the attachment figure or toward the self.

2.    Anger (which may be expressed physically, verbally, or both) is a pervasive feature of the attachment relationship and goes well beyond age-appropriate noncompliance and transitory frustration.

3.   Symptoms of anxiety (separation anxiety, sleep disturbances, etc.) may be apparent.

1.   Parent-child relationship is characterized by inversion, so that the child assumes roles and responsibilities ordinarily assumed by the parent. This is a pervasive pattern.

2.  Child maintains a non-anxious proximity to the attachment figure in unfamiliar settings.

3.  Child is over-solicitous, bossy, over-nurturing, or controlling during interaction with the caregiver.

4.  Child maintains an unusual degree of scrutiny about caregiver's psychological well-being.

(Taken from: Zeanah, C. H., Mammen, O K., & Lieberman, A. F. (1993) Disorders of attachment. In C. H. Zeanah (Ed.), Handbook of Infant Mental Health, NY: The Guilford Press.

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